Document Page: First | Prev | Next | All | Image | This Release | Search
File: 950825_0122pgv_91d.txt
Filename:0122pgv.91d
Iraq/Middle East
SUBJ: OTHER DISEASES ENDEMIC IN THE LOCAL POPULATION
DATE: 20 APR 91
1. THIS MESSAGE DISCUSSES DISEASES ENDEMIC IN THE LOCAL
POPULATION THAT WILL BE IMPORTANT TO MEDICAL FORCES PROVIDING
HUMANITARIAN MEDICAL ASSISTANCE FOR REFUGEES OR DISPLACED PERSONS.
DISEASES ARE PRIORITlZED IN DESCENDING ORDER OF EXPECTED IMPACT ON
HUMANITARIAN MEDICAL MISSIONS. ADDITIONALLY, BEST OF THE NATURE OF
SOME MISSIONS, THESE DISEASES WILL-BE INCREASINGLY IMPORTANT TO
OPERATIONAL UNITS. THE AVAILABLE STATISTICS ON THE PREVALENCE AND
INCIDENCE OF MANY OF THESE DISEASES ARE INCOMPLETE, MAKING
REPORTED RATES AND NUMBERS OF CASES GENERALLY UNRELIABLE AS
INDICATORS OF TRUE PREVALENCE OR ENDEMIClTY. TRANSMISSION FACTORS
THAT ARE UNIQUE OR IMPORTANT IN THIS REGION ARE DISCUSSED.
COMPLETE
DISCUSSIONS ON INCUBATION PERIODS, ROUTES OF TRANSMISSION, AND
CLINICAL SIGNS AND SYMPTOMS ARE AVAILABLE IN STANDARD TEXTS AND
ARE BEYOND THE PURPOSE OF THIS WIRE. MILITARY INFLICT WILL WEAKEN
EXISTING MEDICAL INFRASTRUCTURE, RED PREVENTIVE
MEDICINE PROGRAMS, INTERFERE WITH WASTE DISPOSAL, AND COMPROMISE
PERSONAL HYGIENE; THESE FACTORS WILL LEAD TO INCREASED INCIDENCE
OF ENDEMIC DISEASES. DUE TO LIMITED INFORMATION, ACUTE
RESPIRATORY DISEASES ARE NOT SPECIFICALLY ADDRESSED; HOWEVER,
THEY CAN BE EXPECTED TO BE A LEADING CAUSE OF MORBlDITY (PROBABLY
FOLLOWING ACUTE DIARRHEAS), PARTICULARLY AMONG INFANTS' AND
CHILDREN.
A. ACUTE CHILDHOOD DIARRHEA
DISEASE AGENTS: IN CHILDREN YOUNGER THAN 5 YEARS SUFFERING FROM
ACUTE DIARRHEA, THE MOST COMMON ENTEROPATHOGENS ISOLATED, IN
DESCENDING FREQUENCY, GENERALLY ARE ROTAVI RUS, SALMONELLA,
ENTEROPATHOGEN IC ESCHER lCH I A COLI, SHIGELLA, AND
CAMPYLOBACTER JEJuNI. THE MOST COMMON PARASITE ISOLATED WAS
GlARDIA LAMBLIA (4 TO 7 PERCENT OF THE CASES). MULTIPLE INFECTIONS
WERE SEEN IN 0.8 PERCENT OF THE CHILDREN. CHOLERA MAY BE ENDEMIC,
BUT SHOULD NOT BE A. SIGNIFICANT CAUSE OF CHILDHOOD DIARRHEA IN
REFUGEE POPULATIONS.
DISTRIBUTION/RISK PERIOD: WIDESPREAD. YEAR-ROUND. SEASONAL
INCREASES INROTAVlRAL DIARRHEAS PRIMARILY IN COLD MONTHS (DECEMBER
THROUGH MARCH), BUT ALSO IN THE HOT DRY SEASON (JULY THROUGH
SEPTEMBER). SEASONAL INCREASES IN BACTERIAL ETIOLOGlES
OCCUR FROM JUNE TO OCTOBER; PROTOZOAL CASES PEAK IN AUGUST AND
SEPTEMBER.
