Document Page: First | Prev | Next | All | Image | This Release | Search

File: 970613_ww31_90a_90_txt_0001.txt
Page: 0001
Total Pages: 1

[b.2.]


SUBJECT: AFMIC SPECIAL WEEKLY WIRE 31-90(A) (U)

1. (U) GENERAL
(U) THIS MESSAGE CONSISTS OF SCIENTIFIC, TECHNICAL, AND GENERAL
MEDICAL INTELLIGENCE. IT IS INTENDED TO PROVIDE A TIMELY SUMMARY OF
CURRENT DISEASE INTELLIGENCE FINDINGS AND ANALYSES. THE REMARKS ARE

PRELIMINARY AND SUBJECT TO REVISION AND DO NOT NECESSARILY
REPRESENT
AN AGREED DOD POSITION. CLINICAL REVIEW HAS BEEN PROVIDED BY THE
AFMIC-SG [b.6.]
2. (U) THIS SPECIAL WIRE IS INTENDED TO PROVIDE CLARIFICATION AND
FURTHER DISSEMINATION OF MEDICAL INTELLIGENCE ON A SUBJECT OF
CURRENT
INTEREST. BROAD DISSEMINATION TO SUBORDINATE UNITS IS ENCOURAGED.
COUNTRY-SPECIFIC ENVIRONMENTAL (OTHER THAN DISEASE) INFORMATION HAS
BEEN WIDELY DISSEMINATED AT COMMAND LEVELS, AND SHOULD BE REVIEWED
BY
MEDICAL PLANNERS.
3. TABLE OF CONTENTS
    A. DISEASES WITH SHORT INCUBATION PERIODS (USUALLY LESS THAN 15
DAYS)
    B. DISEASES WITH LONG INCUBATION PERIODS (USUALLY MORE THAN 15
DAYS)
    C. OTHER DISEASES ENDEMIC IN THE INDIGENOUS POPULATION
4. INTELLIGENCE FINDINGS AND ANALYSIS
INFECTIOUS DISEASE THREAT ASSESSMENT - NORTHWESTERN PERSIAN GULF
COMMENT: THE OVERALL THREAT OF INFECTIOUS DISEASES IN SOUTHERN
IRAQ,
KUWAIT, EASTERN SAUDI ARABIA, AND BAHRAIN IS LOW AND CAN BE FURTHER

REDUCED THROUGH PREVENTIVE MEASURES.
SUMMARY: DISEASES OF OPERATIONAL IMPORTANCE.
(DISEASES ARE PRIORITIZED IN DESCENDING ORDER OF EXPECTED IMPACT ON
MILITARY OPERATIONS IF NO PREVENTIVE MEASURES ARE TAKEN.)
    A. DISEASES WITH SHORT INCUBATION PERIODS (USUALLY LESS THAN 15
DAYS)
       1. ACUTE DIARRHEAL DISEASES (6 HOURS TO 10 DAYS)
RISK PERIOD/DISTRIBUTION: OCCUR YEAR-ROUND, WITH AN OVERALL
INCREASED
INCIDENCE FROM JULY TO SEPTEMBER. VIRAL CASES INCREASE FROM
DECEMBER
TO MARCH, WHILE BACTERIAL CASES INCREASE FROM JUNE TO OCTOBER.
OCCUR
REGIONWIDE, ALTHOUGH MORE COMMON IN RURAL AREAS.
REMARKS: FREQUENTLY OCCURRING PATHOGENS INCLUDE ENTEROTOXIGENIC
ESCHERICHIA COLI, ROTAVIRUS (MOST COMMON IN CHILDREN), SHIGELLA
SPP.,
SALMONELLA SPP., AND CAMPYLOBACTER SPP. ACUTE DIARRHEAL DISEASE IS
THE MOST COMMON INFECTIOUS DISEASE PROBLEM FOR NON-INDIGENOUS
PERSONNEL. SHIGELLOSIS, USUALLY CAUSED BY SHIGELLA SONNEI, IS
COMMON.
SALMONELLOSIS INCREASINGLY IS BEING REPORTED. MULTIPLE DRUG
RESISTANCE IS COMMON AMONG SALMONELLA AND SHIGELLA ISOLATES.
       2. ACUTE RESPIRATORY DISEASES (1-10 DAYS)

