Cholera Outbreak in Iraq, 2017

Zgheir, Shakir Mohsen; Mustafa, Nabil Mansur; Ali, Ali Abdalkader; Al-Diwan, Jawad K.

doi:10.5958/0976-5506.2019.01654.1

Cited by 5 publications

(9 citation statements)

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“…In addition, V. cholerae positivity may be highest in the early stages of an outbreak [7,9,28], but we could not account for this given the temporal resolution of our dataset. However, a strength of our approach is that we pooled estimates from studies across diverse geographies, time periods, and epidemiological contexts.…”

Section: Discussionmentioning

confidence: 99%

“…One of the limitations of this study was that we could not account for all potential drivers of V. cholerae positivity, which contributed to the large heterogeneity we found between studies. In addition, V. cholerae positivity may be highest in the early stages of an outbreak [7,9,28], but we could not account for this given the temporal resolution of our dataset. However, a strength of our approach is that we pooled estimates from studies across diverse geographies, time periods, and epidemiological contexts.…”

Section: Discussionmentioning

confidence: 99%

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Towards estimating true cholera burden: a systematic review and meta-analysis ofVibrio choleraepositivity

Wiens

Zou

et al. 2022

Preprint

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Background: Cholera surveillance relies on clinical diagnosis of acute watery diarrhea. Suspected cholera case definitions have high sensitivity but low specificity, challenging our ability to characterize cholera burden and epidemiology. Our objective was to estimate the proportion of clinically suspected cholera that are true Vibrio cholerae infections and identify factors that explain variation in positivity. Methods: We conducted a systematic review of studies from 2000-2021 that tested ≥10 suspected cholera cases for V. cholerae O1/O139 using culture, PCR and/or a rapid diagnostic test. We estimated diagnostic test sensitivity and specificity using a latent class meta-analysis. We estimated positivity using a random-effects meta-analysis, adjusting for test performance and study methodology. Results: We included 113 studies from 28 countries. V. cholerae positivity was lower in studies with representative sampling and lower minimum ages in suspected case definitions. After adjusting for sampling methods, case definitions, and tests, on average half (49%, 95% Credible Interval: 43%-54%) of suspected cases represented true V. cholerae infections, although variation across studies was high. Odds of a suspected case having a true infection were 1.64 (95% Credible Interval: 1.06-2.52) times higher when surveillance was initiated in response to an outbreak than in non-outbreak settings. Conclusions: Burden estimates based on suspected cases alone may overestimate the incidence of medically attended cholera about twofold. However, accounting for cases missed by traditional clinical surveillance is key to unbiased overall cholera burden estimates. Given variability between settings, assumptions about positivity, which are necessary without exhaustive testing, should be based on local data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Towards estimating true cholera burden: a systematic review and meta-analysis ofVibrio choleraepositivity

Wiens

Zou

et al. 2022

Preprint

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“…Throughout the epidemics, the cases were slightly higher in females than males, adult age group showed higher incidence and the southern governorates were more affected [33] . In addition, both the Vibrio cholera O1, El Tor, Inaba and Vibrio cholera O1, El Tor, Ogawa were isolated either alone or together in the epidemics of cholera in Iraq [31,[34][35][36][38][39][40] .…”

Section: History Of Cholera In Iraqmentioning

confidence: 99%

“…It was found that both Inaba and Ogawa serotypes of Vibrio cholera O1, El Tor were isolated in the outbreaks (Figure 4). The serotype Ogawa was prevalent in the outbreaks of 1995, 1998, 1999, 2012 and 2022 [35,40,[48][49][50] . In contrast, only the outbreaks of 2007 and 2015 were caused by the Inaba serotype [51][52][53][54][55] .…”

Section: The Serotypes Of Vibrio Cholerae In Kurdistan Regionmentioning

confidence: 99%

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A Flashback to Cholera Outbreaks in Kurdistan region-Iraq