REMARKS: ROTAVlRUS MAY BE A LEADING CAUSE OF GASTROENTERITlS IN
YOUNG CHILDREN (LESS THAN 5 YEARS OLD); THE INCIDENCE IS LOWER IN
BREAST-FED THAN IN BOTTLE-FED
INFANTS. ROTAVIRUS DIARRHEA IS A MAJOR PEDIATRIC HEALTH PROBLEM,
WITH UP TO 30 PERCENT OF THE CHILDREN HAVING CONCURRENT UPPER
RESPIRATORY INFECTION. AMONG THE BACTERIAL ETlOLOGIES, MULTIPLE
DRUG RESISTANCE IS COMMON AMONG SALMONELLA AND SH×IGELLA ISOLATES.
UNTREATED SHIGELLOSIS CASES CAN BE EXPECTED TO HAVE HIGH
MORTALITY.
B. INTESTINAL PARASITES
AGENTS: MOST COMMON IPl ARE GIARDIASIS, AMEBlASlS, ASCARlASIS,
TRICHURIASlS, ENTEROBIASlS, AND HYMENOLEPIASIS.
HUMANDICROCOELIASlS (DICROCOELlUMDENDRlTICUM)
HAS BEEN REPORTED AND IS COMMONLY ASSOCIATED WITH DRINKING RAW
MILK OR EATING RAW LIVER (CAMEL, CATTLE, GOAT, OR SHEEP).
TAENlASIS (TAENIA SAGINATA) AND FASCIOLIASlS ARE REPORTED FROM
DISCRETE FOCI. LOW LEVELS OF TRlCHOSTRONGYLUS COLUMBRlFORMIS AND
STRONGYLOIDES STERCORALIS HAVE BEEN DETECTED IN NORTHERN IRAQ.
DISTRIBUTION/RISK PERIOD: WIDELY DISTRIBUTED, BUT VARY
GEOGRAPHICALLY AND DEPEND ON MANY SOCIOECONOMIC FACTORS; MORE
COMMON AMONG LOWER SOCIOECONOMIC LEVELS. IN DEVELOPED REGIONS,
ROUNDWORI'IS AND WHIPWORMS ARE PRESENT AT LOW LEVELS. H00KWORM
(ANCYLOSTOMA DUODENALE) INFECTIONS GENERALLY OCCUR IN PR IM IT lVE
RURAL COMMUNITIES WHERE PROMISCUOUS DEFECATION EXISTS. ENTERIC
PROTOZOAL AGENTS (GlARDIA LA'IBLlA AND ENTAMOEBA HISTOLYTICA) ARE
COMMONLY ISOLATED. TRANSMISSION OF MOST AGENTS OCCURS YEAR-ROUND,
WITH SEASONAL INCREASES IN THE DRY SEASON. HUMAN CASES OF
DICROCOELlASlS PEAK IN OCTOBER AND NOVEMBER.
REMARKS: HIGHEST lPl RATES CAN BE ANTICIPATED IN REFUGEES FROM
RURAL AREAS.
INTERRUPTION OF POTABLE WATER SUPPLIES AND SEWAGE DISPOSAL, AND
DETERIORATED SANITARY CONDITIONS WILL INCREASE THE INCIDENCE OF
MOST OF THESE PARASITES.
C. CHILDHOOD DISEASES (DIPHTHERIA, MEASLES, PERTUSSIS,
POLIOMYELlTIS, AND TETANUS)
DISTRIBUTION: ENDEMIC, BUT MARKED REGIONAL VARIATIONS IN REPORTED
INCIDENCE EXIST. GENERALLY, IRAQ HAS THE HIGH RATES.
VACCINATION PROGRAMS: EXPANDED PROGRAMS OF IMMUNIZATION (EPI) HAVE
IMPROVED VACCINATION COVERAGE AND REDUCED THE INCIDENCE OF
TARGETED DISEASES IN SOME POPULATIONS SINCE THE EARLY-1980'S.
HOWEVER, DISCRIMINATED GROUPS CAN BE EXPECTED TO HAVE LOWER
COVERAGE RATES.
ESTIMATED COUNTRYWIDE PERCENT COVERAGE IN IRAQ IS BETWEEN SO TO 75
PERCENT FOR ALL EPI DISEASES.
REMARKS: REFUGEE POPULATIONS THAT HAVE RELIED ON EPl TO CONTROL'
CHILDHOOD DISEASES WILL BE AT INCREASED RISK FOR OUTBREAKS OR
EPIDEMICS WHEN VACCINATION PROGRAMS ARE INTERRUPTED.
