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File: 950825_53310003_91r.txt
Page: 91r
Total Pages: 1


Filename:53310003.91r
SUBJECT: IRAQ: DISEASES

[      (b)(1) sec 1.3(a)(4)    ]






















 AMEBIASIS, OR AMEBIC DYSENTERY. ENDEMIC
THROUGHOUT SAUDI ARABIA AND THE MIDDLE EAST. IT IS CAUSED BY
INGESTING CYSTS OF THE AMEBA THROUGH FECAL CONTAMINATION OF WATER
AND FOOD. THEREARE MANY INFECTED PERSONS IN THIS AREA AND THEY ARE
CARRIERS OF THE DISEASE. AMEBIASIS IS TYPICALLY TRANSMITTED THROUG
UNSANITARY FOOD HANDLILNG PRACTICES AND IMPROPERLY WASHED 
VEGETABLES
AND FRUIT. IT IS ONE OF MANY DIARRHEAL DISEASES AND CAN ONLY BE
IDENTIFIED BY MICROSCOPIC EXAMINATION OF STOOL SAMPLES. SYMPTOMS
INCLUDE MILD TO SEVERE DIARRHEA, VOMITING, WEAKNESS AND 
RIGHT-SIDED
ABDOMINAL CRAMPS. REQUIRES MEDICAL TREATMENT. IF LEFT UNTREATED,
IT INVADES THE LIWER, LUNGS AND BRAIN AND CAN RESULT IN DEATH.
2.  HEDATITIS "A" AND "B." SAUDI ARABIA AND ALL OF THE
MIDDLE EAST MUST BE CONSIDERED A HIGH-RISK AREA FOR CONTRACTING
HEPATITIS. THERE ARE TWO COMMON FORMS WHICH ARE SIMILAR IN MANY
WAYS. THEY ARE EXTREMELY CONTAGIOUS, HIGHLY DEBILITATING AND
SOMETIMES FATAL. HEPATITIS "A" IS ALSO KNOWN AS VIRAL OR
INFECTIOUS HEPATITIS. IT IS EASILY SPREAD AND IS ASSOCIATED WITH
POOR SANITATION AND CROWDED LIVING CONDITIONS, IMPROPER FOOD
HANDLING TECHNIQUES, AND IS ESSENTIALLY AN INFECTION BY THE
FECAL-ORAL ROUTE. HEPATITIS "B" IS MORE COMMONLY KNOWN AS SERUM
HEPATITUS AND IS A VIRUS TRANSMITTED BY BLOOD AND BODY WASTES.
THERE IS A RISK TO THE RECIPIENT IN BLOOD TRANSFUSIONS, AND A RISK
TO THOSE WHO HANDLE BLOOD AND SOILED LINENS. CLINICAL STUDIES
AMONG THE SAUDI POPULATION HAVE SHOWN A PREVALENCE RATE OF 
INFECTION
GREATER THAN NINETY PERCENT FOR HEPATITIS "A," AND A RATE GREATER
THAN TEN PERCENT FOR HEPATITIS "B." THIS MEANS THAT A HIGH
PERCENTAGE OF THE:NATIVE POPULATION MUST BE REGARDED AS CARRIERS
AND THEREFORE UNSUITABLE AS BLOOD DONORS OR FOOD HANDLERS. 
SYMPTOMS
OF HEPATITIS INCLUDE WEAKNESS, LOSS OF APPETITE, NAUSEA, VOMITING,
HEADACHE, LOW-GRADE FEVER, ABDOMINAL, PAIN AND A YELLOWING OF THE
WHITES OF THE EYES.
