ABSTRACT
On 2 April 2008, the Ministry of Public Health [MOPH], Afghanistan reported an outbreak in Western Afghanistan, in the Gulran district of Herat Province. The outbreak presented as hepatic venoocclusive disease [VOD]. This outbreak started in November 2007. As of April 2008 a total of 175 cases, including 13 deaths were reported from more than 17 villages. The disease is believed to be caused by exposure to pyrrolizidine alkaloids [PAs]. Preliminary results of charmac samples from Gulran tested in the National Institute for Public Health and the Environment [RIVM] Laboratory, The Netherlands show high levels of PAs, mostly heliotrine and lasiocarpine. On 3 May 2008, WHO and MOPH visited the Gulran district headquarters of Qarabagh and the village of Zergy, the first village to report Gulran disease