Health officials fear leishmaniasis epidemic

Health officials in Iraq are concerned following an outbreak of the disfiguring parasitic disease cutaneous leishmaniasis in Baqubah, some 120 km from the capital Baghdad, with as many as 250 new cases reported in the last two weeks. Dr Abdul Jalil Nafi, director of the Infectious Diseases Control Centre (IDCC), told IRIN in Baghdad, that the discovery of such a high number was extremely worrying and that they feared that there could be an epidemic if prevention and control programmes were not put in place immediately. Leishmaniasis is a disabling disease transmitted by the bite of the female sandfly. Dogs and other animals act as a source of infection from which the flies spread to humans. Rodents, especially certain species of rats, are considered the main carriers. The disease leads to disfigurement of the face and hands, and social stigma, particularly for women and children. Known locally as the "Baghdad sore", leishmaniasis is linked to poor social conditions, especially in areas lacking sanitation and waste disposal. Baqubah has been suffering from poor sewage treatment and accumulation of rubbish in many areas around the city. "The biggest problem that we are having now is related to the poor hygiene in the area and it’s something out of the control of the Ministry of Health. We depend on the cooperation of other ministries to help in the cleaning up of the city to prevent the proliferation of the flies," Nafi said. The doctor added that many areas in Iraq were suffering from poor hygiene and that poor distribution of information on prevention was compounding the problem. He explained that the most common type of leishmaniasis was urban, which is transmitted by human contact. The rural type comes from the interaction of humans with rodents and that in poor hygiene areas the presence of rodents was very high, worsening the situation. According to Dr Husseiny Sami, an infection specialist at the main hospital of Baqubah, the large increase in cases in such a time frame was not common. "We haven’t had such a large number of cases in our city before and this makes the situation worse. We are offering treatment here but with this increase we require much more medicine to be offered as most of the families cannot afford treatments," he explained. Prolonged systemic treatment may be necessary for the disease, according to Sami and, in endemic areas, sandflies should be controlled by spraying homes with insecticide. He added that rubbish heaps, which are breeding areas for sandflies, should be eliminated. Dr Nabil Amin, head of the World Health Organization (WHO) in Iraq, told IRIN that although an increase could be expected during this season in the country, the numbers were larger than predicted. "We are supporting the IDCC with insecticides, instruments, lab materials for the tests and training to provide more efficient and fast diagnosis of the disease," Amin added. The WHO has been working in partnership with Kimadia, Iraq's formerly state-run pharmaceutical company, to cover needs in the country. "All our efforts could come to nothing if the government doesn’t take urgent action to reduce sewage on the streets and repair the water purification system in the country because, without it, the doors will still be open for the appearance of new diseases," Nafi maintained.