Sidiq¹

2023

PJBAS

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Cholera is a contagious acute diarrheal disease due to ingestion of contaminated water and food with Vibrio cholera, a Gram-negative bacterium that naturally inhabits coastal and estuarine ecosystems. Millions of cholera cases and thousands of deaths are annually reported worldwide. Cholera is endemic in Iraq with every 3-5 years interval. Meanwhile, cholera outbreaks have been reporting in Kurdistan region. However, the epidemiology of the disease has not been investigated. This study comprehensively reviewed the cholera outbreaks in Kurdistan region, depending on the WHO situation reports, online resources and scientific researches. The results showed seven reported cholera outbreaks from 1995 to 2022. The cholera epidemics happened at irregular intervals that makes the prediction of next outbreak difficult. Moreover, the trend of cholera is greatly decreasing from thousands to hundreds of cases throughout the outbreaks and in total about 30 people died. These might be the consequences of effective prevention measures, population health and natural acquired immunity against cholera. It was found that Sulaymaniyah is the most affected governorate in the region. This is probably related to the contamination of the main drinking water resource, little Zab river. Besides, the irrigation of the vegetable fields with untreated sewage could be another cause. Also, both Inaba and Ogawa serotypes of Vibrio cholera, O1, El Tor individually caused the outbreaks. Thus, cholera outbreak will be happening in Kurdistan region, particularly in Sulaymaniyah governorate. This definitely needs more scientific investigations, hoping to tackle the future outbreaks and total eradication of the disease.

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Estimating the proportion of clinically suspected cholera cases that are true Vibrio cholerae infections: A systematic review and meta-analysis

Wiens,

Xu,

Zou

et al. 2023

PLoS Med

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Background Cholera surveillance relies on clinical diagnosis of acute watery diarrhea. Suspected cholera case definitions have high sensitivity but low specificity, challenging our ability to characterize cholera burden and epidemiology. Our objective was to estimate the proportion of clinically suspected cholera that are true Vibrio cholerae infections and identify factors that explain variation in positivity. Methods and findings We conducted a systematic review of studies that tested ≥10 suspected cholera cases for V. cholerae O1/O139 using culture, PCR, and/or a rapid diagnostic test. We searched PubMed, Embase, Scopus, and Google Scholar for studies that sampled at least one suspected case between January 1, 2000 and April 19, 2023, to reflect contemporary patterns in V. cholerae positivity. We estimated diagnostic test sensitivity and specificity using a latent class meta-analysis. We estimated V. cholerae positivity using a random-effects meta-analysis, adjusting for test performance. We included 119 studies from 30 countries. V. cholerae positivity was lower in studies with representative sampling and in studies that set minimum ages in suspected case definitions. After adjusting for test performance, on average, 52% (95% credible interval (CrI): 24%, 80%) of suspected cases represented true V. cholerae infections. After adjusting for test performance and study methodology, the odds of a suspected case having a true infection were 5.71 (odds ratio 95% CrI: 1.53, 15.43) times higher when surveillance was initiated in response to an outbreak than in non-outbreak settings. Variation across studies was high, and a limitation of our approach was that we were unable to explain all the heterogeneity with study-level attributes, including diagnostic test used, setting, and case definitions. Conclusions In this study, we found that burden estimates based on suspected cases alone may overestimate the incidence of medically attended cholera by 2-fold. However, accounting for cases missed by traditional clinical surveillance is key to unbiased cholera burden estimates. Given the substantial variability in positivity between settings, extrapolations from suspected to confirmed cases, which is necessary to estimate cholera incidence rates without exhaustive testing, should be based on local data.

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Cholera Outbreak in Iraq, 2017

Cited by 5 publications

References 0 publications

Towards estimating true cholera burden: a systematic review and meta-analysis ofVibrio choleraepositivity

Towards estimating true cholera burden: a systematic review and meta-analysis ofVibrio choleraepositivity

A Flashback to Cholera Outbreaks in Kurdistan region-Iraq

Estimating the proportion of clinically suspected cholera cases that are true Vibrio cholerae infections: A systematic review and meta-analysis

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