Infectious Diseases - Long Incubation

Other Diseases of Potential Military Significance

• Anthrax
  
• Brucellosis
  
• Echinococcosis
  
• Q Fever
  
  

• Vector-Borne Diseases Plague
  
• Relapsing Fever(Louse-Borne)
  
• Relapsing Fever(Tick-Borne)
  
• Typhus(Flea-Borne)
  
• Typhus(Louse-Borne)
  
  

• Infections of ascariasis, hookworms, strongyloidiasis
  
• Trachoma
  
• Tuberculosis
  
  

• Acute Hemorrhagic Conjunctivitis
  
• Cholera
  
  
  

Unexplained Symptoms

Highly endemic. Bacterial agents that may be a major cause of morbidity among nonindigenous personnel include Campylobacter spp., Escherichia coli, Salmonella spp., and Shigella spp. Resistance has been reported to the standard therapeutic agents macrolides and TMP/SMX.

Endemic protozoans such as Cryptosporidium spp., Cyclospora spp., Entamoeba histolytica, and Giardia lamblia often are associated with more chronic infections but can cause acute diarrhea (see CCDM). A limited 1994 study of children under 5 years of age with "gastroenteritis" reported fecal positive prevalences of 20 percent for Entamoeba histolytica, 13 percent for Giardia lamblia and 9 percent for Cryptosporidium.

Cyclosporiasis was diagnosed in Al Basrah in the late 1990s. This is the first time cyclosporiasis has been reported in Iraq. Amoebiasis (see CCDM) carriers also are common among healthy adults in all socioeconomic groups.

Rotavirus is a common cause of diarrhea in children. Regionally, Norwalk virus infection occurred among US military personnel stationed in Saudi Arabia during Operations Desert Shield and Desert Storm. Overall infection rates were estimated at 6 percent. No specific data are available on other viral agents.

For more information click here: www.cdc.gov/ncidod/dpd/parasiticpathways/diarrhea.htm

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Endemic, probably at high levels. Serological studies indicate that the Sicilian and Naples viruses are present. Although local populations generally become immune during childhood, sandfly fever poses a significant risk to nonindigenous personnel. Sandfly fever (see CCDM) caused significant morbidity among Allied forces in the Persian Gulf theater during World War II.

For more information click here:
 http://www.dpd.cdc.gov/dpdx/HTML/Leishmaniasis.htm

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Endemic at increasing levels. The carrier rate probably is high. Based on regional data, strains of S. typhi likely are resistant to the standard therapeutic agent chloramphenicol.

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Endemic at increasing levels. A 1996 World Health Organization report cited increased incidence of new malaria cases, particularly in the north (87.2 per 100,000 in 1989 to 2,585.2 per 100,000 in 1994). Resurgence after the Gulf War attributed to Kurdish resettlement in the north, lack of vector control programs, and increased rice farming. In 1995, vector control programs were implemented in the north by nongovernmental organizations. Plasmodium vivax causes 99 percent of reported cases, with the rest caused by P. falciparum. Based on limited data, falciparum strains may be resistant to chloroquine and sulfadoxine/pyrimethamine (Fansidar; 15 treatment failures to chloroquine/Fansidar were reported from the northern Province of Dahuk in 1994).

For more information click here:
http://www.cdc.gov/malaria/

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Crimean-Congo Hemorrhagic Fever (CCHF):
Risk is greatest from May through September. In July 2000, an outbreak in Arbil included at least two human deaths. The number of cases is unknown but probably much higher and the geographic distribution probably is greater than reported. Focally enzootic in northern agricultural areas, with cases reported in 1996. CCHF was first reported in 1979 from Baghdad, Dyala, and Karbala. An early 1980s survey detected seropositivity levels up to 31 percent among persons associated with livestock rearing in northern provinces. CCHF is more prevalent than reported as many infections are asymptomatic and many cases are West Nile Fever (see CCDM) and Sindbis Virus Disease (see CCDM). Potential mosquito vectors (Culex spp.) are present. Likely enzootic, based on regional data. Sindbis virus has been isolated from mosquitoes in eastern Saudi Arabia; West Nile virus has been serologically detected in Israel, Kuwait, and Pakistan. Risk likely is elevated during spring and summer.

