# 5052
While the world’s attention has been (at least briefly) focused on the Cholera epidemic in Haiti, it is worth noting that there are other serious health threats affecting the residents of that beleaguered nation.
I’ve selected three that were around before the cholera outbreak began (but have been greatly exacerbated by last January’s earthquake) to highlight.
Earlier this week I mentioned the abstract book from this past week’s American Society of Tropical Medicine and Hygiene (ASTMH) 59th Annual Meeting. A search on the word `Haiti’ produced several studies on serious health problems endemic to that Caribbean nation.
A few excerpts from these abstracts along with some background. You can find the entire abstract book here.
The first, like cholera, involves a serious diarrhea producing waterborne contaminant; cryptosporidium.
Although rarely fatal in healthy individuals, `Crypto’ can be deadly for the very young, the very old, and those with compromised immune systems. Cohorts that are common in Haiti.
The CDC maintains a large Crypto Information Site.
Occasionally campers, swimmers, or those drawing water from untreated wells will contract Crypto here in the United States. The largest outbreak occurred in Milwaukee in 1993, when Cryptosporidium entered the public water supply (exactly how, remains a mystery), and sickened 400,000 people and killed more than 100 who were immunocompromised.
Cryptosporidium is chlorine resistant, making it particularly difficult to eliminate from water sources. The Milwaukee incident has led to increased water testing, and the use of ozone, filters, and other interventions across the nation to help make our water supply safer.
Measures that are pretty much unavailable for most of Haiti.
Crypto is spread via the fecal-oral route, and as the study below indicates, is abundant in water samples taken in Haiti.
#440 CRYPTOSPORIDIUM CONTAMINATION OF SURFACE AND WATER SUPPLIES IN HAITI
Philippe M. Brasseur, Ketty Balthazard-Accou, Patrice
Agnamey, Evens Emmanuel, Michel Vaillant, Christian RaccurtCryptosporidiosis is one of the most frequent causes of diarrhoea in Haiti. Transmission in children less than five years-old, HIV-infected individuals, and people living in low socio-economic conditions is frequently due to consumption of water or food contaminated by Cryptosporidium oocysts.
<SNIP>
In the district of Port-au-Prince, 24/37 (65%) of water samples collected were contaminated by Cryptosporidium oocysts and the number of oocysts per 100L ranged from 4 to 1,274.
In the reservoirs used by people living in peripheral
areas, 10/11 (91%) of samples collected were contaminated with a mean number of 140 oocysts per 100L. In water samples from public standpipes
provided by Camep, the public company of water distribution in Port-au-Prince, 7/13 (54%) were contaminated.
All surface water 4/4 collected in Port-au-Prince or in peripheral areas was highly contaminated. In Les Cayes 8/15 (53%) samples contained ryptosporidium oocysts and the number detected varied from 5 to 100 (mean 29) / 100 L of water filtered.
In conclusion, a commitment to environmental improvement in Port-au-Prince and in Les Cayes is required to improve the quality of drinking water
and to limit the risk of human transmission of cryptosporidiosis.
Another common tropical parasite, Malaria, is also endemic in Haiti – and with hundreds of thousands of post-earthquake displaced persons living in tents and under tarps, exposure to malaria (Anopheles) mosquitoes has increased.
Once again you’ll find a comprehensive Malaria information site at cdc.gov.
In the wake of the January earthquake, the CDC, Save the Children, and the Ministry of Public Health in Port-au-Prince conducted a malaria surveillance program to determine just how prevalent the infection was among refugees.
# 778 MALARIA SURVEILLANCE IN HAITI, POST-EARTHQUAKE, 2010
David A. Townes, Ribka Amsalu, Roc Magloire, Michelle Chang, Meredith McMorrow, S. Patrick Kachur
<SNIP>
Plasmodium falciparum malaria is endemic in Haiti where the principal vector is the Anopheles albimanus mosquito, which frequently bites outdoors. Thus, displaced persons living outdoors or in temporary shelters in Haiti are at substantial risk for malaria.
We conducted a survey of 1,629 consecutive suspected malaria patients presenting to medical clinics managed by Save the Children in the earthquake affected areas of Leogane and Jacmel from March 4 to April 9, 2010. Suspected malaria accounted for 3.0% of all consultations.
Females accounted for 59% of suspected malaria
consultations. A malaria rapid diagnostic test (RDT) was performed on 96% (1,564/1,629) of these patients with an overall positivity rate of 20.3% (317/1,564).
Among 341 children less than five years of age, 7.6% were RDT positive, 87.7% were RDT negative, and 4.7% had no RDT result recorded.
<SNIP>
Of the 317 patients with a positive RDT, 87.7% received chloroquine, 2.5% received quinine, and 9.8% had no anti-malarial documented.
Malaria is an important public health problem in Haiti post-earthquake with the potential for an increase in cases given the large number of displaced individuals and the onset of the rainy season. Continued malaria surveillance is essential to monitor prevalence, identify areas of potential increased transmission, detect epidemics should they occur, and help direct and monitor interventions and response.
A third surveillance study, again by Save The Children, indicates that ARIs (acute respiratory infections) constitute the most common health threat to children under the age of five in post-earthquake Haiti.
You may recall that earlier this week I highlighted the World Lung Foundation’s Acute Respiratory Infection Atlas, which details the global impact of ARI’s and in particular, childhood pneumonia.
Even in 2008, the death rate in children under 5 from pneumonia was more than twice that of neighboring Dominican Republic (72 vs. 33 per 100K).
# 1135 ACUTE RESPIRATORY INFECTION, MAIN CAUSE FOR MORBIDITY FOR CHILDREN 0-5 YEARS OF AGE, IN POST-ARTHQUAKE, HAITI, 2010
Ribka Amsalu Tessera
Save the Children , Wahington, DC, United States
<SNIP>
Disease surveillance is one of the key tasks of the medical team to prioritize health action and determine the occurrence of disease outbreaks. From January 31st - April 4th, 21 Mobile Medical team of Save the Children composed of medical doctors, midwife and nurses, had 52,761 consultations in Port-au-Prince and Jacmel, out of which 22% were due to Acute Respiratory Infections (ARIs).
ARI accounted for 48.4% of consultations among children 0-5yr of age, and 12.5% among those over the age of 5yrs. The total consultation due to ARIs was four fold higher than the total number of consultations due to diarrhea and suspected malaria among children 0-5yr of age.
The World Health Organization (WHO), estimates that prior to the earthquake pneumonia accounted for 20% of mortality among children in Haiti, much higher than diarrhea (16%) and malaria (1%).
Crowded leaving conditions, low vaccination coverage, and poor nutritional situation have exacerbated the risk for pneumonia among children in post-earthquake Haiti.
All of this means that once the furor and media attention over the cholera outbreak fades away, Haiti will still face huge public health and humanitarian challenges.
So if you can find a way to help support the relief efforts in Haiti through a donation to one of the reputable NGOs working on the ground there (ie. Red Cross, CARE.ORG, SAVE THE CHILDREN), I’m certain they - and the people of Haiti - will be grateful for your generosity.
