ECDC: Epidemiological Update On Cholera In Mexico

Cholera In The Americas 10/12 – 10/13 - Credit PAHO 

 

# 7848

 

 

According to a recent epidemiological alert, issued on October 1st, PAHO (the Pan American Health Organization) lists four nations in the Americas reporting cholera over the past 12 months. Of these, three have been battling this disease for some time; Cuba, Haiti, The Dominican Republic. While the fourth – Mexico – has only recently begun reporting locally acquired  cases. 

They write:

 

In  Mexico, the International Health Regulations (IHR) National Focal Point of Mexico reported 36 new confirmed cases of autochthonous infection with Vibrio cholerae O:1 Ogawa toxigenic in the state of Hidalgo. With the additional confirmed cholera cases, the national total is now 46, including one death; with two of the cases in the Federal District and 44 in the
state of Hidalgo. 

The cases are 24 women and 22 men with ages ranging from 2 to 82 years old. 

The Mexico health authorities continue to: strengthen epidemiological activities at the national level; ensure the availability of inputs and quality of care in medical units; implement actions to ensure access to drinking water and basic sanitation at the community level; and monitor and check the chlorine levels.

 

On October 5th, the CDC’s Traveler’s Health website posted a low-level advisory regarding the situation in Mexico (See Cholera in Mexico : Watch - Level 1, Practice Usual Precautions).

 

Today, the ECDC has posted an epidemiological update on the situation.

 

 

Epidemiological update: Cholera in Mexico

10 Oct 2013

​On 1 October, 46 confirmed cases of cholera, including one death, were reported by the Pan American Health Organization (PAHO) in Mexico. Of those, two were identified in the Federal District and 44 in the state of Hidalgo. However, media reports mention up to 81 confirmed cases: 77 in the state of Hidalgo, two in the state of Mexico and two in the Federal District, which is the most populated area of Mexico.

 

Of the cases where information was available, 44% are male and 56% are female, age ranging from two to 82 years old; 30% have been hospitalized.

 

This is the first sustained autochthonous transmission of cholera recorded since the 1991-2001 endemic period. These infections are caused by Vibrio cholerae O:1 Ogawa toxigenic. The strain is different from the one that circulated in Mexico during the 1991-2001. Genetic testing suggests this strain to be similar to the strain currently circulating in Haiti, Dominican Republic and Cuba.

 

Travellers to Mexico should be aware of preventive hygiene measures and seek advice from travel medicine clinics prior to their departure, to assess their personal risk. In addition, physicians in the European Union should consider the diagnosis of cholera in returning travellers from Mexico presenting with compatible symptoms. Upon diagnosis, notification to the relevant public health authorities is essential.

 

In Cuba, according to the same update, 678 confirmed cholera cases, including 3 deaths, have been reported from July 2012 through August 2013. The affected provinces are Camaguey, Granma, Guantanamo, Havana, and Santiago de Cuba. Twelve of the confirmed cases had travelled to Cuba from other countries (two from Chile, two from Germany, three from Italy, one from the Netherlands, two from Spain, and two from Venezuela). The overall risk for travellers is still considered low.

 

ECDC Rapid Risk Assessment: Outbreak of cholera in Cuba, potential risk for European travellers; 12 July 2012

Updated ECDC Risk assessment: Outbreak of cholera in Cuba, potential risk for European travelers, 17 January 2013

PAHO Epidemiological alert on 1 October 2013

 

State Dept: USIS Security Message On Cholera Reports In Cuba

 

 

# 7586

 

A story that Crof has been covering extensively over the past year (see Cuba: Cholera and dengue in Havana's Lisa municipality, Venezuela: 2 cholera cases imported from Cuba, Chile worries about importing cholera from Cuba) have been reports of cholera spreading in Eastern Cuba.

 

You’ll find some of my earlier (admittedly, less comprehensive) coverage in Fresh Reports Of Cholera In Cuba and Cuban MOH Confirms Cholera Outbreak.

 

Yesterday the United States State Department posted the following Warden Message.

 

U.S. Interests Section
Havana, Cuba

Security Message – Cholera Outbreak

August 20, 2013

This message is to inform U.S. citizens residing in or visiting Cuba that media reports have indicated
that cases of cholera have been identified in the city of Havana, possibly linked to a reported outbreak of cholera in eastern Cuba.

 

The Panamerican Health Organization (PAHO) issued an epidemiological alert noting the presence of cholera in Cuba and confirming that foreign travelers have contracted cholera during recent trips to Cuba.

 

Eating or drinking fecally contaminated food or water is the main risk factor.  Unsterilized water, food from street vendors, raw fish dishes (e.g. ceviche) and inadequately cooked (e.g. steamed) shellfish are common sources of infection.