D. TRACHOMA
TRANSMISSION: PRIMARILY TRANSMITTED BY DIRECT CONTACT WITH
OCULAR AND NASOPHARYNGEAL DISCHARGES ON FINGERS AND CONTAMINATED
MATERIALS (FACE CLOTHS AND COSMETIC KHOL STICKS USED TO DARKEN
EYELIDS). FILTH FLIE ARILY MUSCA SORBENS, THE MARKET OR BAZAAR
FLY, BUT ALSO M. DOMESTICA)SCO(NPTRpI~UTE TO THE SPREAD OF THE
DISEASE.
DISTRiBUTION/RISK PERIOD: WIDELY DISTRIBUTED AND HIGHLY ENDEMIC,
PARTICULARLY IN RURAL AREAS WITH POOR HYGIENE. YEAR-ROUND.
REMARKS: IN ENDEMIC AREAS, THE HIGHEST INFECTION RATES ARE IN
CHILDREN. TRACHOMA REMAINS THE MOST WIDESPREAD EYE DISEASE IN THIS
REGION AND THE LEADING CAUSE PREVENTABLE BLINDNESS.
E. BRUCELLOSIS
TRANSMISSION/RESERVOIR: OVER 80 PERCENT OF REPORTED HUMAN CASES
ARE DUE TO CONSUMPTION OF RAW DAIRY PRODUCTS (GOAT AND CAMEL MILK
AND CHEESES). CONTACT WITH INFECTED MATERIAL PLAYS A MINOR ROLE.
IN HUMAN CASES NOT ASSOCIATED WITH DIRECT ANIMAL OR PRODUCT
EXPOSURE, MOST APPEAR TO HAVE CONTRACTED THE DISEASE WHILE
TRAVELING THROUGH AREAS CONTAMINATED WITH ANIMAL FETAL TISSUES.
THE DISEASE IS
ENDEMIC IN NATURAL RESERVOIRS (GOATS, SHEEP, CAMELS, AND
CATTLE), WHICH PRINCIPALLY ARE INFECTED WITH BRUCELLA MELITENSIS.
AS RECENTLY AS MAY 1990, THE PREVALENCE OF INFECTION OF SHEEP AND
GOATS COMMONLY EXCEEDS 10 PERCENT.
DISTRIBUTION/RISK PERIOD: WIDESPREAD, BUT REGIONAL VARIATIONS
EXIST. HUMAN CASES CAUSED BY B. MELITENSIS ARE WIDELY DISTRIBUTED,
IN BOTH RURAL AND URBAN AREAS. SEASONALLY DISTRIBUTED, WITH MOST
CASES OCCURRING MARCH TO JULY, PEAKING IN APRIL AND MAY. PEAK
INCIDENCE OF CASES ASSOCIATED WITH ENVIROI'IMENTAL EXPOSURE
COINCIDES WITH THE LAMBING AND KIDDING SEASONS.
REMARKS: ONE OF THE COMMONEST HUMAN INFECTIOUS DISEASES IN THE
REGION; MANY AREAS HAVE EXPERIENCED TRUE INCREASES IN INCIDENCE,
WITH SOME OUTBREAKS REACHING EPIDEMIC PROPORTIONS. PARTICULARLY
COMMON AMONG FARMERS, SHEPHERDS, NOMADIC TRIBESMEN, AND THEIR
FAMILIES (10 TO 25 PERCENT SEROPREVALENCE HAS BEEN DETECTED
IN AGRICULTURAL WORKERS). FOR EACH CASE REPORTED AN ESTIMATED
25---CASES ARE UNRECOGNIZED OR UNREPORTED.
F. TUBERCULOSIS
-TRANSMISSION/RESERVOIR: MOST TUBERCULOSIS (TB) IS CAUSED BY
HUMAN-TO-HUMAN TRANSMISSION OF MYCOBACTERlUM TUBERCULOSIS.
ZOONOTIC TUBERCULOSIS IS OF LESSER SIGNIFICANCE
DISTRIBUTIONjRISK PERIOD: TB IS WIDELY DISTRIBUTED THROUGHOUT THE
REGION.
REMARKS: TB IS AN IMPORTANT DISEASE IN THE INDIGENOUS POPULATION.
MOST OF THE REPORTED HUMAN CASES ARE PULMONARY RATHER THAN
DISSEMINATED OR EXTRAPULMONARY.