3.  CUTANEOUS (SKIN SURFACE) LEISHMANIASIS IS ALSO KNOWN
AS ALEPPO, BAGHDAD OR DELHI BOIL AND ORIENTAL SORE. IT IS FOUND
THROUGHOUT THE ARABIAN PENINSULA; HOWEVER, THE MAJORITY OF 
REPORTED
CASES COME FROM THE AREAS AROUND JIZAN //GEOCOORDS: 1654N4232E//
IN THE SOUTHWEST NEAR YEMEN, AL-HASA //GEOCOORDS: 3049N3559E//
OASIS AND HOFHUF //GEOCOORDS: NA// IN THE EASTERN PROVINCE, AND
FROM THE NUMEROUS OASES FROM RIYADH //GEOCOORDS: 2438N4643E//
NORTHWESTERLY TO HAIL //GEOCOORDS: 2733N4142E//. IN 1982, SOME
FIVE THOUSAND FIVE HUNDRED CASES CAME TO THE ATTENTION OF THE 
SAUDI
MINISTRY OF HEALYH, BUT UNDERREPORTING IS A PROBLEM. THE DISEASE
CAUSES A LARGE, ULCERATING SORE TO APPEAR ON THE SKIN WITHIN
SEVERAL DAYS TO MANY MONTHS AFTER EXPOSURE. UNLESS THE
INFECTION SPREADS TO THE NASO-PHARYNGEAL MEMBRANES, IT IS NOT
DANGEROUS. THE DISEASE CANNOT BE SPREAD FROM ONE INDIVIDUAL TO
ANOTHER, AND IMMUNITY USUALLY COMES AFTER THE SORES HEAL. ALL
NEWCOMERS TO THE AREA ARE SUSCEPTIBLE. VISCERAL (INTERNAL)
LEISHMANIASIS IS ANOTHER FORM. VERY FEW CASES HAVE BEEN REPORTED
IN SAUDI ARABIA, BUT IT IS NINETY PERCENT FATAL IF NOT PROPERLY
TREATED. LEISHMANIASIS IS CAUSED BY THE INJECTION OF MICROSCOPIC,
FLAGELLATE PROTO OANS INTO THE SKIN BY THE BITING SANDFLY. FEMALES
TAKE BLOOD MEALS AFTER SUNEST AND BEFORE SUNRISE SEASONALLY, FROM
MARCH THROUGH NOVEMBER, WITH PEAK ACTIVITY IN JULY AND AUGUST.
THE SANDFLY IS V6RY SMALL, TAN-COLORED, ALMOST TRANSPARENT AND
AGGRESSIVE. IT INHABITS RODENT BURROWS, VILLAGE WALLS AND CRACKS
IN THE EARTH, AVOIDING DIRECT SUNLIGHT AND THE HEAT OF THE DAY.
IT NEEDS A LITTLK HUMIDITY TO SURVIVE. MOST OF ITS BLOOD MEALS
ARE FROM RODENTS AND LIZARDS.
4.  MALARIA IS ENDEMIC THROUGHOUT THE MIDDLE EAST AND
OCCURS IN MANY AREAS OF SAUDI ARABIA, IN SPITE OF MASSIVE
ERADICATION EFFORTS BY THE SAUDIS. IT IS TRANSMITTED BY THE
BITE OF THE FEMALE MOSQUIT0 OF THE ANOPHELES SPECIES. THE BITE
INJECTS A PROTOZOAN, PLASMODIUM. FOUR OF ITS SPECIES ARE
INFECTIVE TO MAN. OF THESE FOUR, P. FALCIPARUM CAN KILL MAN.
EIGHTY-ONE PERCENT OF ALL CONFIRMED CASES IN SAUDI ARABIA DURING
A FOUR YEAR PERIOD HAVE BEEN P. FALCIPARUM. IN THE EASTERN
PROVINCE, THE MOSQUITO ANOPHELES STEPHENSI SURVIVED ERADICATION
EFFORTS AND HAS DEVELOPED A RESISTANCE TO DDR AND DIELDRIN. SHOULD
THIS MOSQUITO CONNECT WITH EXPATRIATE WORKERS FROM ENDEMIC AREAS
LIKE INDIA, PAKISTAN, THAILAND, THE PHILLIPINES, INDONESIA, SUDAN
OR ETHIOPIA WHERE P. FALCIPARUM HAS DEVELOPED A RESISTANCE TO
THE DRUGS CHLOROQUINE OR FANSIDAR, OR BOTH, MALARIA COULD BE
REINTRODUCED. THE EASTERN AREA OF SAUDI ARABIA IS CONSIDERED
HAZARDOUS. PERSONNEL ENTERING THE AREA SHOULD BE STARTED 0N
CHEMOPROPHYLAXIS IF THEY ARE TO BE IN THE FIELD. IN THE NORTHERN
AREA, MALARIA WAS REINTRODUCED IN AUGUST 1982 INTO THE DOUMAT
AL-JANDAL OASIS OF AL JAWF //GEOCOORDS: 2950N3952E//. IN THE
WESTERN AREA OF SAUDI ARABIA, THE OASES OF HAYIT //GEOCOORDS:
NA// AND HOWAYIT //GEOCOORDS: NA// AND THE VILLAGES ALONG THE
WADI WAJIDA //GEOCOORDS: NA//, WADI MAKIDA //GEOCOORDS: NA//,
WADI ZAYIDA //GEOCOORDS: NA//, AND THE WADI HERHAL //GEOCOORDS:
NA// ARE ENDEMIC; THE NUMEROUS HAMLETS IN THE MECCA-JEDDAH 
ALIGNMENT
HAVE REPORTED CASES OF P. FALCIPARUM AND P. VIVAX. THE SOUTHERN
AREA IS HYPER-ENDEMIC AND ANYONE ENTERING THIS AREA MUST BE ON
CHEMOPROPHYLAXIS. THE HAZARDS OF CONTRACTING MALARIA ARE GREATEST
THIS AREA AND JIZAN //GEOCOORDS: 1654N4232E// IS THE REAL CORE.
