Copyright (c) 2025 Dana Khdr Sabir, Karzan Jalal Salih, Salar Saadi Hussain, Sevan Omer Majed, Karzan Ghafoor Khidhir, Hazha Jamal Hidayat (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
- Articles
- Submited: May 10, 2023
-
Published: August 20, 2025
Abstract
Background and objective: Cholera is a highly contagious acute diarrheal infection caused by Gram negative Vibro cholerae. A number of disease outbreaks are recorded annually in different countries around the world. The aim of current study is characterization of the 2022 cholera outbreak in the city of Erbil, Kurdistan region/ Iraq.
Methods: The data of2,192 suspected cholera patients who were admitted to the hospital in the period from June 2022 to September 2022.
Results: The results show that 205 (9.4%) of the hospital-admitted patients were identified as cholera positive, and they have complete data. The mean age ±SD of cholera cases was of 35.71 ± 21.9 years old. No association between males and females regarding the age distribution of cholera cases, and the percentage of male-to female-patients were close together (50.2% males to 49.8% females). Moreover, the etiology of the outbreak was identified as V. cholerae O1 serotype Ogawa. The antibiotic sensitivity test of the isolates showed that the strains are sensitive towards meropenem (10µg), Gentamicin (10µg), and Ciprofloxacin (10µg), whereas all the tested bacterial samples shown to be resistant to trimethoprim.
Conclusion: The etiology of the cholera outbreak in the city of Erbil was V. cholerae O1 serotype Ogawa. Around half of the infected people were aged between 20 to 44 years old. This is the first report on the recent outbreak in the Erbil-Iraq.
Metrics
References
- Lemos-Paião AP, Silva CJ. Torres DF. An epidemic model for cholera with optimal control treatment. Comput Appl Math. 2017; 318: 168-80. doi.org/10.1016/j.cam.2016.11.002
- Bhandari M, Rathnayake IU, Huygens F, Jennison AV . Clinical and Environmental Vibrio cholerae Non-O1, Non-O139 Strains from Australia Have Similar Virulence and Antimicrobial Resistance Gene Profiles Microbiol Spectr. 2023; 11(1): e02631-22. https://doi.org/10.1128/spectrum.02631-22
- WHO. Cholera. World Health Organization fact sheet (2023). (Accessed February 2023). Available online at: http://www.who.int/mediacentre/factsheets/fs107/en/.
- Mutreja A, Kim DW, Thomson NR, Connor TR, Lee JH, Kariuki S, et al. Evidence for several waves of global transmission in the seventh cholera pandemic. Nature. 2011; 477(7365):462-5. doi: 10.1038/nature10392.
- Kim EJ, Lee CH, Nair GB, Kim DW. Whole-genome sequence comparisons reveal the evolution of Vibrio cholerae O1. Trends Microbiol. 2015; 23(8):479-89. doi: 10.1016/j.tim.2015.03.010.
- Grim CJ, Hasan NA, Taviani E, Haley B, Chun J, Brettin TS, et al. Genome Sequence of Hybrid V ibrio cholerae O1 MJ-1236, B-33, and CIRS101 and Comparative Genomics with V. cholerae. J Bacteriol. 2010; 192(13):3524-33. doi:10.1128/JB.00040-10
- Ilic I, Ilic M. Global Patterns of Trends in Cholera Mortality. Trop Med Infect Dis. 2023; 13; 8(3):169. doi: 10.3390/tropicalmed8030169.
- Niranjan AK, Patel SK, Channabasappa NK, Rana J, Agrawal A, Kumar R, et al. Resurgence of cholera in the COVID-19 Era: Global health concern commentary. Ann Med Surg (Lond). 2023; 85(4):1321-2. doi.org/10.1097/MS9.0000000000000415
- Burki T. Things have gone seriously wrong: global cholera surges. Lancet. 2023; 401(10377):633-4. doi: 10.1016/S0140-6736(23)00386-0
- Parvin I, Shahid AS, Das S, Shahrin L, Ackhter MM, Alam T, et al. Vibrio cholerae O139 persists in Dhaka, Bangladesh since 1993. PLoS Negl Trop Dis. 2021; 15(9): e0009721.
