Clinical Updates
25 October 2010
Cholera outbreak: Haiti, Hispaniola
On 21 October 2010, the Pan American Health Organization (PAHO) received confirmation of an outbreak of cholera in Haiti and initiated an emergency response [1]. On 22 October 2010, the Ministère de Santé Public et de la Population (MSPP), Haiti confirmed 1,526 cases and 138 deaths, from the departments of Arbonite and Centre, and declared a State of Emergency in Arbonite department [2, 3]. These areas were not affected by the devastating earthquake that struck Haiti on 12 January 2010.
As of 23 October, five cases had been reported from Ouest department (Port au Prince) [3]. Of these cases, four originated from Arbonite and one from Centre department. Additional suspected cases in Nord and Sud departments are under investigation. The worst affected areas are St. Marc (Bocozelle), Grande Saline, L’Estere, Marchand Dessalines, Desdunes, Petite Riviere, Lachapelle, and St Michel de l’Attalaye in Arbonite department.
The situation continues to evolve and as of 24 October 2010, the number of confirmed cases had increased to 3,015 including 253 deaths [4].
A coordinated international and national response, involving local health authorities, PAHO, the humanitarian community and United Nations forces that have been present since the earthquake of 12 January 2010, is underway [4]. The priority is to ensure that medical aid and sources of clean water reach the most vulnerable, including those displaced by the earthquake and who continue to live in refugee camps [3, 4]. Public health officials are also working to contain the spread of the disease, but it is expected that with the current high ambient temperatures and seasonal rainfall, the number of cases is likely to rise.
As of 24 October 2010, no cases of cholera had been reported from the neighboring country of the Dominican Republic. However, public health officials have issued advice on good hygiene and safe water practices to people residing and trading in border provinces and the country remains on high alert [5, 6].
Advice for travellers
This is the first appearance of cholera in the island of Hispaniola (Haiti and the Dominican Republic) in decades. At present it is not clear how the Vibrio cholerae bacteria have entered the population in Haiti. The current poor condition of health services and sanitation in Haiti, and the thousands of displaced persons secondary to the earthquake in January, present challenges to control the outbreak and deliver life-saving hydration to those affected by the disease. However, the local and international aid and medical communities have responded with a coordinated approach.
Cholera is transmitted through contaminated water or food in areas of poor sanitation. It can cause rapidly dehydrating diarrhoea that can be fatal in as many as 50% of cases when there is inadequate medical care. However, with prompt intervention with hydration, either by oral rehydration solutions in mild to moderate cases, or by intravenous therapy in severe cases, the case fatality should be less than 1% [7].
Those travelling to Haiti should practise food and water hygiene precautions. Cholera vaccine is recommended in this situation for those at higher risk: humanitarian aid workers and those who will have limited access to safe drinking water or medical care [7, 8].
UK travellers should consult the Foreign and Commonwealth Office (FCO) for advisories relating to travel to Haiti. Country-specific health advice can be found on the NaTHNaC Country Information Page. General advice can also be found in the NaTHNaC health information sheet: Advice for relief workers and other travellers to areas affected by natural disasters.
Those wishing to assist should contact appropriate aid and charity agencies for guidance on how best they can help. Travelling to an affected area independently and without adequate preparation may put a strain on the already challenged emergency and medical services in the area.
Advice for health professionals: returned travellers
Information for health professionals advising travellers returning from affected areas in Haiti is available from the Health Protection Agency.
References
1. Pan American Health Organization. PAHO responds to cholera outbreak in Haiti. 21 October 2010. [Accessed 25 October 2010]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=
2. Pan American Health Organization. EOC SITUATION REPORT No. 1. Cholera Outbreak in Haiti. 22 October 2010. [Accessed 25 October 2010]. Available at: http://www.reliefweb.int/rw/RWFiles2010.nsf/FilesByRW
DocUnidFilename/MUMA-8AH285-full_report.pdf/$File/full_report.pdf
3. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Situation Report No. 2. 23 October 2010. [Accessed 25 October 2010]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/MCOI-8AJC9F/$File/full_report.pdf
4. Pan American Health Organization. EOC SITUATION REPORT No. 3. Cholera Outbreak in Haiti. 24 October 2010. [Accessed 25 October 2010]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=
5. Pan American Health Organization. EOC SITUATION REPORT No. 2. Cholera Outbreak in Haiti. 23 October 2010. [Accessed 25 October 2010]. Available at: http://new.paho.org/disasters/index.php?option=com_
docman&task=doc_download&gid=1160
6. República Dominica. Centro de Informatión Gubernamental. El país prohíbe traer alimentos desde Haití [in Spanish]. [Accessed 25 October 2010]. Available at: http://www.cig.gob.do/app2/article.aspx?id=16667
7. Hill DR, Ford L, Lalloo DG. Oral cholera vaccines: use in clinical practice. Lancet Infect Dis 6:361-73, 2006.
8. Cholera. In Salisbury D, Ramsay M, Noakes K [eds]. Immunisation against infectious disease.2006. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_
digitalassets/documents/digitalasset/dh_078541.pdf
Links
Foreign and Commonwealth Office
NaTHNaC Health Information Sheet: Cholera
NaTHNaC Health Information Sheet: Prevention of food and water-borne disease
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