#17,059
In January of 2010 Haiti suffered a 7.0 Earthquake which killed - by some estimates - more than 200,000 people. Ten months later, Haiti was embroiled in their first Cholera epidemic in more than 100 years, likely inadvertently imported by Nepali UN peacekeepers who arrived shortly before the outbreak began.
A December 2010 MMWR described the outbreak:
December 8, 2010 / 59(Dispatch);1-5
The first cholera outbreak in Haiti in at least a century was confirmed by the Haitian National Public Health Laboratory on October 21, 2010 (1). Surveillance data through December 3, provided by the Haitian Ministry of Public Health and Population (MSPP), indicated that the outbreak had spread nationwide and that cases of cholera and cholera-associated hospitalizations and deaths had climbed rapidly in November. As of December 3, MSPP reported 91,770 cases of cholera from all 10 departments and the capital city of Port-au-Prince; 43,243 (47.1%) patients had been hospitalized, and 2,071 (2.3%) had died.
A rapid mortality assessment in Artibonite Department found that deaths occurred as rapidly as 2 hours after symptom onset and identified important gaps in access to life-saving treatments, including oral rehydration solution (ORS). Urgent activities are under way, and additional efforts are imperative to reduce cholera mortality by expanding access to cholera treatment and to reduce cholera transmission by improving access to safe water and adequate sanitation.
As the chart at the top of this blog illustrates, Haiti's Cholera epidemic peaked in 2011 (with 350,000 cases), and declined slowly over the next 7 years. The last Cholera case was reported in January of 2019 - at least - until now.
Four days ago PAHO issued a Statement on the recent detection of Cholera in Haiti, citing 2 confirmed, and 20 suspected cases with 7 deaths.
Cholera Haiti - Risk assessment
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After more than three years with no cases of cholera reported in Haiti, on 2 October 2022, the national authorities reported two confirmed cases of Vibrio cholerae O1 in the greater Port-au-Prince area. Clusters of suspected cases and deaths are under investigation in various communes of Ouest Department. In epidemiological week (EW) 39 of 2022 (ending 2 October), healthcare facilities reported an increase in cases of severe acute diarrhea among hospitalized patients, including both children and adults. As of 2 October, more than 20 suspected cases of cholera, including seven fatalities, were detected by healthcare personnel.
Haiti has been experiencing a security crisis due to violence from armed gangs in Port-au-Prince and other cities which has exacerbated the humanitarian crisis in the country. The current vulnerabilities include malnutrition, internally displaced persons (IDPs), non-functional structures, limited or lack of access to health services, fuel shortages, limited access to safe water and poor sanitation and hygiene facilities, amongst others. These factors would have an impact on the dynamics of the cholera resurgence and on the severity of the disease in patients with acute diarrhea. Access to the affected areas is difficult and therefore, timely assessment of the epidemiological situation and provision of health care for cases is complex.
A gang crisis has driven more than 20,000 people from their homes, an economic crisis has led to soaring food prices and a black market for fuel and — as these trials play out — political stakeholders struggle to find common ground and define a path towards elections. On 18 September, one of the largest alliances of criminal gangs in Port-au-Prince blocked the Varreux fuel terminal, and the continuing state of siege has cut the capital off from its primary source of fuel.
12 October 2022
Situation at a glance
After more than 3 years with no reported cases of cholera in Haiti, on 2 October 2022, the national authorities reported two confirmed cases of Vibrio cholerae O1 in the greater Port-au-Prince area.
The current cholera outbreak is taking place in Port-au-Prince and Cité Soleil. These are areas that are experiencing civil unrest with several thousand people having been displaced as a result of the increase in violence.
Description of the cases
Between 25 September and 8 October 2022, the Haiti Ministry of Public Health and Population (MSPP per its acronym in French) reported 32 laboratory-confirmed cases of Vibrio cholerae (including two identified as serogroup O1), and 224 suspected cases from Port-au-Prince and Cité Soleil. A total of 189 cases have been hospitalized, of which 16 deaths have been reported. Of the total reported cases, 55% are males and 49% are aged 19 years or younger. The most affected age group is 1 to 4-year-olds (Figure 3).
(SNIP)
WHO risk assessment
The current cholera outbreak in Haiti, combined with the ongoing crisis related to gang violence, social unrest, and insecurity, has strained the health system’s response capacity. In addition, the country is highly vulnerable and at risk of natural hazards, which have exacerbated previous humanitarian crises.
The overall risk assessed for this outbreak is very high at the national level, due to the following reasons:
- The current socio-economic situation, ongoing humanitarian crisis and poor health conditions are affecting a large proportion of the population leaving them vulnerable to the risk of cholera infection and recurrence of cholera.
- In the affected areas of Port-au-Prince metropolitan area and southern departments, there are 24 200 internally displaced people who have been displaced due to gang violence.
- Limited access of the general population to safe drinking water and to sanitation facilities.
- Due to the insecurity, the public health system and international partners have limited human resources in Haiti, reducing the capacity to respond.
- Logistics issues and lack of access to fuel and insecurity lead to difficulties to import supplies and challenges to access the affected areas. Therefore, timely assessment of the epidemiological situation is complex. Additionally, for the same reasons the shipment of biological samples from healthcare facilities to reference laboratories could also be hampered.
The risk at the regional level is assessed as moderate, due to the following reasons:
- Since 2010, confirmed cases of cholera have predominantly been reported from Haiti, followed by the Dominican Republic, Cuba, and Mexico.
- Sporadic imported cases have also been reported in other countries in the Region. However, there is greater capacity in other countries to detect and control outbreaks of cholera. Neighboring Dominican Republic which is likely the most at risk of an increase in cases, has the capacity to detect and control cholera.
The risk at the global level was assessed as low.
WHO will continue to evaluate the epidemiological situation in Haiti.
While most countries with modern water treatment and sanitation facilities only have to deal with imported cases, Cholera still claims tens of thousands of lives each year in the developing world. This summary from the WHO:
CholeraUnless and until the security situation in Haiti can be improved, the conditions conducive to Cholera's spread are unlikely to change in that beleaguered Caribbean nation.
30 March 2022
Key facts
- Most of those infected will have no or mild symptoms and can be successfully treated with oral rehydration solution.
- A global strategy on cholera control, Ending Cholera: a global roadmap to 2030, with a target to reduce cholera deaths by 90% was launched in 2017.
- Researchers have estimated that each year there are 1.3 to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to cholera (1)
- Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
- Provision of safe water and sanitation is critical to prevent and control the transmission of cholera and other waterborne diseases.
- Severe cases will need rapid treatment with intravenous fluids and antibiotics.
- Oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.