- Kuna A, Gajewski M. Cholera—the new strike of an old foe. Int Marit Health. 2017; 68(3):163-7. doi: 10.5603/IMH.2017.0029.
- Al-Obaidi RM, Arif SK, Abed RM, Yaaqoob LA, Mahmood SAF, Mohammed SJA, et al. Vibriocholerae: epidemiology, surveillance and occurrence in iraq. Publisher: https://uniquescientificpublishers.com/ 2023; 2:80-6. https://doi.org/10.47278/book.oht/2023.45.
- Qamar K, Malik U, Yousuf J, Essar MY, Muzzamil M, Hashim HT, et al., Rise of cholera inn Iraq: A rising concern. Ann Med Surg. 2022; 81:104355. doi.org/10.1016/j.amsu.2022.104355
- Shackleton D, Economou T, Memon F, Chen A, Dutta S, Kanungo S. Seasonality of Cholera in Kolkata and the Influence of Climate. Res Sq. 2023; doi.org/10.21203/rs.3.rs-2539131/v1
- Hussein NR., Rasheed NA, Dhama K, Cholera in Iraq and Syria: a silent outbreak with a serious threat to the middle-east and beyond. Int J Surg. 2023; 6(1):e108. http://dx.doi.org/10.1097/gh9.0000000000000108.
- Sabir DK, Hama ZT, Salih KJ, Khidhir KG . A Molecular and Epidemiological Study of Cholera Outbreak in Sulaymaniyah Province, Iraq, in 2022. Pol J Microbiol 2023; 72(1):39-46. 2023; 72(1):39-46. doi:10.33073/pjm-2023-008.
- WHO. Situation report Iraq [Internet]. United Nations Iraq: 2022 [cited 2023 Jan 07] Available from https://iraq.un.org/en/192647-who-situation-report-iraq.
- UNICEF. Interagency Standard Operating Procedures (SOP) for Interim Alternative Care in Dohuk, KRI. 2014. [internat]. avilable from: logistics_cluster_iraq_sops_140806.pdf
- Monsur KA. Highly Selective Gelatin-taurocholate-tellurite Medium for the Isolation of Vibrio Cholerae. Trans R Soc Trop Med Hyg. 1961; 55(5):440-2. doi: 10.1016/0035-9203(61)90090-6
- Shields P, Cathcart L. Oxidase test protocol. m Bio. 2016:1-9. [internat] avilable from: oxidase-test-protocol-3229.pdf (asm.org) [cited 2023 Jan 10].
- Kia kligler iron agar. instruction for Use. 2019. [internat]. avilable from: Kligler Iron Agar (KIA) - or the identificaiton of enteric bacteria (bioactiva.com) [cited 2023 Jan 11]
- Hudzicki J. Kirby-Bauer disk diffusion susceptibility test protocol. m Bio. 2009; 15:55-63. [internat] avilable from: Hudzicki J. Kirby-Bauer disk diffusion susceptibility test protocol 2009. 15: 55-63. - Google Search [cited 2023 Jan].
- Rhee C, Gupta BP, Lal BK, Lim JK, Wartel TA, Lynch J, et al. Mapping the high burden areas of cholera in Nepal for potential use of oral cholera vaccine: An analysis of data from publications and routine surveillance systems. Asian Pac J Trop Med. 2020; 13(3):107-14. DOI: 10.4103/1995-7645.278095
- Hameed JA, Mahmood OI, Al-Azawy AF. Epidemiological Study of Entamoeba Histolytica among Children in Kirkuk Province, Iraq. Ann Rom Soc Cell Biol. 2021; 25(7):1915-25.
