Health Professionals

Clinical Updates

11 January 2011

Cholera outbreak: Haiti, Dominican Republic, and USA (ex Haiti)

This updates the Clinical Update 3 December 2010

The outbreak of cholera first confirmed in Artibonite department Haiti, on 20 October 2010 continues. As of 1 January 2011, the Ministère de Santé Public et de la Population (MSPP) in Haiti reported 171,304 cases of cholera with 3,651 deaths [1]. There is evidence that the outbreak is stabilising in some departments including Artibonite, which has reported the greatest number of cases overall during the outbreak (52,465) [1, 2]. However, increased cases and mortality are being reported from other remote areas, particularly South, South East and Nippes departments. An interactive map showing the outbreak situation in Haiti is available on the Pan American Health Organization (PAHO) website.

In the Dominican Republic as of 28 December 2010, 131 cases have been laboratory confirmed with no deaths [1]. The provinces reporting the greatest number of cases are San Juan, Santiago, Elias Pina and Santo Domingo [3].

In Florida, United States, five cases of cholera have been confirmed in persons who became ill in Haiti or shortly after returning to the United States [4].

A recently convened expert committee has advised on the use of cholera vaccine in Haiti and the Dominican Republic as well as in other situations of complex emergencies [5]. They recommended that the stockpile of the oral cholera vaccine be expanded, and that a pilot study of implementation of vaccine be done in Haiti with existing supplies.

Advice for travellers

Cholera is transmitted through contaminated water or food in areas of poor sanitation. It can cause rapidly dehydrating diarrhoea that can be fatal in up to 50% of cases where medical care is inadequate. 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% [6]. 

Those travelling to Haiti and the Dominican Republic should practise food and water hygiene precautions. Cholera vaccine is recommended in this situation for those at higher risk, such as humanitarian aid workers and those who will have limited access to safe drinking water or medical care [6-8].

UK travellers should consult the Foreign and Commonwealth Office (FCO) for advisories relating to travel to Haiti and the Dominican Republic. 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 assessing travellers returning from affected areas is available from the Health Protection Agency.

References

1. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Haiti:  Cholera. Situation Report #31. 6 January 2011. [Accessed 11 January 2011]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/VDUX-8CVRBP/$File/full_report.pdf

2. Republique d’Haiti. Ministère de Santé Public et de la Population (MSPP). Rapport de Cas: Journalier et Cumulatif (donées preminaires). 1 Janvier 2011. (in French) [Accessed 11 January 2011]. Available at: http://www.mspp.gouv.ht/site/index.php?option=com_content&

view=article&id=57&Itemid=1

3. Pan American Health Organization. Epidemiological Alert: Weekly Update on the Cholera Situation. EW 51. 3 January 2011. [Accessed 11 January 2011]. Available at: http://new.paho.org/hq/index.php?option=com_

docman&task=doc_download&gid=11508&Itemid=2206

4. Centers for Disease Control and Prevention. Update on cholera – Haiti, Dominican Republic, and Florida, 2010. Morbid Mortal Wkly Rep. 59: 1637, 2010. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5950a1.

htm?s_cid=mm5950a1_w

5. Pan American Health Organization. Press Release. 17 December 2010.  [Accessed 11 January 2011]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=

view&id=4569&Itemid=1926

6. Hill DR, Ford L, Lalloo DG. Oral cholera vaccines: use in clinical practice. Lancet Infect Dis 6:361-73, 2006.

7. 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

8. Summary of Product Characteristics; Dukoral Oral Cholera Vaccine. Crucell 20 May 2010. Electronic Medicines Compendium. Available at:  http://www.medicines.org.uk/EMC/medicine/14463/SPC/

Dukoral+Oral+Cholera+Vaccine/#INDICATIONS

Links

Ministry of Public Health Dominican Republic: Health message for tourists

PAHO Cholera page

Foreign and Commonwealth Office

NaTHNaC Health Information Sheet: Cholera

NaTHNaC Health Information Sheet: Advice for relief workers and other travellers to areas affected by natural disasters

NaTHNaC Health Information Sheet: Prevention of food and water-borne disease

PAHO Recommendations for cholera clinical management