 

We urge you to follow public health recommendations and guidelines, such as safe food and water precautions and frequent hand washing to help prevent cholera infection.  The Cuban Ministry of Public Health is urging people to comply with sanitary measures associated with personal hygiene, water and food.  The U.S. Centers for Disease Control (CDC) and World Health Organization both provide information about cholera to the travelling public.

 

U.S. citizens traveling abroad should regularly monitor the U.S. Department of State's, Bureau of Consular Affairs website, where the current Worldwide Caution, Travel Warnings, Travel Alerts, and Country Specific Information can be found.

 

The U.S. Interests Section also encourages U.S. citizens to review "A Safe Trip Abroad,” which includes valuable security information for those both living and traveling abroad.  Follow us on Twitter and the Bureau of Consular Affairs page on Facebook as well.

 

You can also download our free Smart Traveler iPhone App to have travel information at your fingertips.  In addition to information on the Internet, travelers may obtain up-to-date information on security conditions by calling 1-888-407-4747 toll-free in the United States and Canada, or outside the United States and Canada on a regular toll line at 1-202-501-4444.  These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

U.S. Interests Section 

Address:  Calzada  between L and M Streets, Vedado, Havana Telephone:  (53)(7)-839-4100

For after hours emergencies, please call the main switchboard at (+53)(7) 839-4100 and dial 1 to speak with the emergency operator.

Fresh Reports Of Cholera In Cuba

Photo Credit  Wikipedia

 

# 6769

 

 

In the beginning of July (see Media: Reports Of Cholera In Cuba) we began to get multiple reports of cholera in Cuba, reports that were at first denied - and then later confirmed - but played down by local and national officials.

 

While the source of that outbreak was not given, there was media speculation that it may have been imported by returning medical and humanitarian relief personnel who served in Haiti during their recent (and ongoing) cholera epidemic.

 

The CDC posted the following in their Travels’ notices, in August.

 

Outbreak Notice Cholera in Cuba

Updated: August 22, 2012

What Is the Current Situation?

The Cuban Ministry of Health has confirmed the first cholera outbreak in Cuba in more than a century. As of July 31, 2012, 236 confirmed cases and 3 deaths have been reported in the cities of Manzanillo, Bayamo, Yara, and Campechuela Niquero in Granma Province. Currently, cases are limited to Granma Province, mostly in Manzanillo. According to the Cuban Ministry of Public Health, control measures have been implemented, including public awareness campaigns and efforts to ensure safe drinking water and to improve environmental sanitation.

The Pan American Health Organization (PAHO) (PDF) is also closely monitoring this situation.

 

By the end of August, the Cuban government declared the outbreak over (see Global Post story).  A month later (see Havanna Times’ More Cholera in Eastern Cuba) Cuban officials once again acknowledged a small outbreak in the eastern province of Granma, where nine cases had been confirmed.

In November, after the passage of Hurricane Sandy, reports of fresh outbreaks of cholera began to emerge, such as this report in the Havana Times on November 22nd.

 

More Cholera Cases Reported in Eastern Cuba

November 22, 2012

HAVANA TIMES — The cholera epidemic has spread to the eastern provinces of Santiago de Cuba, Guantanamo and Holguin, with dozens of people hospitalized and some municipalities facing critical conditions, reports Hablemos Press.

 

Sources in the public health-care industry and residents in the east of the country have confirmed off-the-record the proliferation of the epidemic that has plagued Cuba since last June. They noted that the province of Guantanamo could be declared in quarantine.

(Continue . . . )

 

 

Officially, the Cuban government has remained silent regarding fresh cholera cases, and has said little about outbreaks of Dengue fever as well.  

 

Yesterday, the Miami Herald/El Nuevo Herald carried a long, eye-opening report, challenging the official Cuban silence on these issues.

 

Cuba stays silent about deadly cholera outbreak

It’s the disease that the government doesn’t acknowledge, because it might deter tourists from coming to the island.

Posted on Saturday, 12.08.12

Life on the island

(Excerpt)

Cuba, especially the eastern third of the island, is suffering through an alarming outbreak of cholera — as well as the mosquito-borne dengue fever — brewed in its decrepit water and sewer systems and fueled by Hurricane Sandy’s floods, according to residents.

 

More than a dozen deaths have been reliably reported. Hospitals and prisons have been quarantined at times. Schools have been shut down, and so have restaurants and street kiosks selling juices and other products made with water.

(Continue . . .)

 

 

Although the Cuban medical system is often highly praised, the island’s infrastructure – particularly potable water delivery and sewage treatment – are insufficient for their population, and are often reported to be in disrepair. 