- WHO, WHO Situation Report on Iraq - Week 29 (Ending 24 July 2022). 2022. [internat]. available from: WHO Iraq SitRep_Week 29 copy
- Jameel S, Shafek M, Abdulmohsen A, Mohamed N, Naji S, Mohammed T. The Isolation of Vibrio cholera and Other Enteric Bacteria with Molecular Characterization of Vibrio cholera during the Outbreak of Baghdad/Iraq in 2015. Adv Microbiol. 2016; 6:699-715. doi:10.4236/aim.2016.69069.
- Sidiq K. A Flashback to Cholera Outbreaks in Kurdistan region-Iraq. Passer J Basic Appl Sci. 2022; 5(1):7-12. https://doi.org/10.24271/psr.2022.367483.1177.
- Saleh TH, Sabbah MA, Jasem KA, Hammad ZN. Identification of virulence factors in Vibrio cholera isolated from Iraq during the 2007–2009 outbreak. Can J Microbiol. 2011; 57(12):1024-31. doi: 10.1139/w11-094
- Asadgol Z, Mohammadi H, Kermani M, Badirzadeh A, Gholami M. The effect of climate change on cholera disease: The road ahead using artificial neural network. PLoS One 2019; x
- (11):e0224813. https://doi.org/10.1371/journal.pone.0224813
- Fagbamila IO, Abdulkarim MA, Aworh MK, Uba B, Balogun MS, Nguku P, et al., Cholera outbreak in some communities in North-East Nigeria, 2019: an unmatched case–control study. BMC Public Health. 2023; 23(1):446-57. doi: 10.1186/s12889-023-15332-4.
- Rancourt N. Gender and Vulnerability to Cholera in Sierra Leone: Gender analysis of the 2012 cholera outbreak and an assessment of Oxfam's response. 2013: Oxfam GB. [intrnat]. Available from: Gender and Vulnerability to Cholera in Sierra Leone (alnap.org) [cited 2023 Jan 25].
- Bwire G, Munier A, Ouedraogo I, Heyerdahl L, Komakech H, Kagirita A, et al., Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015. PLoS Negl Trop Dis. 2017; 11(3):e0005407. doi: 10.1371/journal.pntd.0005407
- Hanan ZK. Molecular Detection of Cholera Infection during the Outbreak in Thi-Qar Province/Iraq in 2015-2016. J Phys Conf Ser. 2019. DOI: 10.1088/1742-6596/1279/1/012068
- Das S, Saha R, Kaur IR. Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi. Indian J Med Res. 2008; 127(5):478-2.
- Rijal N, Acharya J, Adhikari S, Upadhaya BP, Shakya G, Kansakar P, et al., Changing epidemiology and antimicrobial resistance in Vibrio cholerae: AMR surveillance findings (2006–2016) from Nepal. BMC Infect Dis. 2019; 19:801-9. doi.org/10.1186/s12879-019-4432-2
- Nateghizad H, Sajadi R, Shivaee A, Shirazi O, Sharifian M, Tadi DA, et al. Resistance of Vibrio cholera to antibiotics that inhibit cell wall synthesis: A systematic review and meta-analysis. Front Pharmacol. 2023; 14. https://doi.org/10.3389/fphar.2023.1027277.
- Ambrose SJ, Hall RM. dfrA trimethoprim resistance genes found in Gram-negative bacteria: compilation and unambiguous numbering. J Antimicrob Chemother. 2021; 76(11): 2748-56. DOI:10.1093/jac/dkab212
- Yuan Xh, Li Ym, Vaziri AZ, Kaviar VH, Jin Y, Jin Y, et al. Global status of antimicrobial resistance among environmental isolates of Vibrio cholerae O1/O139: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2022; 11(1):62. doi: 10.1186/s13756-022-01100-3
- Das B, Verma J, Kumar P, Ghosh A, Ramamurthy T. Antibiotic resistance in Vibrio cholerae: Understanding the ecology of resistance genes and mechanisms. Vaccine. 2020; 29(38 Suppl 1):A83-92. doi: 10.1016/j.vaccine.2019.06.031.