CHOLERA - HAITI: SUSPECTED, REQUEST FOR INFORMATION
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International Society for Infectious Diseases
Date: 21 Oct
Source: AFP [edited]
Cholera outbreak behind Haiti deaths: health official
An outbreak of cholera was to blame for dozens of
deaths in Haiti in recent days, a health official
"The first results from the lab tests show that
there is cholera, but we don't know which type,"
an official from the public health ministry told
AFP, asking to remain anonymous.
"The government and the health authorities are
meeting at the moment and an announcement will be
made," he added.
Health officials said earlier that at least 50
people had died from acute diarrhea and hundreds
were being treated in local hospitals as
laboratory tests were carried out to determine
the cause of the illness.
The outbreak of illness was outside the capital,
which was ravaged by a devastating 7.0 earthquake
in January, leaving more than 250,000 people dead
and another 1.2 million homeless.
Cholera is transmitted by water but also by food
that has been in contact with unclean water
contaminated with by cholera bacteria.
It causes serious diarrhea and vomiting, leading
to dehydration. With a short incubation period,
it can be fatal if not treated in time.
The World Health Organization says on its website
that "cholera is an extremely virulent disease.
It affects both children and adults and can kill
Aid agencies have voiced fears for months that
any outbreak of disease could spread rapidly in
Haiti due to the unsanitary conditions in the
makeshift camps housing the homeless, with little
access to clean water.
The impoverished Caribbean nation has also been
hit in recent days by severe flooding, adding to
the misery of those struggling to survive in the
scores of tent cities now dotting the country.
Date: 21 Oct 2010
Source: Miami Herald [edited]
Cholera blamed in deaths of more than 100 in Haiti
Haitian health officials are blaming the deaths
of more than 100 people suffering from acute
diarrhea and dehydration on an outbreak of
"For sure it is that," said a Ministry of Health
official, who asked not to be identified because
the government had yet to make an official
At least 1,000 people had been hospitalized in
the lower Artibonite region in recent days, with
the main hospital in St. Marc filled to capacity.
The conclusion of cholera was supported by
diplomats at one foreign embassy. A report
obtained by The Miami Herald stated that foreign
health experts working with the Haitian
government to identify the problem were "99
percent sure it is cholera" that caused severe
diarrhea and vomiting in St. Marc, Mirebalais,
Drouin and Marchand Dessalines. On Thursday,
Haitian health specialists along with the Centers
for Disease Control and Prevention in Atlanta
continued to investigate the source of the
outbreak while the government trucked in
thousands of gallons of water.
South Florida-based Food for the Poor also
announced that it was shipping in antibiotic,
oral dehydration salts, water filtration units
and other critically needed supplies to several
cities and rural villages near the outbreak. So
far, it had not reached Gonaives, the largest
city in the Artibonite region.
The U.S. Embassy warned U.S. citizens that they
should only drink bottled water, avoid
undercooked or raw seafood and ``seek medical
assistance if you develop acute, water
diarrhea,'' it said.
Cholera is a contagious bacterial disease that
affects the intestinal system. Symptoms include
severe vomiting, diarrhea and dehydration. It can
cause death within four to 12 hours after
symptoms begin if untreated. Spread through
consumption of infected food and water, or feces,
the disease is treated with fluids and
The disease outbreak is the country's first since
January's 7.0 earthquake claimed more than
A spokeswoman with the United Nations Office for
the Coordination of Humanitarian Affairs said the
source of what's causing the problems is still
"We have not received any confirmation on what is
causing an increase of diarrhea in the lower
Artibonite region," Jessica Duplessi, a
spokeswoman with OCHA said. "There has been an
increase in cases of severe vomiting and
diarrhea, which in particular is quite an
epidemic in Haiti. We still don't know if it's
coming from one central source or not. That is
what the doctors and experts are trying to
The Pan American Health Organization also warned
against concluding too soon that cholera was the
source of the outbreak.
"We just need confirmation of further
investigation before we change the labeling and
we have a precise diagnosis of the underlying
cause," said Dr. Michel Thieren, senior program
management officer with the PAHO Haiti Office.
"No one can say for sure. We are assisting with
all sorts of rumors."
He said PAHO officials and the ministry of health
officials sent an evaluation mission to the area,
and are awaiting the results of tests.
He said the joint PAHO/Ministry of Health
evaluation mission received reports of 1,526
cases and 138 deaths of unconfirmed severe
diarrhea. The numbers he said must be
investigated and remain "very questionable."
The reports spurred interest among some of
Haiti's candidates in the Nov. 28 presidential
and legislative elections. Both presidential
hopefuls Jude Célestin and Charles Henri Baker
spent the day visiting rural communities impacted
by the outbreak and said they went as concerned
"Every courtyard has at least three to four
deaths," Célestin said in a statement, noting
that he first heard the news Wednesday and
traveled to the communities early Thursday
morning. "People told us they had their kids
dying and they did not know what it was. They
said the deaths came after the rain. In Drouin,
the chief doctor told us they had more than 50
Baker said he was on a campaign tour in the
region when he heard the news. He described a
scene of people being laid out onto sidewalks,
and children dying in the back of one of his
campaign pickup trucks before it even reached the
"It's bad, Baker told The Herald by telephone,
describing the emaciated look of people in the
rural towns of Bac d'Aquin and Danash. ``They
were just putting people on the side of the road.
They look like skeletons.''