5.  ONCHOCERCIASIS, OR RIVER BLINDNESS, IS FOUND IN
AREAS OF FLOWING STREAMS WHERE THE INSECT VECTOR, BLACKFLY, LIVES
AND BREEDS. A LIGHT INFECTION CAN OCCUR DURING A RELATIVELY BRIEF
EXPOSURE. SYMPTOMS INCLUDE ITCHING AND MAY INCLUDE A REDDISH,
PAPULAR RASH. THE EFFECT OF THE DISEASE IS CUMULATIVE, DEPENDING
UPON THE LENGTH OF STAY IN THE INFESTED AREA AND EXPOSURE TO 
BITES.
LARVAE GROW INTO ADULT WORMS OVER A PERIOD OF MONTHS, OFTEN 
OCCURING
AFTER THE PERSON LEAVES THE AREA. FEMALE WORMS CAN LIVE AS LONG
AS FIFTEEN YEARS, PRODUCING SEVERAL THOUSAND MICROFILARIAE DAILY
WHICH MIGRATE THROUGH THE SKIN, LYMPHATIC TISSUES AND TO THE EYES.
THE DISEASE IS DIFFICULT TO DIAGNOSE AND DIFFICULT TO CURE, BUT
IT IS NOT FATAL AND CAN BE ARRESTED WITH TREATMENT. BLINDNESS IS
THE RESULT OF AN ABSENCE OF TREATMENT OFTEN SEEN IN THE NATIVES
OF THE AREA. IT IS SEEN IN THE EASTERN PROVINCE AROUND HOFHUF
//GEOCOORDS: NA// AND IN THE COASTAL AREAS OF THE RED SEA NORTH
AND SOUTH OF JIZAN //GEOCOORDS: 1654N4232E//.
6. SHISTOSOMIASIS IS AN ENDEMIC DISEASE FOUND IN THE
WET AREAS OF SAUDI ARABIA. TWO FORMS OF THE ORGANISM ARE FOUND IN
SAUDI: SHISTOSOMA HEMATOBIUM INVADES THE URINARY TRACT; S. MANSONI
INVADES THE INTESYINAL TRACT. HEMATOBIUM IS PRESENT IN FRESH AND
STAGNANT WATERS AROUND JIZAN //GEOCOORDS: 1654N4243E//. MANSONI
HAS BEEN SEEN IN THE SPRINGS AT AL-HASA //GEOCOORDS: 3049N3550E//
AND THE IRRIGATION CANALS THERE AND AT HOFHUF //GEOCOORDS: NA//
SHOULD BE CONSIDERED ENDEMIC. THREE FACTORS ALLOW SHISTOSOMIASIS
TO EXIST: MAN, WATER AND A COUPLE SPECIES OF SNAILS. THE CYCLE
IS PERPETUATED BY INFECTED HUMANS URINATING OR DEFECATING INTO THE
WATER, THEREBY PASSING MICROSCOPIC-SIZED EGGS WHICH HATCH INTO
MINUTE, FREE-SWIMMING MIRACIDIUM. THESE INVADE THE TISSUE OF THE
SNAIL WHICH SERVES AS AN INTERMEDIATE HOST, FROM WHICH EMERGES A
FORK-TAILED FREE-SWIMMING CERCARIAE. IN THIS FORM IT CAN PENETRATE
THE SKIN OR MUCOUS MEMBRANES OF THE HUMAN. THESE CERCARIAE DEVELOP
INTO ADULT WORMS AND LIVE IN THE VEINS AND THE LYMPH SYSTEM. WORM
PAIRS MATE AND FEMALES BEGIN TO LAY EGGS. SOME EGGS MAY BE TRAPPED
IN THE BODY'S FILSERS: THE BLADDER, LIVER, LUNGS AND SPLEEN, WHILE
REMAINING EGGS PASS OUT IN URINE AND FECES. SHISTOSOMIASIS IS
REATIVELY EASY TO TREAT AND CURE, HOWEVER, ITS SYMPTOMS INCLUDE
RASH, FEVER, HEADACHE, TIREDNESS, COUGH, ABDOMINAL PAIN, AN 
ENLARGED
AND TENDER LIVER AND DIARRHEA. ALL OF WHICH SUGGEST OTHER 
DISEASES.
