IHR/Epidemic Alert and Response and Water Borne Diseases
Focus is on timely treatment and prevention through clean water, improved hygiene
Washington, D.C., October 25, 2010 (PAHO) — Cholera cases in Haiti are likely to increase in number and to appear in new areas of the country, a top Pan American Health Organization (PAHO) official said today in a press briefing about the cholera epidemic in Haiti.
The most recent reports from Haiti’s Ministry of Health indicate 3,015 cases of cholera and 253 deaths. Suspected cases are being investigated in the North and South departments, and five cases have been confirmed in the West Department, where the capital, Port-au-Prince is located.
However, these numbers “almost certainly under-represent the true number of cases,” said PAHO’s Deputy Director, Dr. Jon K. Andrus.
This is because, in general, some 75 percent of people infected with cholera do not show symptoms. However, they can shed the bacteria back into the environment for up to two weeks after infection, potentially infecting others. The risk is especially high in places where good sanitation is lacking, as in many parts of Haiti.
PAHO is supporting the Haitian Ministry of Health in carrying out prevention efforts, providing powdered chlorine for water treatment and testing water quality as well as supporting efforts to promote improved personal hygiene, including hand washing, safe food handling, and avoiding defecation in open areas.
Although many Haitians are living in temporary resettlement camps as a result of the Jan. 12 earthquake, Andrus noted that these displaced people are being provided with safe water as part of relief and reconstruction efforts. He acknowledged it was possible that residents of more established slum areas, such as in Port-au-Prince, are at higher risk, since relief efforts have not been as focused on these areas.
In addition to prevention, PAHO efforts are also focusing on ensuring prompt treatment of people who become ill. About 80 percent of these have only mild or moderate symptoms, and some 20 percent develop acute diarrhea with severe dehydration, which can lead to death. People with low immunity, such as malnourished children and people infected with HIV, are at a greater risk of death if they become infected with cholera.
“If a person becomes infected, it is critical to ensure that effective treatment is available on a timely basis,” said Andrus. For most patients, oral rehydration salts are effective treatment and can be administered without taking patients to hospitals or health facilities.
More severe cases require treatment with intravenous fluids and antibiotics, which he said the U.S. Centers for Disease Control and Prevention (CDC) has reported are effective against the strain of cholera in Haiti’s outbreak.
Safe handling of bodies—including preparation for burial—is also important, since bodily fluids from cadavers can be a source of contagion. About 46 percent of reported deaths so far are taking place in hospitals, but 54 percent are in the community.
“Proper body disposal is definitely an issue, and PAHO is in the process of mobilizing experts in this area to travel to Haiti,” Andrus said.
PAHO has been mobilizing international experts in epidemiology, emergency management, water and sanitation, risk communication, and case management to Haiti as well as to the Dominican Republic to support both countries’ ministries of health.
Andrus said the probability of cholera appearing in the Dominican Republic was high, given the continual flow of people across the border.
PAHO’s Caribbean Epidemiology Center (CAREC), located in Trinidad, is supporting the efforts of other Caribbean islands’ ministries of health to prepare for potential cases.
PAHO is coordinating its efforts with other UN agencies and nongovernmental organizations working in
Haiti and with health officials in the