RISK PERIOD/DISTRIBUTION: OCCUR YEAR-ROUND, WITH INCREASED
INCIDENCE
IN JULY AND AUGUST DUE TO THE DUSTY ENVIRONMENT AND IN DECEMBER TO
FEBRUARY DUE TO INFLUENZA ACTIVITY. OCCUR REGIONWIDE.
REMARKS: ACUTE RESPIRATORY DISEASES ARE THE MOST COMMON REASON FOR
SEEKING MEDICAL ATTENTION AMONG THE LOCAL POPULATION. ACUTE
RESPIRATORY DISEASES MAY BE A MAJOR SOURCE OF MORBIDITY AMONG NON-
INDIGENOUS PERSONNEL.
       3. ENTERIC PROTOZOAL DISEASES (1 WEEK TO SEVERAL MONTHS)
RISK PERIOD/DISTRIBUTION: YEAR-ROUND, WITH INCREASED INCIDENCE IN
AUGUST AND SEPTEMBER. OCCUR REGIONWIDE.
REMARKS: USUALLY ASSOCIATED WITH MORE CHRONIC INFECTIONS, SOME
PROTOZOANS SUCH AS ENTAMOEBA HISTOLYTICA AND GIARDIA LAMBLIA CAN
CAUSE ACUTE DIARRHEA. CLINICAL CASES OF GIARDIASIS AND AMEBIASIS
ARE
COMMON, ALTHOUGH UNDER-REPORTED. FECAL SAMPLES OF APPARENTLY
HEALTHY
ADULTS HAVE INDICATED HIGH CARRIER RATES, ESPECIALLY AMONG THE NON-
INDIGENOUS WORKERS, FOR GIARDIASIS AND AMEBIASIS. CLINICAL CASES OF
GIARDIASIS USUALLY ARE SEEN IN CHILDREN; AMEBIASIS USUALLY IS SEEN
IN
ADULTS. CRYPTOSPORIDIOSIS HAS BEEN FOUND IN 10 PERCENT OF STOOL
SAMPLES FROM APPARENTLY HEALTHY CHILDREN, BUT THE CLINICAL

SIGNIFICANCE IS UNKNOWN.
       4. TYPHOID AND PARATYPHOID FEVERS (1-3 WEEKS)
RISK PERIOD/DISTRIBUTION: OCCUR YEAR-ROUND, WITH INCREASED
INCIDENCE
FROM APRIL TO JUNE. OCCUR REGIONWIDE.
REMARKS: ENDEMIC, WITH THE MAJORITY OF CASES DUE TO SALMONELLA
TYPHI.
A HIGH CARRIER RATE AMONG THE IMPORTED WORK FORCE HAS BEEN
REPORTED.
A LOW LEVEL OF MULTIPLE DRUG RESISTANCE IS REPORTED. MAY BE A
SIGNIFICANT SOURCE OF MORBIDITY AMONG NON-INDIGENOUS PERSONNEL.
       5. MENINGOCOCCAL MENINGITIS (2-10 DAYS, USUALLY 3 TO 4 DAYS)
RISK PERIOD/DISTRIBUTION: CASES OCCUR YEAR-ROUND, WITH A PEAK
INCIDENCE BETWEEN NOVEMBER AND FEBRUARY. OCCURS REGIONWIDE, WITH
INCREASED RISK AMONG LOWER SOCIOECONOMIC GROUPS.
REMARKS: ENDEMIC, CAUSING SPORADIC CASES WITH CYCLIC EPIDEMICS
EVERY
8 TO 12 YEARS. GROUP A IS THE PREDOMINANT TYPE. AN EPIDEMIC
OCCURRED
AFTER THE HAJJ (PILGRIMAGE TO MECCA) IN AUGUST 1987. MOST CLINICAL
CASES OCCUR IN CHILDREN OR YOUNG ADULTS. THE OVERALL CASE FATALITY
RATE IS BETWEEN 10 AND 25 PERCENT.
       6. SEXUALLY TRANSMITTED DISEASES (STDS) (2 DAYS TO 3 WEEKS)
RISK PERIOD/DISTRIBUTION: YEAR-ROUND; REGIONWIDE.

