Cholera cases in Haiti double

Lisa Schnirring

Oct 25, 2010 (CIDRAP News) Global health officials responding to a quickly spreading cholera outbreak in Haiti say cases in the past few days have doubled, to 3,015, while deaths are up by about 100, to 253.

The figures were published yesterday by the Pan American Health Organization (PAHO), which also reported that the disease is reaching new parts of the country.

CIDRAP News reported Oct 22 that 1,500 cases and more than 150 deaths had been attributed to cholera at that point. The outbreak started in Haitian earthquake refugee settlements, which often have poor sanitation, in the country's rural Artibonite department.

At a media briefing today, Dr Jon Andrus, PAHO deputy director, told reporters that PAHO is coordinating the response and that several teams arrived over the weekend. He said his group is conducting a needs assessment and international partners are supporting the distribution of clean water and powered chlorine.

He said a PAHO warehouse near the capital is well stocked with rehydration supplies and antibiotics, which are essential for treating the waterborne bacterial disease that typically causes severe watery diarrhea that often leads to dehydration and death.

The PAHO update said the highest numbers of hospitalizations were reported on Oct 21 and 22, with about 46% of deaths occurring in healthcare facilities. It said 12 cholera treatment centers are being built to help handle the surge in cases, six in Artibonite, one in neighboring Central department, and five in Port-au-Prince.

Andrus said that although scientists haven't identified the genetic sequence of the newest cases in other parts of the country, health officials assume the cholera outbreak is spreading. Health officials fear that the disease could spread across Haiti's porous border with the Dominican Republic, the other country on the Caribbean island of Hispaniola, Andrus said. "It [the response] should be an islandwide approach."

Haiti has not had a cholera outbreak in about a century, and Andrus said health officials were surprised in 1991 when a South American epidemic of the disease bypassed Hispaniola and other Caribbean locations as it reached as far as New York and Montreal with isolated cases.

"A strong cholera foothold in Haiti makes it clear to us that this won't go away for several years," Andrus warned. "The bacteria are well established in the environment, and we need to plan that way."

Andrus said the main contamination sources are water, food, and dead bodies. Certain cultural practices, such as keeping bodies in the home during funeral rituals, can increase the risk of exposure, and he said proper handling of dead bodies is one key to slowing the spread of cholera.

He said person-to-person contact, which could occur during intimate contact, isn't a strong predictor of cholera transmission.

CDC response
In a related development, the US Centers for Disease Control and Prevention (CDC) on Oct 23 updated its information on travel for Haiti but did not change its current advisory against all nonessential travel to the area.

The CDC said the hardest hit Artibonite area is 50 miles north of Port-au-Prince and that hospitals in the affected hospitals are strained by large numbers of sick people. It said the outbreak is further burdening the country's public health infrastructure, which is already struggling from the effects of the January earthquake and recent flooding.

It said though most travelers aren't at high risk for getting cholera, people traveling to outbreak areas should consider taking along a supply of antibiotics, follow food and water precautions, seek prompt medical care for diarrhea, and consider getting medical evacuation insurance due to the current strain on Haitian medical facilities.

In an e-mail notice to journalists today, the CDC said it is helping Haiti's health ministry assess treatment supplies, illness management, and prevention measures as part of a broader US government response led by the State Department's US Agency for International Development (USAID).

Cases in Pakistan, Africa
Elsewhere, Pakistan's health ministry has confirmed 99 cholera cases from the beginning of flooding in the country through late September, the WHO reported today. The cases have been reported from a wide area of flood-stricken provinces of Sindh, Punjab, and Pakhtunkhwa.

Pakistan's health ministry, the WHO, and local and international partners are collaborating closely to treat suspected cases and prevent outbreaks. The WHO said more than 60 diarrhea treatment centers are either operational or will soon open in 46 of the country's districts that are most affected by cholera.

Earlier this month the WHO reported that unusually high cholera activity was affecting Central African countries, sickening about 40,468 people and killing 1,879. The total included cases and deaths from Cameroon, Chad, Niger, and Nigeria. The WHO said in an Oct 8 statement that though cholera is endemic in the areas and small outbreaks are common, flooding, poor hygiene, and population movements were contributing to the increased disease activity.