TUBERCULOUS CERVICAL LYMPHADENITIS REPRESENTS A SIGNIFICANT
PORTION OF EXTRAPULMONARY TB (BIOPSlED NECK MASSES ARE
FREQUENTLY DIAGNOSED AS TUBERCULOSIS). BASED ON THE ESTIMATED
LEVEL OF RISK OF INFECTION (THE PROPORTION OF THE POPULATION WHICH
HAS BEEN INFECTED OR REINFECTED IN THE COURSE OF 1 YEAR),
IRAQ IS CONSIDERED TO HAVE INTERMEDIATE LEVEL PREVALENCE (0.5 TO
1.5 PERCENT).
IT IS UNCLEAR IF IRAQ HAS INCORPORATED CHILDHOOD BCG VACCINATION
OF CHILDREN INTO THEIR EPI. KURDlSH POPULATIONS CAN BE EXPECTED TO
HAVE HIGHER RATES THAN COUNTRYWIDE ESTIMATES. A 21.3 PERCENT
PREVALENCE OF RESISTANCE TO PRIMARY ANTITUBERCULOUS DRUGS WAS
REPORTED FROM RIYADH, SAUDI ARABIA. PRIMARY RESISTANCE
TO INH WAS 19.4 PERCENT; PRIMARY AND SECONDARY RESISTANCE TO
RIFAMP'ICIN WAS 3 PERCENT AND 33.7 PERCENT, RESPECTIVELY. MOST
ISOLATES FROM PATIENTS WITH ACQUIRED RESISTANCE TO RIFAMPIClN ALSO
WERE RESISTANT TO INH.
G. ECHINOCOCCOSlS
TRANSMISSION/RESERVOIR: CARNIVORES HARBORING THE ADULT TAPEWORMS
(ECHINOCOCCUS
GRANULOSUS) BECOME INFECTED BY EATING VlSCERA OF INTERMEDIATE
HOSTS CONTAINING HYDATID CYSTS; THE DOG-SHEEP CYCLE (PARTICULARLY
ASSOCIATED WITH DOGS USED FOR SHEEP HERDING) IS IMPORTANT IN THIS
REGION. CATTLE, GOATS, AND CAMELS ARE LESSER IMPORTANT
INTERMEDIATE HOSTS. INFECTION RATES IN DOGS IN IRBIL PROVINCE ARE
HIGH
(67 TO 100 PERCENT). DOGS COMMONLY ARE INFECTED BY FEEDING ON
UNCOOKED OFFAL DISCARDED AFTER SLAUGHTER.
DISTRIBUTION/RISK PERIOD: ENDEMIC AND ENZOOTIC, ESPECIALLY IN
RURAL AGRICULTURAL AREAS WHERE DOGS ARE USED TO NERD GRAZING
ANIMALS, PARTICULARLY SHEEP. HOWEVER, HUMAN CASES ALSO OCCUR IN
LARGER URBAN AREAS. WIDELY DISTRIBUTED AND HIGHLY ENDEMIC/ENZQOTlC
IN IRAQ. YEAR-ROUND.
REMARKS: IMPORTANT PARASITIC INFECTION IN THIS REGION,
PARTICULARLY AMONG GROUPS HAVING INTIMATE CONTACT WITH DOGS (AND
OBJECTS SOILED WITH FECES). ISLAMIC TEACHINGS STRESS AVOIDANCE OF
DOGS; HOWEVER, THIS DOES NOT PROVIDE COMPLETE PROTECTION. THE
HIGHEST INCIDENCE OF HUMAN DISEASE GENERALLY IS IA-HE 31 TO 40
YEAR OLD AGE GROUP. HUMAN INFECTION RATES IN IRAQ ARE ESTIMATED TO
BE SLIGHTLY LESS THAN 1 PERCENT, ACCOUNTING FOR 1 PERCENT OF ALL
SURGICAL PROCEDURES.
H. TYPHUS, LOUSE-BORNE (EPIDEMIC TYPHUS)
TRANSMISSION/RESERVOIR: BY RUBBING CRUSHED BODY LICE (PEDICULUS
HUMANUS) OR TilIRFECES INTO THE BITE SITE OR ABRASlONS; LlCE
DEFECATE RlCKETTSlAE (RlCKETTSIA PROWAZEKI) WHILE FEEDING. MAN IS
THE RESERVOIR AND MAINTAINS THE INFECTION DURING INTER-EPIDEMIC
PERIODS.
DISTRIBUTION/RISK PERIOD: THOUGHT TO BE PRESENT, BUT PREVALENCE IS
UNKNOWN.