 

Two factors that could help Cholera to remain an ongoing threat on the island for some time to come.

Cuban MOH Confirms Cholera Outbreak

 

Photo Credit  Wikipedia

 

# 6519

 

Although earlier reports have indicated that the Cuban government has had little to say about the outbreak of diarrhea  (suspected to be Cholera) in Manzanillo (see Media: Reports Of Cholera In Cuba), today a notice from the Cuban Ministry of Health appears in the official newspaper of the the Cuban Communist Party; Diario Granma.

 

According to this release, there have now been 3 deaths - and as many as 1,000 cases of diarrhea - which they are blaming on contaminated of local supply wells and a variety of (mostly unnamed) pathogens. 

 

In this report they state that 53 cases have been diagnosed as Vibrio cholerae.

 

The following is a machine translation of the announcement.

 

 

Briefing Note

The Ministry of Health reports that in recent weeks has been reported in some areas, an increasing trend of diarrheal diseases, which has been influenced by high temperatures and heavy rains.

 

One of the provinces with the highest incidence is recorded Granma, with a majority of cases the municipality of Manzanillo, where there was an outbreak of gastrointestinal infection, transmitted by water, from contamination of several local supply wells, it which has been reporting by the media that territory.

 

They have treated about 1 000 patients, which has positively affected the active screening conducted more than 98% of the population of the municipality.

 

In the total patients seen, different germs have been identified and indicating the diagnosis of Vibrio cholerae in 53 cases, including 3 deaths seniors, 95, 70 and 66 years old with a history of chronic illness, what is added gastrointestinal infection, so it continues in the research rigor to determine the actual cause of death in each.

 

This outbreak is controlled city of Manzanillo and the trend is to reduce cases as a result of sanitary measures and anti-epidemic being implemented, among which are the sampling of private wells and state with the closure of the contaminated water supply chlorinated by conductive pipes and to the affected areas, the removal of water leaks, pit cleaning and sanitation and health education program to the population. It has the resources necessary for adequate patient care in all health institutions.

 

People are encouraged to comply with sanitary measures associated with personal hygiene, water and food.

Ministry of Public Health
July 2, 2012
"Year 54 of the Revolution"

 

Credit goes to an AFP (Agence France-Presse) report Cuba cholera outbreak kills Three  that mentioned the publication of the MOH statement, which allowed me to track it down.

Media: Reports Of Cholera In Cuba

 

Photo Credit  Wikipedia

 

# 6413

 

My thanks to Pathfinder, Gert van der Hoek, and Alert on FluTrackers for picking up and posting early media reports of what appears to be an outbreak of Cholera in Manzanillo, Cuba.

 

Two representative reports, with the first appearing last Thursday in Café Fuerte, which gives 50 people hospitalized, and two dead from the outbreak.  

 

Dos muertos y 50 hospitalizados por cólera en el oriente de Cuba  Por Café Fuerte

 

A translation of the article yields:

 

Two dead and 50 hospitalized for cholera in eastern Cuba Posted on Thursday, June 28, 2012 17:59

By Calixto R. Martínez *

Manzanillo, Granma. - Two people died and more than 50 remain hospitalized in the town of Manzanillo, in eastern Cuba, where authorities decreed a quarantine at the Provincial Hospital Surgical Clinic "Celia Sanchez."

 

Police and State Security agents guard the medical center, according to testimony given by residents in the cities of Manzanillo and Bayamo.

 

Although the government maintained total silence and the news has not spread in official media, the medical situation seems rather complicated.

(Continue . . )

 

 

 

A similar report (albeit with more cases) appeared on Friday in the El Nuevo Herald, a Spanish language daily paper published in Miami by McClatchy (and sister paper to the Miami Herald).  This is a machine translation, hence the mangled syntax.

 

 

Cholera Outbreak in Cuba

Juan Carlos Chavez

jcchavez@elnuevoherald.com

At least two dead and more than a hundred people hospitalized has stopped a cholera outbreak in the Cuban city of Manzanillo, Granma province. The health emergency was presented to half of the deals this week in The fisheries and Around the drain. Cuban government officials have not spoken officially about the situation.

 

"We have suspended sales of liquid ambulatory and have said that police have closed several palates (restaurants) as a precautionary measure," said Roberto de Jesús Guerra, director of Let's Talk Press news agency, based in Havana.

 

(Continue . . .)

 

While the source of this outbreak is not yet known, there is some media speculation that it may have been imported by returning medical and humanitarian relief personnel who served in Haiti during their recent (and ongoing) cholera epidemic.