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News

17 November 2010

Cholera outbreak: Haiti and Dominican Republic, Hispaniola – Update 2

This updates the Clinical Update 4 November 2010

The outbreak of cholera in Haiti, first recognised in the Artibonite region on 21 October 2010, continues to escalate. As of 14 November 2010, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported 16,799 hospitalised cases and 1,034 deaths from cholera; cases have been confirmed by the Ministère de Santé Public et de la Population (MSPP), Haiti [1]. Cases and deaths have been reported from the departments of Artibonite, Centre, Nord, Nord-Est, Nord-Ouest, Ouest and Sud. As of 9 November, the first cases were reported in the capital, Port-au-Prince [2], where over 250 people have been admitted to hospital with severe diarrhoea and 10 deaths have been reported. The following communes of Port-au-Prince have reported increasing numbers of cases: Carrefour, Cite Soleil, Delmas, Kenscoff, Petion Ville and Tabarre [3].

In response to the epidemic, the MSPP has developed a national strategy to address health needs of the population, working with the World Health Organization (WHO)/PAHO, the United Nations (UN) and many NGOs to provide medical care in cholera treatment centres and to prevent the spread of disease [1, 4, 5].

The Northeast department of Haiti has confirmed cholera cases in Ouanaminte, Terrier Rouge, Trou du Nord, and Perche, all communities close to Dominican border [1]. On 17 November 2010, the first case of cholera to occur in Dominican Republic since the beginning of the outbreak in Haiti was confirmed by the Ministry of Public Health, Dominican Republic [6]. The case is presumed to have acquired the infection whilst working in Haiti.

Dominican Republic public health officials are closely monitoring the situation along the border and have issued advice on good hygiene and safe water practices to people residing and trading in border provinces [7].

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% [8]. 

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 [8, 9].

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. United Nations Office for the Coordination of Humanitarian Affairs. (OCHA). Haiti; Cholera Situation Report #18; 16 November 2010. [Accessed 17 November 2010]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/JDUN-8BA58R/$File/full_report.pdf

2. Pan American Health Organization. Cholera outbreak in Haiti. EOC Situation Report #13. 11 November 2010. [Accessed 15 November 2010]. Available at: http://new.paho.org/hq/index2.php?option=com_docman&

task=doc_view&gid=11040&Itemid=

3. Pan American Health Organization. Health Cluster Bulletin#2. 16 November 2010. [Accessed 17 November 2010]. Available at:

http://www.reliefweb.int/rw/rwb.nsf/db900sid/JDUN-8BA34F/$File/full_report.pdf

4. Pan American Health Organization. A clean water partnership in Haiti. http://new.paho.org/disasters/index.php?option=com_

content&task=view&id=1360&Itemid=906

5. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Cholera Inter-Sector Response Strategy for Haiti Nov. 2010 – Dec. 2011. 11 November 2010. [Accessed 15 November 2010]. Available at: http://reliefweb.int/rw/rwb.nsf/db900SID/MDCS-8B4K6A

6. Republica Dominicana. Ministerio de Salud Pública. Press Release. Public Health urged the public to be calm against cholera because the country is well prepared for eventuality [In Spanish]. 17 November 2010. [Accessed 17 November 2010]. Available at:

http://www.sespas.gov.do/Institucional/noticias_sespas_full.

asp?id_news=980

7. Republica Dominicana. Ministerio de Salud Pública. Press Release.  Authorities will step up efforts to maintain the free RD cholera patient clinical outcomes of Haitian origin and suspected cholera [In Spanish]. 15 November 2010. [Accessed 16 November 2010]. Available at: http://www.sespas.gov.do/Institucional/noticias_sespas_

full.asp?id_news=978

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

9. 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

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