ENDEMIC FOCl ARE PRESENT IN IRAQ. NORTHERN SAUDI ARABIA, AND
KUWAIT ARE AT THE SOUTHERN LIMITS OF THE DISTRIBUTION BELT IN THE
MIDDLE EAST. THE DISEASE MAY BE PRESENT IN THE SOUTHWEST REGIONS
OF THE ARABIAN PENINSULA (ASIR PROVINCE OF SAUDI ARABIA AND
YEMEN). SEASONAL, USUALLY MORE PREVALENT IN COLDER MONTHS.
REMARKS: LOUSE-BORNE TYPHUS IS ONLY ASSOCIATED WITH OVER-CROWD I
NG, TRANSIENT POPULATIONS, IMPOVERISHED PEOPLE, AND POOR
SANITARY CONDITIONS; REFUGEE POPULATIONS WOULD BE AT INCREASED
RISK. IN 1977, 19 CASES WERE REPORTED FROM IRAQ, WITH MOST CASES
FROM JULY TO SEPTEMBER. AN OUTBREAK WAS REPORTED AMONG
NOMADIC TRIBES IN NORTHERN SAUDI ARABIA IN 1961 RESULTING IN 49
CASES AND 2 DEATHS.
l. RABIES
TRANSMISSION/RESERVOIR: SYLVATIC AND URBAN RABIES ARE IMPORTANT.
URBAN RABIES, WITH STRAY DOGS (CATS AND OTHER ANIMALS TO A LOWER
EXTENT) SERVING AS THE RESERVOIR AND MAIN SOURCE OF HUMAN
EXPOSURE, OCCURRS IN CITIES AND VILLAGES. THE PRINCIPAL ENZOOTIC
RESERVOIR FOR SYLVATIC RABIES IS THE DESERT FOX AND JACKAL, AND
SPILL OVER INTO STRAY DOG AND CAT POPULATIONS FREQUENTLY OCCURS.
SHEEP RABIES
IS REPORTED WITH LOW SPORADIC OCCURRENCE.
DISTRIBUTION/RISK PERIOD: YEAR-ROUND TRANSMISSION OCCURS, BUT AN
INCREASED RISK IN THE SPRING AND SUMMER CAN BE EXPECTED DUE TO
ELEVATED ANIMAL POPULATIONS AND INCREASES IN ANIMAL BITES IN
WARMER SEASONS.
REMARKS: DOG AND CAT BITES/SCRATCHES PROBABLY WILL BE THE PRIMARY
SOURCES OF HUMAN EXPOSURE AND REASONS FOR POST-EXPOSURE
PROPHYLAXlS. ANIMAL CASES ARE LIKELY TO BE UNRECOGNIZED AND
UNDERREPORTED BY THE INDIGENOUS POPULATION. ADDITIONALLY,
THE CURRENT DISRUPTION MAY INCREASE THE STRAY DOG POPULATION.
J. Q FEVER
TRANSMISSION/RESERVOIR: COMMONLY TRANSMITTED BY AIRBORNE
DISSEMINATION OF RICKETTSlA (COXIELLA BURNETll) AND SECONDARILY BY
DIRECT CONTACT WITH INFECTED ANIMALS AND FROM CONSUMPTION OF RAW
MILK; IXODES AND ARGASID TICKS ARE CAPABLE OF TRANSMITTING THE
DISEASE, BUT PROBABLY ARE ONLY OF SECONDARY IMPORTANCE.
DOMESTIC ANIMALS, RODENTS, AND TICKS (PRIMARILY HYALOMMA
DROMEDARII) SERVE AS NATURAL RESERVOIRS.
DISTRIBUTION/RISK PERIOD: WIDELY DISTRIBUTED; SEROLOGICAL STUDIES
SUGGEST THAT IT IS HIGHLY ENDEMIC. ENZO0TIC IN LIVESTOCK.
YEAR-ROUND.
REMARKS: SPORADIC CASES HAVE BEEN REPORTED, BUT INCIDENCE IS
SUSPECTED TO BE GREATER THAN REPORTED DUE TO LIMITED DIAGNOSTIC
CAPABILITIES. SEROLOGY FROM INDIGENOUS PERSONNEL IN RURAL AREAS
INDICATES THAT SU8CLlNICAL INFECTION DEVELOPS IN CHILDHOOD, AND
VIRTUALLY ALL YOUNG ADULTS HAVE HAD SENSITIZING CONTACT
(INDUCING ACQUIRED IMMUNITY).
