Health Professionals

Clinical Updates

4 November 2010 

Cholera outbreak: Haiti, Hispaniola – Update 1

This updates the Clinical Update 25 October 2010

Following recognition of cholera in Haiti on 21 October 2010, cases continue to be reported [1]. As of 4 November 2010 the Pan American Health Organization (PAHO) reported 6,742 cases and 442 deaths confirmed by Ministère de Santé Public et de la Population (MSPP), Haiti; cases have been registered in the departments of Artibonite, Centre, Nord, Nord-Est, Nord-Ouest [2, 3]. The strain has been confirmed as Vibrio cholerae serogroup O1, serotype Ogawa [4] and recommendations for appropriate management of cholera in Haiti have been published by PAHO [5].

Ministère de Santé Public et de la Population (MSPP), the World Health Organization (WHO)/PAHO, the United Nations (UN) and many NGOs are working together to provide medical care and stop the spread of disease. Supplies of rehydration salts, intravenous fluids and antibiotics are being distributed and cholera treatment centres are being established in affected areas [6].

As of 1 November, no cases of cholera had been reported from the neighbouring country of the Dominican Republic [7]. 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.

The hurricane season affects Hispaniola between June and November. Since 31 October 2010, health officials and humanitarian organisations in Haiti have been on alert as Tropical Storm/Hurricane Tomas is expected to strengthen and make landfall in the southwest of the country by 5 November [2, 3, 8]. 

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 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% [9]. 

Those travelling to Haiti 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 [9, 10].

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 4 November 2010]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=

view&id=4367&Itemid=1926

2. Pan American Health Organization. EOC Situation Report No. 10. Cholera Outbreak in Haiti. 3 November 2010. [Accessed 4 November]. Available at: http://new.paho.org/hq/index.php?option=com_

content&task=view&id=4404&Itemid=3487

3. United Nations for the Coordination of Humanitarian Affairs (OCHA). Haiti, Hurricane Tomas Preparations: Cholera. Situation report No.13. 3 November 2010. [Accessed 4 November 2010]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/JDUN-8AV8R7/$File/full_report.pdf

4. Centers for Disease Control and Prevention. Laboratory Test Results of Cholera Outbreak Strain in Haiti Announced.1 November 2010. [Accessed 4 November 2010]. Available at: http://www.cdc.gov/media/pressrel/2010/r101101.html

5. Pan American Health Organization. Epidemiological Alert: Cholera 28 October 2010. [Accessed 4 November 2010]. Available at: http://new.paho.org/hq/index2.php?option=com_docman&task

=doc_view&gid=10776&Itemid=1091

6. Pan American Health Organization. EOC Situation Report No. 9. Cholera Outbreak in Haiti. 1 November 2010. [Accessed 4 November]. Available at: http://new.paho.org/disasters/index.php?option=com_

docman&task=doc_view&gid=1374

7. International Society of Red Cross and Red Crescent Societies. Dominican Republic: Cholera Outbreak Prevention. DREF operation No. MDRDO002. 28 October 2010. [Accessed 4 November 2010]. Available at: http://www.reliefweb.int/rw/RWFiles2010.nsf/FilesByRWDoc

UnidFilename/EDIS-8ANPDM-full_report.pdf/$File/full_report.pdf

8. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Flash note: Hurricane Tomas 2 November 2010. [Accessed 4 November 2010]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/MCOI-8AUC2L/$File/full_report.pdf

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

10. 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: Advice for relief workers and other travellers to areas affected by natural disasters

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