REMARKS: ENDEMIC, ALTHOUGH UNDER-REPORTED. PATTERNS OF STD ISOLATES
APPEAR SIMILAR TO WESTERN EUROPE, WITH NON-SPECIFIC URETHRITIS AND
GONORRHEA COMMONLY REPORTED AND RARE REPORTS OF TROPICAL STDS
(CHANCROID, LYMPHOGRANULOMA VENEREUM, AND GRANULOMA INGUINALE).
SYPHILIS IS UNCOMMON. PENICILLINASE-PRODUCING NEISSERIA GONORRHOEAE
(PPNG) IS REPORTED AT LOW LEVELS.
       7. MALARIA (12-14 DAYS)
VECTOR ECOLOGY: THE PRIMARY MOSQUITO VECTORS IN IRAQ ARE ANOPHELES
SACHAROVI, AN. SUPERPICTUS, AND AN. STEPHENSI, AND IN SAUDI ARABIA,
AN. ARABIENSIS (IN THE TIHAMA/COASTAL AREA OF THE SOUTHWESTERN
PROVINCES) AND AN. SERGENTI (IN SCATTERED FOCI IN WESTERN AND THE
HIGHER ELEVATIONS OF THE SOUTHWESTERN PROVINCES).
RISK PERIOD/DISTRIBUTION: TRANSMISSION DOES NOT OCCUR IN KUWAIT,
BAHRAIN, OR EASTERN SAUDI ARABIA. IN IRAQ AND SAUDI ARABIA,
TRANSMISSION OCCURS BETWEEN MAY AND OCTOBER, WITH A SEASONAL PEAK
IN

/****** BEGINNING OF SECTION 002 ******/
JULY AND AUGUST. IN IRAQ, TRANSMISSION OCCURS IN RURAL AND URBAN
AREAS IN THE NORTHERN PROVINCES (DAHUK, NINAWA, IRBIL, AND AS
SULAYMANIYAH), AND AT ELEVATIONS BELOW 1,500 METERS (BAGHDAD IS
RISK-
FREE). IN SAUDI ARABIA, TRANSMISSION OCCURS IN ALL AREAS OF THE

COASTAL REGION OF THE SOUTHWESTERN PROVINCES CJIZAN, ASIR, AL
BAHAH)
AND IN SCATTERED RURAL AREAS OF SEVERAL VALLEYS IN THE HIJAZ
MOUNTAINS OF THE WESTERN PROVINCES (MAKKAH, AL MADINAH), UP TO
2,000
METERS ELEVATION.
REMARKS: MALARIA IS ENDEMIC ONLY IN NORTHERN IRAQ AND WESTERN SAUDI
ARABIA; TRANSMISSION WAS INTERRUPTED IN OTHER PARTS OF THE REGION
DURING THE EARLY 1980S. IN IRAQ, THE NUMBER OF CASES REPORTED
ANNUALLY HAS BEEN INCREASING (6,833 IN 1988). CLINICAL CASES
USUALLY
ARE SEEN FROM JULY TO SEPTEMBER. PLASMODIUM VIVAX CAUSES THE
INDIGENOUS CASES; THEREFORE, DRUG RESISTANT FALCIPARUM MALARIA IS
NOT
A RISK. IN SAUDI ARABIA, THE OVERALL ANNUAL PARASITE (API)
INCIDENCE
IS 2.1/1,000, WITH THE HIGHEST API IN THE SOUTHWEST (JIZAN
PROVINCE,
20/1000). CLINICAL CASES USUALLY ARE SEEN FROM DECEMBER TO APRIL,
WITH EPIDEMICS OCCURRING IN WET YEARS. COUNTRYWIDE, THE NUMBER OF
CASES REPORTED ANNUALLY HAS BEEN DECLINING, FROM MORE THAN 64,000
IN
1982 TO 9,797 IN 1988. PLASMODIUM FALCIPARUM CAUSES OVER 95 PERCENT
OF THE INDIGENOUS CASES IN THE SOUTHWEST AND 80 PERCENT IN THE
WEST,
WITH P. VIVAX CAUSING THE REMAINING CASES. AN ACTIVE MONITORING
PROGRAM HAS NOT DETECTED DRUG RESISTANT FALCIPARUM MALARIA.

