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Cholera Outbreak in Haiti

Jon Andrus
Deputy Director
Pan American Health Organization
25 October 2010

Good afternoon. Thank you for taking the time to come to this press briefing on Haiti.

Today the Ministry of Health Haiti, with support from partners like PAHO and the CDC, is reporting 3015 cases of cholera and 253 deaths. I would emphasize that you may hear different case counts circulating. What I am reporting is based the most recent information we have received from the Haitian Ministry of Health, which again is being supported by PAHO and the CDC.  

Testing is being done on specimens from the Nord and Sud departments, and five cases have been confirmed in the Ouest Department, where the capital of Port-au-Prince is located.

I should emphasize that we expect these numbers to continue to increase and to be reported from different areas of Haiti.

The data is a result of intensive efforts to build capacity in Haiti for early detection and to establish an Early Warning Surveillance System as part of the response to the earthquake on January 12th this year. The MOH is building on those efforts to further strengthen surveillance and reporting of cholera.

The official numbers almost certainly under-represent the "true" number of cases, because, in general terms, approximately 75 percent of the people infected with cholera do not exhibit any symptoms, yet they can carry the bacteria and shed them for up to two weeks days after infection back into the environment, especially where good sanitation facilities are lacking, potentially infecting other community members.
Of the one-in-four infected people who do develop symptoms, 80 percent have only mild or moderate symptoms. In the absence of treatment, about 20 percent develop acute watery diarrhea with severe dehydration, putting them at risk of death.
People with low immunity - such as malnourished children or people infected with the HIV virus - are at a greater risk of death if infected.

Because most people have less serious symptoms, effective treatment can be given outside hospitals and health facilities. For most, it involves administration of oral rehydration salts to replace lost fluids.
Severe cases require intravenous fluids to replace lost fluids, and antibiotics. We have learned from the CDC that this strain of the bacterium is susceptible to antibiotics.
To give some background, during the last epidemic in the Americas, which broke out in Peru in 1991, there were more than 500,000 cases reported over a two-year period, in a country that at the time had more than twice the population of Haiti (22.6 million vs. under 10 million). The case fatality rate in Peru remained less than 1 percent.
So as I said, we expect the numbers to rise. But the emphasis is on prevention by ensuring clean water and promoting good personal hygiene and food handling practices, including hand washing but also trying to prevent defecation in open areas.
Then if a person becomes infected, it is critical to ensure that effective treatment is available on a timely basis to minimize the number of deaths.
Another important thing in the case of cholera, is proper disposal of bodies. Body fluids from cadavers can be a source of contagion, so bodies need to be disposed of safely.

Just under half of reported deaths so far are taking place in hospitals, but more than half are in the community, so proper body disposal is definitely an issue, and PAHO is in the process of mobilizing experts in this area to travel to Haiti.

PAHO continues to mobilize international experts to Haiti and also to the Dominican Republic, in epidemiology, emergency management, water and sanitation engineering, risk communication, and case management.

PAHO's PROMESS warehouse is well stocked with oral rehydration salts, IV fluids, and antibiotics, and PAHO is currently conducting needs assessments to make sure it can procure additional needed supplies as more cases occur.

We are also supporting the Water & Sanitation Cluster in Haiti, providing powdered chlorine (including supplies from Brazil) for water purification and testing water that is being distributed to settlement camps.

We are also making special efforts to ensure clean water in hospitals.

PAHO's Caribbean Epidemiology Center (CAREC) located in Trinidad is helping Caribbean ministries of health to mobilize and be prepared for any potential cases in the other islands.

PAHO continues to coordinate these efforts with other UN agencies, and with health officials in the U.S. and Canada.

You will find updated information on PAHO's website at

I will stop there and answer any questions that you may have.

Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America
Tel.: +1 (202) 974-3000 Fax: +1 (202) 974-3663

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