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The potential mosquito vector, Aedes aegypti, is present. Historically reported from southern areas, but current endemic status is unclear. Regionally, a large outbreak was last reported in early 1994 in western Saudi Arabia. unreported.

For more information click here:
www.cdc.gov/ncidod/dvbid/dengue/facts.htm

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Endemic with sporadic epidemics. Neisseria meningitidis group A predominates. In 1989, an unconfirmed epidemic attributed to group W-135 occurred in Al Basrah. Regionally, 241 cases (primarily Group W135) were reported in Saudi Arabia following the February 2000 Hajj.

For more information click here:
www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_t.htm

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STDs, including gonorrhea and chlamydial cervicitis/urethritis (see CCDM), are endemic. See "Other Diseases of Potential Military Significance" for discussion of HIV/AIDS (see CCDM) and syphilis (see CCDM).

For more information click here:
http://www.cdc.gov/nchstp/dstd/disease_info.htm#GenInfo

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Viral hepatitis A (see CCDM) is highly endemic. Most Iraqis contract hepatitis A virus infection during childhood. Viral hepatitis E (see CCDM) has been reported, but the level is unclear.

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Viral hepatitis B is endemic at intermediate levels. Serosurveys in the late 1980s detected hepatitis B virus (HBV) markers in nearly 40 percent of pregnant women and more than 50 percent of Kurdish refugees. The HBV carrier rate is estimated at 5 percent. Hepatitis D virus antibodies have been detected in approximately 5 percent of HBV carriers.

For more information click here:
http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm

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Endemic at increasing levels.
A 1996 World Health Organization (WHO) report cited increased incidence of new cases of cutaneous and visceral leishmaniasis (from 14.9 per 100,000 population in 1989 to 54.3 per 100,000 in 1994) due to a steady increase in vector density.

Most cutaneous leishmaniasis (CL) (see CCDM) cases in rural or periurban areas are caused by L. major, which is focally distributed primarily in the northern border provinces with Turkey and Iran, based on the distribution of the zoonotic reservoir, primarily gerbils (Psammomys obesus and Meriones spp.).

Humans become infected when they intrude into the enzootic cycle. Most CL cases in urban areas (including Baghdad and Mosul-also called Al Mawsil) are caused by L. tropica. No animal reservoir has been identified.

Visceral leishmaniasis (see CCDM) caused by L. donovani generally occurs in focal rural areas, mainly in central Iraq; the reservoir is unknown, but is likely jackals and dogs.

For more information click here:
www.cdc.gov/ncidod/dpd/parasites/Leishmania/default.htm

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Rates increased in 1990s, likely due to lack of adequate control programs after sanctions were imposed. Reported annual case totals (and likely infection rates) had decreased in the 1980s, attributed to control programs.

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Enzootic, with cases in livestock reported. Occupational exposure usually involves sheep. Human cases are underreported; human cases last "officially" were reported from 1976 to 1980.

For more information click here:
www.bt.cdc.gov/DocumentsApp/Anthrax/10312001/han49.asp

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Human cases are common and usually are associated with the consumption of raw dairy products and exposure to infected livestock, particularly at parturition. The numbers of cases are likely increasing prompting a massive livestock immunization program that began early in 2000. Although under-reported, more than 10,000 cases officially were reported in 1995. The 1994 official infection rate was 73 cases per 100,000 population.

For more information click here:
www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_t.htm

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Enzootic primarily in a dog-domestic animal cycle. Dogs are the primary source of human exposure. Hydatid disease caused by Echinococcus granulosus is common countrywide. An early 1990s study reported infection rates up to 79 percent in stray dogs. A limited 1990 to 1998 study found human prevalences of 2 per 100,000 population in Arbil Province. The same study found prevalences of 15 percent in sheep, 6.2 percent in goats, and 10.9 percent in cattle.

