Thousands Sicken, Hundreds Die (needlessly) in Haiti from (Suspect) Cholera

Cholera as a WMD; http://www.millennium-ark.net/News_Files/NBC/Bio.Bugs.Cholera.html

CHOLERA - HAITI: SUSPECTED, REQUEST FOR INFORMATION


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ProMED-mail is a program of the

International Society for Infectious Diseases





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[1]

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

said Thursday.



"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

within hours."



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.

--

Communicated by:

ProMED-mail





*****

[2]

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

cholera.



"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

announcement.



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

antibiotics.



The disease outbreak is the country's first since

January's 7.0 earthquake claimed more than

300,000 lives.



A spokeswoman with the United Nations Office for

the Coordination of Humanitarian Affairs said the

source of what's causing the problems is still

being investigated.



"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

analyze."



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

citizens.



"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

deaths."



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

hospital.



"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

residents.



"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

already sick."



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]

--

Communicated by:

ProMED-mail







*****

[3]

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)

Executive Director

Praecipio International





[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]



[See also:

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]

.................lm/mpp/lm

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