       8. ARBOVIRAL FEVERS (3-12 DAYS)
          (A) CRIMEAN-CONGO HEMORRHAGIC FEVER IS ENDEMIC IN
DISCRETE
FOCI, WITH A SMALL NUMBER OF SPORADIC CLINICAL CASES. FIRST
REPORTED
IN 1979 FROM BAGHDAD, DYALA, AND KARBALA. AN UNCONFIRMED SOURCE
REPORTED OVER 300 FATALITIES AMONG EGYPTIAN AGRICULTURAL WORKERS IN
1980 IN IRAQ. THE CASE FATALITY RATE IN CONFIRMED CASES IS OVER 50
PERCENT. THE VIRUS IS TRANSMITTED BY THE HYALOMMA TICK OR BY
EXPOSURE
TO INFECTED HUMANS (OR OTHER ANIMALS). TRANSMISSION OCCURS DURING
THE
SUMMER, FROM JUNE TO SEPTEMBER. THE VIRUS IS CIRCULATING IN RURAL,
AGRICULTURAL AREAS, ESPECIALLY IN NORTHERN IRAQ. MANY INFECTIONS
APPARENTLY ARE ASYMPTOMATIC; SEROLOGICAL STUDIES INDICATE EXPOSURE
RATES OF UP TO 30 PERCENT AMONG PERSONS ASSOCIATED WITH LIVESTOCK.
          (B) SANDFLY FEVER MAY BE CIRCULATING, ALTHOUGH CLINICAL
CASES ARE NOT REPORTED. SEROLOGICAL STUDIES INDICATE PREVALENCE OF
5
PERCENT FOR THE SICILIAN AND NAPLES VIRUSES. THE POTENTIAL VECTOR,
PHLEBOTOMUS PAPATASII, A NIGHT-BITING SANDFLY, IS PRESENT
COUNTRYWIDE. THE VECTOR IS REPORTED BETWEEN APRIL AND NOVEMBER,
PEAKING IN POPULATION IN SEPTEMBER.
          (C) WEST NILE FEVER CASES HAVE NOT BEEN REPORTED, BUT THE

VIRUS MAY BE CIRCULATING LOCALLY. ALTHOUGH THE 15 PERCENT POSITIVE
SERUM SAMPLES FOUND FROM 1979 THROUGH 1982 INCLUDED MOSTLY NON-
INDIGENOUS PERSONS, SEVERAL INDIGENOUS POSITIVES WERE SUSPECTED.
SEVERAL POTENTIAL MOSQUITO (CULEX) VECTORS ARE PRESENT.
          (D) SINDBIS REPORTEDLY HAS CAUSED VIRAL ENCEPHALITIS
ALONG
THE COAST IN THE EASTERN PROVINCE OF SAUDI ARABIA. HOWEVER, HUMAN
CASES HAVE NOT BEEN REPORTED RECENTLY, AND SEROLOGICAL STUDIES
INDICATE THE VIRUS MAY NO LONGER BE CIRCULATING. POTENTIAL MOSQUITO
VECTORS (CULEX SPP.) ARE PRESENT IN THIS AREA.
          (E) DENGUE HAS BEEN REPORTED HISTORICALLY FROM THE
EASTERN
COASTAL AREAS, BUT IS BELIEVED NOT TO BE CIRCULATING AT PRESENT.
THE
MOSQUITO VECTOR, AEDES AEGYPTI, MAY BE PRESENT.
       9. CHOLERA (USUALLY 2-3 DAYS, RANGE OF 6 HOURS TO 5 DAYS)
TRANSMISSION: INGESTION OF CAUSATIVE AGENT, PRIMARILY IN WATER
CONTAMINATED WITH FECES OR VOMITUS OF INFECTIVE HUMANS.
RISK PERIOD/DISTRIBUTION: CURRENTLY NOT ENDEMIC.
REMARKS: OCCASIONAL IMPORTED CASES (AND OUTBREAKS) OCCUR, USUALLY
DURING THE SUMMER. THE LAST OUTBREAK (DUE TO BIOTYPE EL TOR,
SEROTYPE
OGAWA) OCCURRED IN 1978 AND 1979, WITH 946 OFFICIALLY REPORTED
CASES,