Leptospirosis: Enzootic. Risk in rural and urban areas may be elevated from July through September.

For more information click here:
www.dpd.cdc.gov/dpdx/html/Echinococcosis.htm

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Rarely reported in humans, but human serology in rural areas indicates exposure. Rabies (see CCDM): Risk likely is elevated in rural areas. Jackals and foxes are the primary reservoirs, with some spillover into dogs and other domestic animals; although many more cases likely occur, 31 human cases were "officially" reported in 1996.

For more information click here:
www.cdc.gov/ncidod/dvrd/qfever/index.htm

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Flea-borne. Bubonic plague cases were last reported in early 1994 from Al-Basrah, al-'Amarah, and Baghdad. Enzootic foci historically have existed in the highlands near the Syrian border and along the Tigris-Euphrates River-extending to Kuwait.

For more information click here:
www.cdc.gov/ncidod/dvbid/plague/facts.htm

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Endemic in northern Iraq.

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Enzootic foci occur in a belt across central Iraq, extending from Syria to Iran. Rickettsioses (see CCDM), Tick-Borne: Likely endemic based on foci of North Asian tick typhus in Turkey and Iran, and foci of Boutonneuse fever in the Eastern Mediterranean region.

For more information click here:
www.cdc.gov/mmwr/preview/mmwrhtml/00001736.htm

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Sporadic cases occur, particularly in southern areas. Suspected cases were reported among Kurds in northern Iraq in 1991.

For more information click here:
www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_t.htm

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Endemic status is unclear. Last reported in 1977-1978 from endemic foci in central areas.

For more information click here:
www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_t.htm
www.cdc.gov/travel/disease/typhoid.htm

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For more information click here:
www.dpd.cdc.gov/dpdx/HTML/Ascariasis.htm
www.dpd.cdc.gov/dpdx/HTML/Hookworm.htm
www.dpd.cdc.gov/dpdx/HTML/Strongyloidiasis.htm
www.dpd.cdc.gov/dpdx/HTML/Trichuriasis.htm
www.dpd.cdc.gov/dpdx/HTML/Enterobiasis.htm
www.dpd.cdc.gov/dpdx/HTML/Hymenolepiasis.htm

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Widespread, especially in rural areas and among nomadic tribesmen. Control measures reduced incidence in the 1980s, but trachoma still is the most common cause of preventable blindness.

For more information click here:
www.cdc.gov/ncidod/dbmd/diseaseinfo/trachoma_t.htm

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Highly endemic, especially among lower socioeconomic groups. The 1997 overall prevalence was estimated at 264 cases per 100,000 population, much higher than surrounding countries in the region. Resistance to standard therapeutic agents likely occurs, based on data from Saudi Arabia, where a April 1996 to March 1998 limited study found 29.7 percent of cases resistant to at least one of the following standard therapeutic agents: isoniazid, rifampin, pyrazinamide, and ethambutol.

For more information click here:
www.cdc.gov/nchstp/tb/faqs/qa.htm

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Probably endemic; epidemics have occurred regionally along coastal areas of other countries, including a 1988 epidemic in Saudi Arabia.

For more information click here:
http://www.emedicine.com/oph/byname/conjunctivitis-acute-hemorrhagic.htm 

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Endemic countrywide at increasing levels. A 1999 outbreak reportedly affected Baghdad and vicinity and spread north and northeast to the cities of Dahuk, Mosul (Al Mawsil), and As Sulaymaniyah and their surrounding areas. Annual cases are reported. A 1996 WHO report estimated 1994 incidence at 7.8 per 100,000 population. As of August 2000, WHO considered the following provinces officially cholera endemic: Al Anbar, Al Basrah, Al Muthanna, Al Qadisiyah, An Najaf, At Ta'mim, Babil, Baghdad, Dhi Qar, Diyala, Karbala', Maysan, Ninawa, Salah ad Din, and Wasit.

For more information click here:
www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_t.htm

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