4 October 2007 Cholera is continuing to spread across Iraq and dissemination to as yet unaffected areas remains highly possible, with more than 30,000 people having already fallen ill with acute watery diarrhoea, according to the latest update by the United Nations health agency.
More than 3,300 cases have been identified as positive for Vibrio cholerae, the bacterium that causes the debilitating and sometimes fatal intestinal infection, but clinical symptoms indicate the presence of cholera in many others, the UN World Health Organization (WHO) said.
Fourteen are known to have died from the disease which is often caused by polluted water, but the low case-fatality rate throughout the outbreak that began in August indicates that those who have become sick have been able to access adequate treatment on time.
Most laboratory-confirmed cases have occurred in the north in Kirkuk and Sulaymaniah, but an increasing number of cases of acute watery diarrhoea has been reported in Diala, a province neighbouring Baghdad, with clinical symptoms indicating cholera. The number of cases has been stable in Basra, Baghdad, Dahuk, Mosul and Tikrit, but a case has now been confirmed in the previously unaffected province of Wasit.
The Government has mobilized a multi-sectoral response, specific controls have been reinforced and preventive measures to reduce the risk of transmission to unaffected areas have been put in place.
But the overall quality of water and sanitation is very poor, a factor known to greatly facilitate cholera contamination. WHO is procuring 5,000,000 water-treatment tablets and two of its epidemiologists are being deployed to support the Health Ministry.
WHO does not recommend any restrictions to travel or trade to or from affected areas as a means to control, but urges neighbouring countries to reinforce active surveillance and preparedness systems. Mass chemoprophylaxis is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.
Use of the current internationally available pre-qualified oral cholera vaccine is not recommended once an outbreak has started due to its 2-dose regimen, the time required to reach protective efficacy, high cost and the heavy logistics associated with its use.