Cholera Outbreaks in Iraq

Between 23 August and 6 September 2007, the cumulative number of cases of acute watery diarrhoea reported from five out of eleven districts of Sulaymaniyah Governate stands at 3,182 including 9 deaths (case fatality rate, CFR: 0.3%). Of these reported cases, Vibrio cholerae has been laboratory confirmed in 283 stool specimens.

During the period from 29 July to 2 September 2007, the health authority of Kirkuk Governate reported a total of 3,728 cases of acute diarrhoeal disease including 1 death (CFR: 0.03%). The first index case of cholera, confirmed by laboratory test, was reported from Kirkuk Governate on 14 August 2007. Most recently, six laboratory-confirmed cases of cholera were reported from Erbil Governate.

The Government of Iraq has mobilised a multi-sectoral response to the outbreak. A high-level National Committee on Cholera Preparedness and Outbreak Response has been established. The provincial health authorities of Sulaymaniyah, Kirkuk and Erbil Governates have initiated a number of public health control measures to contain the outbreak, including risk assessment, improving water safety and sanitation, strengthening the surveillance system for diarrhoeal disease, improving coordination and information flow, standardising clinical case management, mobilising medical and other essential supplies, and implementing social mobilisation and health education campaigns. All public water supply systems in the affected districts have been chlorinated by the provincial authorities. In addition, water samples from the public water supply sources are being collected and tested routinely to ensure they meet potable water safety standards.

Currently there are roughly 160,000 U.S. military troops in Iraq, most of them in and around Baghdad. The U.S. Central Command declared on Sept. 2 that the cholera outrbreak was "not an epidemic" and that "[t]he risk of cholera spreading to Baghdad is reasonably low." But Iraqi health officials have since told the New York Times that the illness could reach Baghdad "within weeks" via the occupied country's "decrepit and unsanitary water system."

According to the WHO, cholera "can kill healthy adults within hours." Although "with proper treatment, the fatality rate should stay below 1%"; when sufferers go untreated, "as many as one in two people may die."

Cholera is an acute diarrhoeal infection caused by ingestion of the bacterium Vibrio cholerae. Transmission occurs through direct faecal-oral contamination or through ingestion of contaminated water and food. The disease is characterized in its most severe form by a sudden onset of acute watery diarrhoea that can lead to death by severe dehydration and kidney failure. The extremely short incubation period - two hours to five days - enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, potentially infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera.