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3 December 2010

Cholera outbreak: Haiti and Dominican Republic, Hispaniola – Update 3

This updates the News Item 17 November 2010

The outbreak of cholera in Haiti, first recognised in the Artibonite region on 21 October 2010, has spread to new areas. As of 1 December 2010, the Pan American Health Organization (PAHO) reported 77,208 cases and 1,751 deaths from cholera, confirmed by the Ministère de Santé Public et de la Population (MSPP), Haiti [1]. Cases have spread to all ten departments in Haiti, with deaths in nine departments [1].

As of 27 November, the cumulative number of cases in the capital, Port-au-Prince was 10,542 with 164 deaths [2]. An interactive map showing the outbreak situation in Haiti is available on the PAHO website.

PAHO, the World Health Organization (WHO), the United Nations Office for Humanitarian Affairs and non-governmental organisations, in collaboration with the Haitian government, continue to work to meet the challenges posed by the outbreak by setting up treatment centres and organising educational initiatives in the refugee camps, schools and community centres [2].

In the Dominican Republic, as of 1 December 2010, the Ministry of Public Heath reported two imported cases of cholera and 11 locally acquired cases from the towns of Santo Domingo Este (six) and Santo Domingo Norte (one), in the province of Santo Domingo, and from Navarrete (three) and Jánico (one) in the province of Santiago [3]. A public health education programme, supported by national and international organisations including PAHO and WHO, commenced on 30 November 2010 [4].

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% [5]. 

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 [5, 6].

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 advising travellers returning from affected areas is available from the Health Protection Agency.

References

1. Pan American Health Organization. Epidemiological Alert: Update on the Cholera Situation. 1 December 2010. [Accessed 3 December 2010]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=

view&id=4509&Itemid=2206

2. Pan American Health Organisation (PAHO). Cholera outbreak in Haiti. Health Cluster Bulletin #6. 1 December 2010. [Accessed 3 December 2010]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=

view&id=4404&Itemid=3487

3. Ministerio De Salud Pública. República Dominicana. Cólera [in Spanish]. Boletin Especial No.10. 1 December 2010. [Accessed 3 December 2010]. Available at: http://sespas.gov.do/download/docs/Boletin/Boletin_Colera_

No.10.pdf

4. Pan American Health Organisation (PAHO). National Day of Education and Prevention of Cholera in the Dominican Republic. [Accessed 3 December 2010]. Available at: http://new.paho.org/hq/index.php?option=com_content&task=

view&id=4510&Itemid=1926

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

6. 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_digitalasse

ts/documents/digitalasset/dh_078541.pdf

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