News
9 May 2012
Cholera outbreak: Haiti and Dominican Republic, Hispaniola
This updates the Clinical Update 17 June 2011
The outbreak of cholera, first recognised in Haiti on 21 October 2010, which subsequently spread to Dominican Republic, is ongoing.
Haiti
As of 10 April 2012 the cumulative number of cholera cases since the beginning of the outbreak are 534,647 with 7,091 deaths [1]. Increasing case numbers associated with the start of the rainy season are reported from Artibonite, Nord-Ouest and Ouest departments. The majority of cases (144,478) were reported from the Port-au-Prince areas of Carrefour, Cité de Soleil, Delmas, Kenscoff, Petionville and Port-au-Prince); of these cases 121,921 were in children aged less than five years [1]. Rains are expected to continue to June; the risk of cholera transmission increases as a result of flooding and exposure to contaminated water. The Pan American Health Organization (PAHO) predict 200,000 additional cases in the country during 2012 [2].
Dominican Republic
As of 4 May 2012, the cumulative number of cholera cases since the beginning of the outbreak are 23,347 and 399 deaths [3].
In January 2012, the presidents of Haiti and Dominican Republic joined the PAHO, UNICEF and the US Centers for Disease Control and Prevention (CDC) in calling for major international investments to eliminate cholera from Hispaniola [4].
On 14 April 2012, it was announced that the Haitian government along with international partners, have launched a cholera vaccination campaign targeting 100,000 people [5].
Active epidemiological surveillance is ongoing [3].
Advice for travellers
The risk of cholera in travellers to Haiti and Dominican Republic is low. To date only two cases of cholera, associated with this outbreak, have been reported in England and Wales; these were in travellers who recently returned from the Dominican Republic [6, 7]. A confirmed case has also been reported in a 60-year old German woman who had travelled to Dominican Republic [8].
All travellers should practise food and water hygiene precautions. In particular, travellers should avoid the consumption of shellfish unless they are sure it has been thoroughly cooked.
Cholera vaccine is not routinely recommended for travellers, but may be considered for those at higher risk such as humanitarian aid workers and those who will have limited access to safe drinking water.
Advice for health professionals: returned travellers
Information for health professionals assessing travellers returned from cholera-affected areas including Haiti and Dominican Republic is available from the Health Protection Agency.
References
1. Republique d’Haiti. Ministere de la Sante Publique et de la Population (MSPP). Rapport de Cas du 10 Avril 2012. [In French] [Accessed 9 May 2012]. Available at: http://www.mspp.gouv.ht/site/index.php?option=com_
content&view=article&id=120&Itemid=1]
2. United Nations Office for the Co-ordination of Humanitarian Affairs (OCHA) Humanitarian Bulletin. Haiti.Issue 16. 2 April 2012 [Accessed 9 May 2012]. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/OCHA_
Haiti_Humanitarian_Bulletin_16.EN_.pdf
3. Pan American Health Organization. Epidemiological Alert: cholera. 4 May 2012. [Accessed 9 May 2012]. Available at: http://new.paho.org/hq/index.php?option=com_docman&task=
doc_view&gid=17567&Itemid=1091
4. Pan American Health Organization. Experts call for major investments in water and sanitation to end cholera in Haiti and the Dominican Republic. 12 January 2012. [Accessed 9 May 2012]. Available at: http://new.paho.org/blogs/haiti/?p=2182
5. Lancement du vaccine (Schancol) contre le choléra en Haiti. Rapport de la conferénce de presse de la ministre de la santé publique et de la population le Dr Florence D Guillame sur le lancement d’un vaccin contre choléra en Haiti. [In French] 11 April 2012. [Accessed 9 May 2012]. Available at: http://www.mspp.gouv.ht/site/downloads/ConfTrence_
6. Health Protection Agency. Cholera outbreak in Haiti and Dominican Republic (Hispaniola). Health Protection Report 2011: 5(24): news. [Accessed 9 May 2012]. Available at: http://www.hpa.org.uk/hpr/archives/2011/hpr2411.pdf
7. Travel and Migrant Health Section, Health Protection Agency. Personal communication, 2 May 2012.
8. European Centre for Disease Control and Prevention. Risk of travel associated cholera from the Dominican Republic, June 2011 [Accessed 9 May 2012]. Available at: http://ecdc.europa.eu/en/publications/Publications/110722_
TER_Risk_Assessment_Cholera.pdf
Links
PAHO Cholera in Disaster Situations
Foreign and Commonwealth Office: Dominican Republic
Foreign and Commonwealth Office: Haiti
NaTHNaC Health Information Sheet: Cholera
NaTHNaC Health Information Sheet: Prevention of food and water-borne disease
PAHO Atlas of cholera outbreak in La Hispaniola & cholera treatment facilities in Haiti 2010-2012
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