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Cholera Outbreak in Haiti

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  • The Pan American Health Organization said today that it has received laboratory confirmation of cases of cholera in Haiti, in Artibonite province, and is responding to help the Ministry of Health assess the situation and respond appropriately to save lives. So far, PAHO has been informed that more than 1,500 cases of severe diarrhea and at least 138 deaths have been reported in St. Marc, Grande Saline, and Mirebalais.

  • Link to video conference.

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

    An outbreak of cholera in the Artibonite region of Haiti has resulted in more than 1,500 cases and 138 deaths since Tuesday, according to reports received by the Pan American Health Organization or PAHO. These are preliminary figures and we expect them to change.

  • 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.

  • Press Briefing on Cholera Outbreak in Haiti

    Jon Kim Andrus, MD
    Deputy Director
    Pan American Health Organization
    27 October 2010

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

    Haiti's cholera epidemic continues to spread and produce more cases. As of this morning, the Ministry of Health is reporting 4,147 cases of cholera and 292 deaths. Departments reporting cases include: Arbonite, Central, Ouest. Suspect cases are also being investigated in Nord, Nordouest, and Nordest.

    As I emphasized in Monday's press conference, you will hear different numbers from different sources, but these numbers are the latest data from the Haitian Ministry of Health as of this morning.

    Today I would like to focus my remarks on the national strategy that will guide actions by Haiti's Ministry of Health and its partners in responding to the cholera epidemic.

    The Ministry of Health presented this strategy to all its international partners in Haiti, including members of the UN Health Cluster. It was developed in close collaboration with PAHO and other UN agencies as well as major nongovernmental and bilateral partners.

    The strategy prioritizes measures to protect families at the community level. strengthen primary health care centers already operating across the nation, and establish a network of special Cholera Treatment Centers and designated hospitals for treatment for severe cases.

    In summary, the strategy is aimed at minimizing the number of cases, and for those who are already infected, providing treatment to minimize the number of deaths.

    To provide protection for families, health officials and partners are continuing to distribute oral rehydration salts-these life-saving salts--directly in communities. These have been developed and used over the last decades to save millions of children's lives around the world.

    This simple treatment can be administered at home and is usually adequate to treat and prevent complications for about 80 percent of cases.

    The strategy also calls for disseminating messages over the radio and TV, via community health workers and leaders, and over loudspeakers mounted on trucks and other vehicles.

    These community-based messages encourage hand washing and sanitation measures such as proper management of human feces and garbage, purification of drinking water by boiling or using chlorination tablets, and eating only cooked foods or peeled foods.

    The messages also describe how to prepare oral rehydration salts and how to care for cholera patients safely in the home and when to take them to a health facility.

    The Ministry of Health is also sending community health aides into poor and densely populated areas, including temporary settlement areas that were created after the earthquake, to actively seek out and refer the sickest people to the Cholera Treatment Centers, while at the same time giving them a first dose of oral rehydration salts.

    They will also supervise measures in the local communities and neighborhoods to ensure clean drinking water and that proper waste disposal and maintenance of latrines is being done.

    More than 60 community health aides are in the process of being deployed to the temporary settlement camps that were set up after the earthquake.

    The community health aides are intended to support and complement the many Red Cross community health aides that are already working in the country on the ground.

    The Ministry also will be establishing a network of community health posts, with the idea of having 1 post for every 25 families, that will have the capacity to  treat diarrhea.

    The overall strategy is aimed to strengthen primary health care centers across the country with 24/7 coverage, and to build new structures in addition to 33 designated hospitals nationwide that will serve as Cholera Treatment Centers for the most severe cases.

    Assessments have already been done in 8 hospitals to determine what they need in support of this action.

    To support the Ministry of Health's planning efforts-and also the Dominican Republic's contingency planning-PAHO has been working with the Centers for Disease Control and Prevention (CDC) to develop projections of cases, estimates of cases, based on different modeling scenarios.

    Those estimates will help with planning efforts. It is impossible, however, to predict the course of the epidemic, even with the best modeling.

    PAHO and CDC experts are also working together on improved surveillance and reporting of cases, analysis of water samples from rivers and other water sources, monitoring of antibiotic resistance, and development of clinical management guidelines, for example, how to treat adults, children and pregnant women.

    You will find updated information on PAHO's website at

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

  • Dr. Jon AndrusTranscript of the press conference conducted by Dr. Jon Andrus, Deputy Director of the Pan American Health Organization on 2 November 2010: "As expected, the number of cases of cholera and deaths are continuing to increase in Haiti. The latest figures from the Ministry of Health show more than 4,700 cases and 337 deaths."

  • Dr. Jon AndrusTranscript of the press conference conducted by Dr. Jon Andrus, Deputy Director of the Pan American Health Organization on 9 November 2010: "We have every reason to expect that the widespread flooding has increased the risk of cholera spreading. The effects of this could become apparent through an upsurge of cases over the coming days."

  • {mosMiniYT}CMfolwzzwUw,l,Watch video{/mosMiniYT}Transcript of the press conference conducted by Dr. Jon Andrus, Deputy Director of the Pan American Health Organization on 23 November 2010.

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