Cholera outbreak in Iraq spreads as cases increase in Tanzania
More than 500 new cholera cases have been reported in Iraq since last week, and the outbreak has spread to the northern region of Iraqi Kurdistan, according to a Middle East Online update yesterday.
Iraqi health officials reported 546 new cases, bringing the outbreak total to 1,809 since the first detections last month. The Baghdad and Babil governorates, which lie along the banks of the Euphrates River, have each seen more than 500 cases.
The Kurdish Health Ministry reported four cases of cholera in Arbil and Dohuk provinces, located in the northern autonomous region of Iraqi Kurdistan. Two cases in Kurdistan occurred in people displaced from central Iraq by conflict.
Six deaths due to cholera in Iraq have occurred since the outbreak began; four deaths were reported in the Abu Ghraib region before a national response effort was implemented. Iraqi health officials attribute the outbreak to poor water quality caused by the low level of the Euphrates.
Oct 20 Middle East Online article
Oct 12 CIDRAP News scan on outbreak
In related news, the World Health Organization (WHO) today announced an array of interventions to halt a cholera outbreak in Tanzania.
As of Oct 19, 4,835 cholera cases have been reported in the country. Thirteen regions are affected, though cases are highest (3,460, or 72%) in the large urban region of Dar es Salaam.
The WHO and Tanzanian officials today announced the formation of a national task force that would primarily address water sanitation and education, while collaborating with the US Centers for Disease Control and Prevention to increase regional surveillance.
The WHO is also creating five cholera treatment centers in Dar es Salaam and Morogoro and deploying two public health experts to integrate surveillance, case management, and sanitation activities across the country. At this time, the agency does not recommend travel or trade restrictions to Tanzania.
Oct 21 WHO update
Study: Drug-resistant malarial parasites able to infect African mosquitoes
Artemisinin-resistant forms of the parasite Plasmodium falciparum, which causes malaria, are able to infect Anopheles coluzzii, which is the main transmitter of malaria in Africa, according to a study yesterday in Nature Communications.
Investigators from the US National Institute of Allergy and Infectious Diseases (NIAID) infected five species of Anopheles mosquitoes, including A coluzzii, with three parasites sensitive to artemisinin (ART) and six ART-resistant parasites that have been well-established in western Cambodia.
All nine forms of P falciparum infected the 216 mosquitoes, and the ART-resistant parasite was present in the salivary glands of 153 mosquitoes (71%), including A coluzzii.
The ART-resistant parasites demonstrated genetic similarities that may explain why they are able to infect diverse mosquito species by bypassing the mosquitoes' immune systems, NIAID investigators said in an agency news release.
ART-combination therapies are the frontline treatment for malaria in Africa, and investigators expressed concern that the spread of ART-resistant P falciparum to A coluzzii could lead to malarial treatment failure and increased disease transmission on the continent. Investigators estimate that malaria will cause about 400,000 deaths in Africa this year, with more people at risk if drug-resistant parasites spread from Southeast Asia to Africa.
Oct 20 Nat Commun study
Oct 20 NIAID news release
UN-backed polio vaccination campaign begins in Ukraine
Ukraine, which is experiencing the first polio outbreak in the European region since 2010, today launched a nationwide vaccination campaign whose first phase is aimed at 2.85 million children aged 6 and under, the WHO said today. The agency recently expressed concern over a weeks-long delay to begin the campaign.
Two more campaigns, to follow at 1-month intervals, will target 4.75 million children younger than 10 years, the WHO said. All vaccinations are being given free of charge via funding garnered by the UN Children's Fund (UNICEF) from the Canadian government.
The polio outbreak was first announced Sep 1 when paralysis in two children from southwestern Ukraine, 10 months and 4 years of age, was attributed to the disease. No additional cases of paralysis have been identified, says the WHO, but since paralysis occurs in only about 1 in 200 cases, many infections may be going unnoticed. Millions of children are at acute risk, the agency said, because of low polio vaccine coverage in the country.
The WHO and UNICEF are supporting Ukraine's health ministry in planning the vaccination campaigns, strengthening surveillance, and training health workers. An assessment of risk in Ukraine and surrounding areas as well as of potential routes of transmission is also being conducted by WHO.
International guidelines say that even one case of polio constitutes an outbreak and warrants urgent response.
Oct 21 WHO notice
Oct 12 CIDRAP News scan on outbreak