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09/25/2004:

"Hepatitis Outbreak Laid to Water and Sewage Failures"

by James Glanz
BAGHDAD, Iraq, Sept. 24 - A virulent form of hepatitis that is especially lethal for pregnant women has broken out in two of Iraq's most troubled districts, Iraqi Health Ministry officials said in interviews here this week, and they warned that a collapse of water and sewage systems in the continuing violence in the country is probably at the root of the outbreak. The disease, called hepatitis E, is caused by a virus that is often spread by sewage-contaminated drinking water. The officials said they had equipment to test only a limited number of people showing symptoms, suggesting that only a fraction of the actual cases have been firmly diagnosed. In Sadr City, a Baghdad slum that for months has been convulsed by gun battles between a local militia and American troops, the officials said as many as 155 cases had turned up.

The second outbreak is in Mahmudiya, a town 35 miles south of Baghdad that is known for its kidnappings and shootings as well as for its poverty, where there are an estimated 60 cases. At least nine pregnant women are believed to have been infected, and one has died. Five deaths have been reported over all.

"We are saying that the real number is greatly more than this, because the area is greatly underreported," said Dr. Atta-alla Mekhlif Al-Salmani, leader of the viral hepatitis section at Health Ministry's Center of Disease Control.

The World Health Organization is rushing hepatitis E testing kits, water purification tablets, informational brochures and other materials to Iraq, said Dr. Naeema Al-Gasseer, the W.H.O. representative for Iraq, who is now based in Amman, Jordan.

But viral hepatitis comes in many forms, and another ominous set of statistics suggests that the quality of water supplies around the country has deteriorated since the American-led war began last year, Dr. Salmani said. In 2003, 70 percent more cases of hepatitis of all types were reported across Iraq than in the year before, he said. During the first six months of 2004, as many cases were reported as in all of 2002.

Full Article: NY Times