K. PLAGUE
TRANSMlSSION/RESERVOIR: PRIMARILY TRANSMITTED BY THE BITE OF AN
INFECTIVE FLEA (PRIMARILY XENOPSYLLA CHEOPlS, THE ORIENTAL RAT
FLEA, BUT ALSO PULEX IRRlTANS, THE HUMAN FLEA). RESERVOIRS FOR
SYLVATlC PLAGUE IN THE REGION INCLUDE GERBILS (MERIONES SPP. AND
GERBlLLUS GERBlLLUS) AND DESERT VOLES. RATTUS RATTUS MAY SERVE
AS A RESERVOIR AROUND DWELLINGS IN ENDEMIC AREAS.
DISTRIBUTION/RISK PERIOD: OCCURS AREAWIDE. NATURAL OCCURRING
ENZ00TIC FOCI OF PLAGUE HISTORICALLY HAVE EXISTED BETWEEN THE
TIGRIS AND EUPHRATES RIVERS AND ADJACENT TERRITORIES EXTENDING
FROM SYRIA. IN IRAQ, THE HIGHLANDS NEAR THE BORDER WITH SYRIA
HISTORICALLY HAVE BEEN AN ENZOOTIC FOCUS. YEAR-ROUND, BUT
ESPECIALLY DURING HOT, ORY MONTHS.
REMARKS: UNDERREPORTED.
L. ANTHRAX
TRANSMISSION/RESERVOIR: ENZOOTIC, PRIMARILY IN SHEEP AND GOATS.
INFECTIONS IN THESE ANIMALS SERVE AS THE PRIMARY METHOD OF
ENVIRONMENTAL AND PRODUCT CONTAMINATION WITH SPORES. MANY OF THE
REPORTED HUMAN CASES ARE UNABLE TO IDENTIFY THE TRUE SOURCE OF
THEIR-INFECTION.
DISTRIBUTION/RISK PERIOD: WIDELY DISTRIBUTED, BUT FOCALLY
ENDEMIC. OCCURS SPORADICALLY IN RURAL ARE'AS DURING SUMMER
MONTHS.
REMARKS: CUTANEOUS CASES PREDOMINATE, FOLLOWED BY GASTROINTESTINAL
AND PULMONARY FORMS. CASES AND OUTBREAKS ARE MOST LIKELY IN
NOMADIC POPULATIONS, FARMERS, AND SHEPHERDS AND IN PEOPLE HANDLING
INFECTED ANIMAL PRODUCTS (WOOL, HIDES, MEATS).
IN IRAQ, 200 TO 269 HUMAN CASES WERE OFFICIALLY REPORTED ANNUALLY
FROM 1976 TO 1980.
M. TYPHUS, MURlNE (ENDEMIC TYPHUS)
TRANSMISSION/RESERVOIR: PRIMARY VECTORS ARE INFECTIVE FLEAS,
USUALLY XENOPSYLLA CHEOP IS (ORIENTAL RAT FLEA) AND POTENTIALLY
CTENOCEPHAL IDES FELlS (CAT FLEA). THE DISEASE IS MAINTAINED IN
NATURE BY A RAT-FLEA-RAT CYCLE; LARGE RODENT POPULATIONS
CONTRIBUTE TO THE SPREAD OF MURINE TYPHUS.
DISTRIBUTION/RISK PERIOD: THOUGHT TO BE PRESENT AREAWIDE, BUT
PREVALENCE IS UNKNOWN. YEAR-ROUND, BUT PEAKS DURING SUMMER MONTHS.
REMARKS: SPORADIC CASES ARE REPORTED. HIGHEST ATTACK RATES ARE
AMONG PEOPLE IN LOWER SOCIOECOIIOMIC LEVELS. DETERIORATED SANITARY
CONDITIONS WILL ELEVATE RODENT POPULATIONS WHICH WILL CONTRIBUTE
TO INCREASED INCIDENCE OF MURINE TYPHUS.
N. NONVENEREAL ENDEMIC SYPHILIS
DISTRIBUTION/RISK PERIOD: MODERATELY ENDEMIC. WIDELY DISTRIBUTED,
PARTICULARLY IN REMOTE RURAL AREAS WHERE THE TANDARD OF HYGIENE IS
LOW AND ACCESS TO HEALTH SERVICES IS LIMITED. YEAR-ROUND.