MOSTLY IN CHILDREN. NON-INDIGENOUS PERSONNEL ARE AT A LOW RISK OF
INFECTION.
    B. DISEASES WITH LONG INCUBATION PERIODS (USUALLY MORE THAN 15
DAYS)
       1. VIRAL HEPATITIS (15-180 DAYS)
(INCLUDES HEPATITIS A (HAV), HEPATITIS B (HBV), AND NON-A NON-B
HEPATITIS (NANB))
RISK PERIOD/DISTRIBUTION: YEAR-ROUND, WITH INCREASED INCIDENCE FROM
OCTOBER TO DECEMBER. OCCURS REGIONWIDE.
REMARKS: MOST CASES OF VIRAL HEPATITIS ARE ATTRIBUTED TO HEPATITIS
A
VIRUS (HAV). ALTHOUGH HAV IS CIRCULATING WIDELY, IT MAY BE AT A
LOWER
LEVEL THAN PREVIOUSLY, AS A RESULT OF SANITATION IMPROVEMENTS IN
KUWAIT AND BAHRAIN. ANTIBODIES OCCUR IN AN ESTIMATED 75 PERCENT OF
CHILDREN BY AGE 10 AND IN ALMOST 100 PERCENT OF ADULTS. THE ANNUAL
INCIDENCE OF ACUTE HEPATITIS A CASES IS INCREASING, IN PART BECAUSE
OF A SLIGHTLY LARGER NON-IMMUNE CHILD POPULATION AND THE CONTINUED
CIRCULATION OF THE VIRUS. ANTIBODIES TO HEPATITIS B VIRUS (HBV)
OCCUR
IN 20 TO 40 PERCENT OF THE POPULATION. THE HBV CARRIER RATE IS
ESTIMATED AT 2 PERCENT. THE DELTA AGENT (HDV) HAS BEEN FOUND IN

APPROXIMATELY 5 PERCENT OF HBV CARRIERS. PARENTERALLY TRANSMITTED
NANB HEPATITIS (HEPATITIS C OR HCV) IS REPORTED SPORADICALLY.
ENTERICALLY TRANSMITTED NANB HEPATITIS IS NOT REPORTED. HAV, HBV,
AND
HCV POSE MAJOR HEALTH HAZARDS TO NON-INDIGENOUS PERSONNEL.
       2. LEISHMANIASIS (1 WEEK TO MANY MONTHS)
VECTOR ECOLOGY: MOST SAND FLIES ARE ACTIVE FROM SUNSET TO DAWN, AND
HAVE VERY LIMITED FLIGHT RANGES. THE PRIMARY VECTORS FOR CUTANEOUS
LEISHMANIASIS (CL) ARE PHLEBOTOMUS PAPATASII FOR LEISHMANIA MAJOR
AND
P. SERGENTI FOR L. TROPICA. THE PRIMARY VECTOR FOR VISCERAL
LEISHMANIASIS (VL) IS P. ALEXANDRI IN IRAQ, BUT HAS NOT BEEN
IDENTIFIED IN SAUDI ARABIA.
RISK PERIOD/DISTRIBUTION: TRANSMISSION OF CL MAY OCCUR YEAR-ROUND
BUT
PEAKS FROM JULY THROUGH SEPTEMBER. L. MAJOR (THE WET/RURAL FORM) IS
THE MOST COMMON FORM IN KUWAIT, BAHRAIN, AND EASTERN SAUDI ARABIA,
WHERE IT OCCURS IN SEMI-RURAL AREAS, AT THE OUTSKIRTS OF URBAN
AREAS,

/****** BEGINNING OF SECTION 003 ******/
OR IN OASES. L. TROPICA (THE DRY/URBAN FORM) OCCURS MOSTLY IN
WESTERN
SAUDI ARABIA AND CENTRAL IRAQ (SPORADICALLY IN THE NORTH AND RARELY
IN THE SOUTH). TRANSMISSION OF VL OCCURS YEAR-ROUND IN FOCAL AREAS
OF
THE CENTRAL REGION OF IRAQ AND IN THE SOUTHWESTERN PROVINCES OF
SAUDI