Baker said he was told that between 60 and 70
people had died from dehydration and diarrhea. In
one town, he saw only one ambulance, and left one
of the campaign trucks to transport sick
"I don't even feel like campaigning anymore. It's
unbelievable when they tell you the number of
people who are sick," he said, describing the
problem as "pretty widespread at the moment."
"I don't see anybody really taking charge . . .
The government needs to be here, take some
samples, run some tests and see if it is the
water. We need confirmation, not hearsay. The
urgency is to save the lives of those who are
On Wednesday, the National Palace ordered at
least 4,000 gallons of water, and the Center
National des Equipments (CNE), which Célestin
formerly headed, ordered up 6,000 gallons of
water. The deliveries continued Thursday with
thousands more gallons of water delivered in.
[Byline: Jacqueline Charles]
Date: Thu, 21 Oct 2010 18:06:56 -0500
From: James Wilson
We have indications of an infectious disease
event in Haiti (Artibonite Valley) rated now at a
possible IDIS Category 4 infectious disease event
transitioning to a Category 5, defined as:
IDIS Category 4. Infectious disease event
associated with social disruption. Category
4 events highlight when organized response
has occurred, yet significant social disruption
has been documented.
IDIS Category 5. Infectious disease event associated with disaster indicators.
Key observations as of the date/time of this message:
-Non-routine occurrence of diarrheal disease,
described by Dr. Claude Surena, President of the
Haitian Medical Association, as "according to the
results of the analysis carried out in the
laboratory it is cholera" to AFP
-We note, however, that true laboratory-confirmed
cholera has not been reported since the early
1990s [probably earlier - Mod.LM] and thus are
skeptical of etiology being true cholera
1500 cases reported with 135 fatalities, rapid
disease onset noted along with high pediatric
case counts reported
-Photographs and direct observations from St
Nicholas Hospital in St Marc and comments from
Dr. Surena indicate the hospital is overwhelmed
and now in the process of divesting patients to
other clinics for treatment- indicative /
suggestive of local medical capacity collapse;
photographs show multiple patients on IV therapy
-ORS is being used and is being mobilized.
PROMESS aware, however logistics status unknown.
-Local infrastructure to respond in Artibonite is
severely limited, with evidence of poor
information sharing and alerting capacity.
Public health resources are much more limited
than in Port-au-Prince
-Significant community anxiety noted; indigenous
Haitians claiming the presence of "cholera" and
surging advice via Twitter for proper food and
water handling / sanitation precautions
-International NGOs are mobilizing, and the UN
Clusters are mobilizing around the issue such as
WASH and Health.
-Statements to-date/time from WHO/PAHO and MSPP
emphasize no laboratory confirmation
-Tremendous and abrupt international
sensitization as evidenced by Twitter and HEAS
web portal hit counts
We wish to emphasize the purpose of Infectious
Disease Impact Scale (IDIS) is a heuristic
mechanism to contextualize emerging indicators
pertaining to possible infectious disease
events possibly evolving to crises and perhaps
disasters. Therefore, while we are confident the
event is a true diarrheal disease event, we are
unable to verify if it is truly due to cholera or
that it is truly a Category 4-5 event at this
time. What we are implying is immediate closer
scrutiny and verification is required. Haiti is
currently in the major rainy season, which is
expected to persist through November.
We eagerly await clarity from WHO/PAHO or MSPP.
James M. Wilson V, M.D.
Haiti Epidemic Advisory System (HEAS)
[Cholera entered the Americas region in 1991 with
the initial outbreak starting in Peru (speculated
to be related to a Chinese freighter dumping it's
bilge close to the shore line as it travelled
northward in the country). Checking the table on
the PAHO website
during the period 1991 and 2006 most countries in
continental Latin America were affected at one
point or another with cholera cases (Mexico,
Central America and South America), whereas no
cases were officially reported from the Caribbean
Islands, including Hispanola.
The most recent documented cholera transmission
was in Apr 2009 when there was an outbreak in
indigenous communities in Paraguay
I would not be surprised if there was a cholera
outbreak in Haiti. A 9 percent CFR would not be
surprising for the beginning of such an outbreak
before the supply network is geared up for
distribution of water and ORS, and IV solutions
where needed. (Nigeria reports a 10-14% CFR for
example, although in Peru in 1991 there was a
less than 1% CFR as the country's logistic system
was phenomenal). - Mod.MPP]
[The occurrence of acute watery diarrhea with
many fatalities among adults is indeed suggestive
of cholera. However cholera has not been seen in
Haiti or elsewhere in the Caribbean for many
years and it is difficult to understand how it
could be introduced (food? relief workers?) at
this time. However, laboratory detection of
_Vibrio cholerae_ is not difficult and numerous
media reports (though no official reports) are
now indicating that this has occurred.
Certainly conditions are ripe for the spread of
cholera in Haiti if and when it is introduced,
compounding an already desperate situation.
ProMED awaits further information and
confirmation of the etiology or etiologies, along
with serotype and other details. - Mod.LM]
Cholera, diarrhea & dysentery update 2010 (24) 20100914.3324
Cholera, diarrhea & dysentery update 2010 (23) 20100910.3277
Cholera, diarrhea & dysentery update 2010 (22) 20100907.3222
Disease situation, post-earthquake - Haiti 20100207.0411
Disease situation, post-earthquake - Haiti (02) 20100307.0750]
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