IF UNTREATED, IRREVERSIBLE DAMAGE OCCURS TO THE INTESTINES, 
URINARY
BLADDER, KIDNEYS, LIVER, SPLEEN AND LUNGS. DEATH OCCURS FROM 
MOUNTING
COMPLICATIONS OF FAILING ORGANS. IN ADDITION TO SAUDI ARABIA,
SHISTOSOMIASIS IS ENDEMIC IN EGYPT, YEMEN, IRAQ AND THE SUDEN.
WORLDWIDE, IT RANKS SECOND TO MALARIA AS A MENACE TO HEALTH.
TO DATE, SAUDI ATTEMPTS TO ERADICATE THE DISEASE HAVE BEEN
UNSUCCESSFUL.
7.  CONGO-CRIMEAN HEMORRHAGIC FEVER (CCHF) HAS BEEN
WIDELY REPORTED BETWEEN CENTRAL AFRICA AND THE U.S.S.R. IT IS A
VIRUS TRANSMITTED BY TICK BITES. IT IS PASSED FROM PERSON TO
PERSON BY COMING INTO CONTACT WITH BLOOD, AEROSOLIZED BLOOD
DROPLETS, BODY WASTES, SOILED CLOTHING AND BLOODY LINENS.
SEVERAL EURASIAN EPIDEMICS HAVE TAKEN GREAT TOLLS OF LIVES, AND
IT IS BELIEVED THAT MANY PEOPLE DIED IN BAGHDAD ONLY A FEW YEARS
AGO FROM AN OUTBREAK OF CCHF. AT LEAST TWENTY-FIVE TICK SPECIES
HAVE BEEN IDENTIFIED AS VECTORS AND THEY ARE TRANSPORTED IN 
SEVERAL
WAYS: UPON CAMELS, COWS AND SHEEP MOVING WIDELY TO GRAZE AND TO
MARKET AND UPON BIRDS. WHETHER MIGRATORY OR NOT, BIRDS ACT AS A
HOST FOR THE TICK5 AND TRANSPORT THEM ABOUT. OFFSHORE ISLANDS IN
THE RED SEA AND THE PERSIAN GULF ARE NESTING AREAS AND FAIRLY
INFESTED WITH TICKS. THE HAZARD TO PERSONNEL IS OBVIOUS IF
OCCUPYING ISLANDS OR COASTAL AREAS. CCHF IS A DISEASE OF THE
NERVOUS SYSTEM AND IS DIFFICULT TO DIAGNOSE IN THE FIRST FEW DAYS.
SYMPTOMS OF STOMACH AND BACK PAINS AND NAUSEA ARE EASILY CONFUSED
WITH OTHER ILLNESSES. PROFUSE HEMORRHAGING BEGINS WITHIN SIX TO
EIGHT DAYS AND DEATH TYPICALLY OCCURS BY CARDIAC ARREST. EPIDEMICS
REPORTED IN THE SOVIET UNION HAVE CAUSED DEATH RATES AS HIGH AS
FIFTY PERCENT OF THOSE INFECTED. MEDICAL PERSONNEL ATTENDING CCHF
PATIENTS ARE ALSO AT EXTREME RISK OF INFECTION AND THEIR DEATH
RATES HAVE BEEN SIMILARLY HIGH.
8.  RIFT VALLEY FEVER, UNTIL RECENTLY, PRIMARILY AFFECTED
ANIMALS, AND THE RISK TO HUMANS HAD BEEN IN EATING OR HANDLING 
SICK
ANIMALS. THE TRANSMISSION AGENT IS THE MOSQUITO AND EIGHTEEN 
SPECIES
HAVE BEEN IDENTIFIED. THE DISEASE IS PRESERVED IN AN INFECTED
POPULATION OF ANIMALS. MOSQUITOS WHICH HAVE FED ON INFECTED 
ANIMALS
CAN THEN TRANSMIT THE VIRUS TO HUMANS. RESEARCHERS HAVE FOUND THE
VIRUS TO BE PRESENT IN A WIDENING GEOGRAPHICAL AREA SINCE FIRST
REPORTED IN THE CENTRAL REGION OF AFRICA. TWO PROBABLE VEHICLES
FOR SPREADING THE DISEASE ARE THE GREAT HERDS OF ANIMALS WHICH
ARE MOVED TO MARKETS AND MOSQUITOS CARRIED AFAR BY THE PREVAILING
WINDS. THE IMPLICATION FOR THE SAUDI ARABIAN PENINSULA IS THE
POSSIBILITY OF CARRYING THE VIRUS ACAROSS THE RED SEA BY EITHER
OF THESE MEANS TO THE MOSQUITO-POPULATED LOWLANDS SOUTH OF
JEDDAH //GEOCOORDS: NA//.
[      (b)(1) sec 1.3(a)(4)    ]









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