REMARKS: PRIMARILY CONFINED TO NOMADIC AND SEMI-NOMADIC TRIBESMEN,
WHERE THE PREVALENCE MAY REACH 20 PERCENT; THE MAJORITY OF
CLINICAL CASES ARE BETWEEN 15 AND 35 YEARS OLD. THE MAJORITY OF
CASES ACQUIRE THE INFECTION IN CHILDHOOD. THE SEROPOSITIVITY RATE
IS HIGHER AMONG FEMALES. THE SOCIAL CONSEQUENCES OF MISTAKING
BEJEL FOR VENEREAL SYPHILIS IN A CONSERVATIVE ISLAMIC CULTURE MUST
BE RECOGNIZED.
O. LEPROSY
DISTRIBUTION/RISK PERIOD: INDIGENOUS TRANSMISSION OCCURS AT
LOW LEVELS.
DISTRIBUTED THROUGHOUT THE REGION, WITH REGIONAL VARIATIONS
EXPECTED. GENERALLY ASSOCIATED WITH AREAS OF CROWDING, POVERTY,
POOR SANITATION, AND SUBSTANDARD LIVING CONDITIONS. YEAR-ROUND.
REMARKS: PREVALENCE REMAINS LOW. TUBERCULOlD LEPROSY WAS
SIGNIFICANTLY MORE COMMON IN INDIGENOUS PERSONNEL.
P. TOXOPLASMOSIS
TRANSMISSION/RESERVOIR: HUMAN INFECTION IS PRIMARILY ACQUIRED
THROUGH CONTACT WITH CAT FECES OR FOOD CONTAMINATED WITH OOCYSTS
OR THROUGH CONSUMPTION OF UNDERCOOKED MEAT CONTAINING TISSUE
CYSTS, PRINCIPALLY FROM SHEEP AND `GOATS. RAW
GOAT AND SHEEP MILK CONTAINING TACHYZOITES POSSIBLY MAY BE A
SOURCE OF INFECTION. DOMESTIC AND WILD FELINES ARE THE ONLY
DEFINITIVE HOSTS; CAT FECES ARE THE SOURCE OF ENVIRONMENTAL
CONTAMINATION WITH OOCYSTS. NUMEROUS MAMMALIAN INTERMEDIATE HOSTS
EXIST; RODENTS ARE IMPORTANT SOURCES OF INFECTION FOR FELINES.
THE PREVALENCE OF INFECTION IN SHEEP AND GOATS IS RELATED TO THE
ABUNDANCE OF FELINES
IN PASTURE LANDS.
DISTRIBUTION/RISK PERIOD: WIDELY DISTRIBUTED. YEAR-ROUND.
REMARKS: SEROPREVALENCE IS HIGH. SEROSURVEYS INDICATE THAT
INFECTION MAY BE MORE PREVALENT IN NOMADS.
Q. LEPTOSPlROSIS
TRANSMlSSlON/RESERVOlR: ALL DOMESTIC ANIMALS AS WELL AS MANY W'fLD
ANIMALS, ESPECIALLY RODENTS, MAY SERVE AS RESERVOIRS OF INFECTION.
MANY SEROTYPES HAVE BEEN REPORTED FROM THE REGION, BUT THE
PREDOMINANT SEROTYPE(S) IN AN AREA IS DEPENDENT ON SPECIFIC
ECOLOGlC CONDITIONS.
DISTRIBUTION/RISK PERIOD: LEPTOSPlRES REQUIRE A SLIGHTLY ALKALINE
AND STRICTLY FRESH WATER ENVIROWhENT, WHICH MAY RESTRICT THEIR
PRESENCE.THE DISEASE CAN BE EXPECTED TO BE FOCALLY DISTRIBUTED.
PRIMARILY A RISK DURING WARM MONTHS OF THE YEAR (JUNE TO
SEPTEMBER).
REMARKS: LIMITED REPORTS SUGGEST A VERY LOW ENDEMICITY. CASES ARE
SPORADICALLY REPORTED; THE RISK OF ACQUIRING THE DISEASE AND THE
NUMBER OF EXPECTED CASES IN INDIGENOUS PEOPLE ARE LOW.
LEPTOSPlROSIS GENERALLY IS OCCUPATIONALLY RELATED.
ELEVATED RODENT POPULATIONS MAY CONTRIBUTE TO INCREASED
TRANSMISSION.
Document Page: First | Prev | Next | All | Image | This Release | Search