The World Health Organization has warned Iran about the risks of cholera outbreak due to its geographical proximity to two main sources of the epidemic, Pakistan to the east and Iraq in the west.
The deputy director of the Communicable Diseases Management Center at the Health Ministry said a cholera epidemic in Sistan-Baluchestan is expected every year in April-May when the disease usually breaks out in neighboring Pakistan, and once every few years in Khuzestan and Kurdistan, following regular outbreaks in northern Iraq.
Speaking at the regional workshop on diseases transmitted through food and water with focus on cholera, hosted by Khuzestan Health Center in Ahvaz, Dr. Mahmoud Nabavi pointed to last year’s epidemic in Iraq which was transmitted to Khuzestan as well but did not spread further in Iran as it was controlled by the provincial health centers. The rare cases of the bacterial disease in other provinces this year were caused by pilgrims who had travelled to Iraq.
However, every five or six years, Iran is hit by endogenous epidemics as well those originating from the central parts of the country that spread to other provinces. Since the last outbreak that occurred in 2010, a cholera epidemic is highly likely this year, Nabavi was quoted as saying by ISNA.
Cholera is caused by a number of types of Vibrio cholera bacterium which are spread mostly by water and food that has been contaminated with human feces containing the bacteria. Chlorination is one of the methods of purifying water since the microorganism is sensitive to chlorine.
Around 98% of drinking water in the country is chlorinated at present. Nevertheless, regular cholera infections remain a problem due to the absence of effective wastewater control programs.
“Currently, the main cause of cholera is contamination of vegetables irrigated by untreated wastewater,” Nabavi said. Improving public sanitation is another way of preventing the disease.
Public Education
As a result of public education programs on standards of hygiene of consumable products over the past three decades, the rate of water-borne diseases including diarrhea, typhoid and cholera has decreased. Typhoid has declined now from an annual 30,000 to 300 cases and cholera infections have dropped from 20,000 to 1,000 cases per year.
Stressing the vulnerability to infections from across the borders due to its location, Nabavi said health centers must always remain alert and prepared for an epidemic.
Statistics by WHO indicate that it would take at least one and a half months for an epidemic to be eliminated if timely action is taken to control the spread. If relevant bodies fail to take proper action, it may take four months.
Epidemics often take high casualties in the beginning because neither people nor doctors are prepared. To address this issue, both the public and health centers are alerted in warm seasons because the Vibrio cholera bacteria is activated in warm weather and only dies in temperatures below 11 degrees Celsius.
Cholera first came to Iran in 1965. The most devastating epidemic occurred in 1970 and 20,000 people were infected. Between 1978 and 1998, nearly 10,000 infections were registered but the number fell to 1,000 after 2005 thanks to chlorination of drinking water. In 2011, only 1% of the patients died of cholera.