ARABIA.
REMARKS: CL CAUSED BY L. MAJOR, ALSO CALLED ZOONOTIC CL, HAS A
FOCAL
DISTRIBUTION BASED ON ITS RESERVOIR, THE FAT-TAILED SAND RAT
(PSAMMOMYS OBESUS). THE ANNUAL NUMBER OF CL CASES IS VERY LOW AND
IS
DECREASING, BECAUSE OF THE REDUCTION OF RESERVOIR HABITATS.
CLINICAL
CASES USUALLY ARE REPORTED FROM SEPTEMBER TO MARCH, PEAKING IN
FEBRUARY. MOST CASES OCCUR IN NON-IMMUNE INDIVIDUALS, EITHER
CHILDREN
OR NON-INDIGENOUS ADULTS, INCLUDING MANY WESTERNERS (AMONG WHOM,
WITHOUT PRECAUTIONS, AN ANNUAL ATTACK RATE AS HIGH AS 50 PERCENT IS
REPORTED). L. TROPICA, ALSO CALLED THE DRY FORM, USUALLY OCCURS IN
URBAN AREAS. SOME SOUTHWESTERN AREAS OF SAUDI ARABIA HAVE A HIGH
PREVALENCE (JIZAN - 80 PERCENT). L. TROPICA OCCURS IN ALL AGE
GROUPS
AND CAN CAUSE MULTIPLE CASES IN A SINGLE INDIVIDUAL. ALTHOUGH L.
TROPICA IS THOUGHT TO BE ZOONOTIC AND HAS BEEN ISOLATED FROM
SEVERAL
DOGS, AN ANIMAL RESERVOIR HAS NOT BEEN DEFINITIVELY ESTABLISHED.
THE
ANNUAL INCIDENCE OF VL HAS BEEN INCREASING IN IRAQ AND SAUDI ARABIA
C855 AND 305 CASES RESPECTIVELY IN 1988). CASES OCCUR AMONG
CHILDREN
AND YOUNG ADULTS BETWEEN DECEMBER AND MARCH. IN IRAQ, VL IS CAUSED
BY
L. DONOVANI AND OCCURS IN FOCAL LOWLAND AREAS WITH ALLUVIAL SOIL IN

THE CENTRAL REGION. IN SAUDI ARABIA, VL IS CAUSED BY DONOVANI SENSU
LATA AND OCCURS IN THE SOUTHWESTERN HIGHLANDS (AT ELEVATIONS UP TO
2,000 METERS). DOGS AND JACKALS ARE THE RESERVOIR IN IRAQ, BUT NO
RESERVOIR HAS BEEN REPORTED IN SAUDI ARABIA.
       3. SCHISTOSOMIASIS (2 TO 6 WEEKS)
ECOLOGY: BULIMUS TRUNCATUS IS THE PRIMARY INTERMEDIATE HOST FOR
SCHISTOSOMA  HAEMATOBIUM (URINARY FORM), AND BULIMUS BECCARII IS
THE
PRIMARY INTERMEDIATE HOST FOR SCHISTOSOMA MANSONI (INTESTINAL
FORM).
RISK PERIOD/DISTRIBUTION: TRANSMISSION OCCURS YEAR-ROUND, WITH AN
INCREASE BETWEEN JUNE AND SEPTEMBER. DISTRIBUTION IS FOCAL IN AREAS
OF THE TIGRIS AND EUPHRATES RIVERS IN IRAQ AND IN THE WESTERN (IN
WADIS AND CISTERNS) AND CENTRAL (IN OASES) PROVINCES OF SAUDI
ARABIA.
NO TRANSMISSION OCCURS SOUTH OF BASRAH (DUE TO THE SALINITY OF THE
DELTA WATERS) OR IN BAHRAIN, KUWAIT, OR EASTERN SAUDI ARABIA.
REMARKS: ALTHOUGH STILL PRESENT IN SAUDI ARABIA (PREVALENCE IS
ESTIMATED AT 2 PERCENT OR 20,000 CASES) IN THE 12 IDENTIFIED FOCI,
THE ANNUAL REPORTED INCIDENCE (LESS THAN 1,000 CLINICAL CASES) IS
DECREASING AS A RESULT OF CONTROL PROGRAMS. INTESTINAL
SCHISTOSOMIASIS FOCI OCCUR IN THE CENTRAL (HAIL, RIYADH), NORTHERN

