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	va1-sg19016.securesites.net

	version=3.1.8



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Asia

[2] Cholera - Iran

[3] Cholera - Iran (Kordestan)

Africa

[4] Cholera - Sierra Leone (Northern, Western Areas)



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and Response (EPR) disease outbreak news [edited]





Since the cholera outbreak was 1st detected in Kirkuk, Northern Iraq, 

on 14 Aug 2007, it has spread to 9 out of 18 provinces across Iraq. 

It is estimated that more than 30 000 people have fallen ill with 

acute watery diarrhea, among which 3315 were identified as positive 

for _Vibrio cholerae_, the bacterium causing the disease. A total of 

14 people are known to have died of the disease. The case-fatality 

rate has remained low throughout the outbreak indicating that those 

who have become sick have been able to access adequate treatment on time.



The disease is continuing to spread across Iraq and dissemination to 

as yet unaffected areas remains highly possible. Epidemiological 

curves are still rising in the provinces from which the majority of 

laboratory-confirmed cases have originated, Kirkuk (2309) and 

Sulaymaniyah (870). An increasing number of cases of acute watery 

diarrhea has also been reported in Diala, a province neighboring 

Baghdad. Although _V. cholerae_ has not yet been laboratory 

confirmed, the clinical symptoms indicate the presence of cholera.



The numbers of cases are remaining stable in Basra, Baghdad, Dahuk, 

Mosul, and Tikrit. However, a case has now been confirmed in Wasit, a 

province that has previously been unaffected by the outbreak.



The Government of Iraq has mobilized a multi-sectoral response to the 

outbreak. Specific control measures have been reinforced and 

preventive measures to reduce the risk of transmission to unaffected 

areas have been put in place. However, the overall quality of water 

and sanitation is very poor, a factor known to greatly facilitate 

cholera contamination. WHO is in the process of procuring 5 million 

water-treatment tablets and 2 international WHO epidemiologists are 

being deployed to support the Ministry of Health in Iraq.



WHO does not recommend any restrictions to travel or trade to or from 

affected areas as a means to control the spread of cholera. However, 

neighboring countries are encouraged to reinforce their 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 prequalified oral 

cholera vaccine is not recommended once an outbreak has started due 

to its 2-dose regimen and the time required to reach protective 

efficacy, high cost and the heavy logistics associated with its use. 

The use of the parenteral cholera vaccine has never been recommended 

by WHO due to its low protective efficacy and the high occurrence of 

severe adverse reactions.



--



[A map of Iraq can be found at 



The total number of confirmed cholera cases in this report is 3315 

with 15 deaths. This 15th death was not mentioned in the last 

Situation Report on the outbreak on 1 Oct 2007, posted on 2 Oct 2007. 

20071002.3254 is also not mentioned in the above report. - Mod.LL]



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[2] Cholera - Iran





Cholera has jumped the border from Iraq to Iran, highlighting the 

need for neighboring countries to boost their defenses against the 

deadly disease, the World Health Organisation (WHO) said on Thu 4 Oct 2007.



Cholera has struck at least 3315 people in Iraq since mid-August 

2007, killing at least 15. WHO global cholera coordinator Claire-Lise 

Chaignat said that up to 10 cases have also been confirmed in Iran, 

near the Iraqi border. It was not clear whether these were Iraqi 

refugees or local Iranians, according to the Swiss expert, who warned 

the epidemic could threaten refugee camps in the region if not controlled.



"Some cases, around 9 or 10, have been confirmed in Iran. The 

situation seems contained," in the Islamic Republic, Chaignat told 

Reuters in Geneva. Cholera, which is continuing to spread within 

Iraq, can be carried by refugees and pilgrims, and through normal 

trade, she said. "Borders are permeable, closing them won't stop the germ."



Iraq shares borders with Iran, Turkey, Syria, Jordan, Kuwait, and 

Saudi Arabia. Some 60 000 Iraqis flee their homes each month and 2.2 

million Iraqis have crossed into neighboring countries, mainly Syria 

and Jordan, according to the UN.



"We are particularly worried about countries with Iraqi refugees 

where they don't always have access to good water and sanitation and 

hygienic conditions," Chaignat said. "It is important to catch the 

1st cases and treat them correctly." Iraq's Health Ministry said on 



Chaignat said cholera normally thrives in lower temperatures and 

warned it could spread further in Iraq as the strong sun and heat, 

which kill the germ subside. "That is our fear," she said.





--



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[3] Cholera - Iran (Kordestan)





Iran stifled a potential cholera outbreak 3 weeks ago, after the 

infection was probably carried there from Iraq, the WHO revealed Thu 

4 Oct 2007. "There were a few cases in Iran about 3 weeks ago, it's 

under control," WHO cholera coordinator Claire-Lise Chaignat told AFP.



"Iran reacted very well, they dealt with the cases rapidly," Chaignat 

said, underlining that there was no spread from the less than 10 

known cases. The cholera cases were 1st recorded in Iran's western 

province of Kordestan, next to Iraq, on 19 Sep 2007, she added. The 

WHO was not aware of any other cases elsewhere in Iran.



Chaignat said the infection was probably carried into Iran by 

travelers from Iraq. "There's a link, that's for sure," she added.



--



[The 1st of the 2 Iranian reports does not state the area involved or 

the time period when the cases occurred, which are found in the 2nd 

report. It is of interest that the cases began to be found more than 

2 weeks ago and are only being reported now.



A map of Iran can be found at 



The location of the Iranian cases in Kordestan is in the northwestern 

part of the country, which borders on the most affected areas of 

Iraq. - Mod.LL]



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[4] Cholera - Sierra Leone (Northern, Western Areas)

report [edited]





A deadly cholera epidemic has broken out in several regions of Sierra 

Leone. Since the 1st week of September 2007, at least 523 people have 

been infected in Kambia district in northern Sierra Leone, close to 

the border with Guinea, and in the eastern town of Kenema, and Newton 

on the outskirts of the capital Freetown, according to the Ministry of Health.



"We have the personnel and enough drugs to quickly and professionally 

intervene," The Kambia District medical officer Joseph Kandeh told 

IRIN. Nonetheless, 30 people died from the disease in September 

[2007], the Ministry said.



The district medical officer for Kenema, Yankuba Bah, said that 

people are reluctant to seek treatment when they get sick as they do 

not have confidence in public hospitals. "Most patients only visit 

government hospitals when they are in a precarious condition," he 

said. Bah also said that most of the people infected are women. They 

are more exposed to the disease, he said, because they fetch water 

from streams and work in crowded markets.



Cholera and other waterborne diseases occur each year during the 

rainy season as heavy rains lead to the contamination of streams and 

wells from uncollected garbage and effluent. In 2006, 2560 cholera 

cases were recorded in Sierra Leone during the rainy season between 

August and October, with 77 deaths.



Less than 50 percent of people outside Freetown have access to clean 

water and toilets, according to the UN, and most depend on streams 

and rainfall for their drinking water.



--

Otavio da Silva





[A map of Sierra Leone showing the reported areas can be found at 



2006

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