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Haiti’s cholera outbreak could spread to neighbours

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6057 (Published 26 October 2010) Cite this as: BMJ 2010;341:c6057
  1. Sophie Arie
  1. 1London

Haiti’s cholera outbreak is likely to spread to neighbouring Dominican Republic and may reach the rest of the Americas, the Pan American Health Organization has warned.

“Now that cholera has established itself with a strong foothold in Haiti it’s probably clear to us that this will not go away for several years,” said the organisation’s deputy director, Jon Andrus, days after the first cases were reported.

“During the last epidemic in the Americas, which broke out in Peru in 1991, there were more than 500 000 cases reported over a two year period,” he said. From Argentina to Canada, almost every country in the Americas was affected, apart from some Caribbean islands, including Hispaniola, which is shared by Haiti and the Dominican Republic. Haiti has not seen cholera for more than a century.

The Pan American Health Organization and other international health organisations are working closely with the Haitian government to control the outbreak. After an initial surge of reported deaths—which reached 250 in the first few days—the number of new fatalities reported each day dropped significantly. The numbers infected continued to rise though, passing 3000 within days.

Health services were able to reduce the number of deaths by using oral rehydration salts, intravenous fluids, and water purification tablets stored in anticipation of such an outbreak after the January 2010 earthquake. And additional supplies and expertise arrived within days. Brazil has sent large supplies of powdered chlorine, and the strain seems to respond to antibiotics, said the US Centers for Disease Control and Prevention.

The largest problem for Haiti, which has no living experience of cholera, is to mount a nationwide education campaign among the population and in the medical profession.

In addition to providing medical supplies and assisting the sick, non-governmental organisations such as the International Medical Corps are training local health workers and even the Boy Scouts to identify new cases early and teach local populations about good health and hygiene practice to help reduce the spread of the disease.

Many people had been washing, playing, and drinking in the Artibonite river, the longest in Hispaniola, which is now thought to be contaminated. Many hospitals inundated with cholera patients lack proper waste management systems. And the disposal of bodies, which continue to carry the disease, is a problem, because cultural traditions mean that families sometimes keep bodies at home for days. About 46% of reported deaths in the first days had taken place in hospitals, but the other 54% were in the community, said the Pan American Health Organization.

A massive coordinated effort is under way to protect and prepare the camps in the capital, Port-au-Prince, where 1.3 million people have been living since their homes were destroyed in the earthquake.

Despite the grim conditions in the camps, aid agencies have installed good, well monitored water systems there. The city’s slums have much less well managed water supplies and could be a more fertile ground for cholera.

Notes

Cite this as: BMJ 2010;341:c6057

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