(AL JAWF), NORTHWESTERN (TABUK, MEDINA), AND MIDWESTERN (MAKKAH, AL
BAHAH) PROVINCES, AND THE HIGHLANDS OF THE SOUTHWESTERN PROVINCES
(ASIR, NAJRAN). URINARY SCHISTOSOMIASIS FOCI OCCUR IN THE LOWLANDS
OF
THE SOUTHWESTERN (JIZAN) AND MIDWESTERN (MAKKAH) PROVINCES. IN
IRAQ,
URINARY SCHISTOSOMIASIS OCCURS THROUGHOUT THE TIGRIS AND EUPHRATES
RIVER BASIN, ESPECIALLY IN THE CENTRAL REGIONS. ALTHOUGH STILL
PREVALENT (PREVALENCE IS ESTIMATED AT 5 PERCENT IN FOCAL AREAS),
THE
ANNUAL REPORTED INCIDENCE IS DECREASING AS A RESULT OF CONTROL
PROGRAMS.
    C. OTHER DISEASES ENDEMIC IN THE INDIGENOUS POPULATION
       1. ZOONOTIC DISEASES -- BRUCELLOSIS (CAUSED BY B.
MELITENSIS;
ENZOOTIC IN LIVESTOCK, ESPECIALLY GOATS AND SHEEP, AND A COMMON
CAUSE
OF FEVER IN HUMANS IN BOTH RURAL AND URBAN AREAS, USUALLY AS A
RESULT
OF CONSUMPTION OF RAW DAIRY PRODUCTS); RABIES (ENZOOTIC IN FOXES IN
IRAQ AND SAUDI ARABIA; BAHRAIN AND KUWAIT ARE RABIES FREE);
ECHINOCOCCOSIS (COMMON, ESPECIALLY IN SOUTHERN IRAQ, WHERE IT IS A
FREQUENT CAUSE OF SURGERY; THE TAPEWORM IS CARRIED BY AN ESTIMATED
15
PERCENT OF STRAY DOGS, ESPECIALLY IN AGRICULTURAL AREAS); ANTHRAX
(OCCURS VERY SPORADICALLY IN RURAL AREAS DURING SUMMER MONTHS;

RELATED TO EXPOSURE TO LIVESTOCK, USUALLY SHEEP); Q FEVER (RARELY
REPORTED IN HUMANS, BUT ENZOOTIC IN LIVESTOCK; HUMAN SEROLOGY IN
RURAL AREAS INDICATES EXPOSURE); GLANDERS (SPORADIC CASES HAVE BEEN
REPORTED IN HORSES, WITH OCCASIONAL HUMAN EXPOSURE, DESPITE AN
EFFORT
TO ERADICATE THE DISEASE); SYLVATIC PLAGUE (LAST REPORTED NEAR THE
SAUDI ARABIA-YEMEN BORDER IN 1969, BUT PRESENTLY IS NOT THOUGHT TO
BE
ENDEMIC; IN IRAQ, THE HIGHLANDS NEAR THE BORDER WITH SYRIA
HISTORICALLY HAVE BEEN AN ENZOOTIC FOCUS).
       2. SEXUALLY TRANSMITTED DISEASES -- THROUGH THE END OF 1989,
FEW CASES OF AIDS OR HIV INFECTIONS HAVE BEEN OFFICIALLY REPORTED;
ADDITIONAL CASES ARE BELIEVED TO HAVE OCCURRED. IN-COUNTRY TESTING
FOR HIV INFECTION IS PERFORMED.
       3. OTHER INFECTIOUS DISEASES -- TUBERCULOSIS (ENDEMIC,
ALTHOUGH THE ANNUAL INCIDENCE -- 100 CASES IN 1988 -- HAS BEEN
DECLINING, AND THE PREVALENCE IS ESTIMATED TO BE ONLY 0.1 TO 0.2
PERCENT); TRACHOMA (COMMON, AND THE MOST FREQUENT CAUSE OF
BLINDNESS,
ALTHOUGH THE INCIDENCE HAS BEEN DECLINING AS A RESULT OF CONTROL
MEASURES); NONVENERAL ENDEMIC SYPHILIS (COMMON IN RURAL AREAS IN
SAUDI ARABIA, ESPECIALLY AMONG NOMADIC TRIBESMEN, WHERE THE

PREVALENCE IS AS HIGH AS 20 PERCENT); SOIL TRANSMITTED HELMINTHS
(ROUNDWORMS AND WHIPWORMS ARE PRESENT, BUT THE INCIDENCE IS LESS
THAN
5 PERCENT;  HOOKWORMS ARE UNCOMMON). 
[b.6.]?

Document Page: First | Prev | Next | All | Image | This Release | Search