Communicable Diseases and Health Analysis
Cholera Outbreak in Haiti
Press Conference by Jon Andrus
Pan American Health Organization
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.Cases have been confirmed in three provinces, including Artibonite, Central, and West. Suspect cases are being investigated in other provinces, including North, Northwest, and Northeast.
At this point in time, the specific numbers of cases is less important than knowing where cases are occurring--their geographical distribution—so interventions can be targeted in communities where they are needed.
The reported case fatality rate among hospitalized patients has ranged from 2 percent to 6.8 percent.
Although the case fatality rate appears to be improving since we last reported it—at 9 percent—this is higher than expected and is mostly due to geographic and logistical challenges to accessing health services. Put simply: many patients have arrived too late to health facilities to receive treatment that could have saved their lives.
It’s very important to monitor the case fatality rate to refocus and prioritize training of healthcare workers and as well as to prioritize the support to families and the community. With continued improvement of prevention and treatment practices, the death rates should continue to decline.
To that end, health and hygiene messages have been developed by the Ministry of Health in Creole and have been disseminated to the public. They focus on hand washing, good hygiene and sanitation measures, such as proper management of human feces and garbage, purification of drinking water by boiling and using chlorinated tablets, and eating only cooked or peeled foods.
These messages also describe how to prepare oral rehydration salts, how to care for cholera patients safely in the home, and how to recognize when to take patients to a health facility.
All these measures work—when done effectively—to prevent the continued spread of infection and deaths.
We also now have some data on the age distribution of hospitalized patients, at least from the most affected department, Artibonite. Between Oct. 20 and Oct. 28, 88 percent of hospitalized patients were 5 years old or older, meaning that only 12 percent were younger than 5.
In addition, we have information that approximately half the deaths occur without ever reaching the hospital. They’re occurring in communities and neighborhoods themselves.
The UN response is coordinated through several clusters: Health, Communication, Water, Sanitation and Hygiene, Logistics, Education and Protection, with the support of the Office for the Coordination of Humanitarian Affairs.
As head of the Health Cluster, PAHO has the responsibility of ensuring that the coordination of the agencies and organizations providing health services in Haiti is most effective and properly managed.
Many countries and organizations are involved in these efforts, including the United States, Argentina, Brazil, Canada, Cuba, Spain, Israel, Peru, Ecuador, Mexico, France, Japan, and the Dominican Republic, among others.
Many nongovernmental organizations, or NGOs, are actively involved in the response, including the Red Cross, Doctors without Borders, and Partners in Health.
Haiti’s Ministry of Health has asked these partners to prepare at least a 6-month work plan that outlines their response and contributions to controlling the outbreak.
The Ministry has asked its partners to make settlement camps for internally displaced people a top priority, since their living conditions make them particularly vulnerable.
One of PAHO’s focuses is to increase infectious disease surveillance in these camps as well as throughout the country.
We cannot overlook the vulnerable populations who do not live in these resettlement camps and may not have access to safe drinking water. The response must be comprehensive.
An emerging top priority now for all of us is preparing for Tropical Storm Tomas. We have received reports that the storm has already had a serious impact on St. Lucia, with mudslides and severe damage to the island’s water systems.
If the storm hits Haiti, it’s obvious that is will make a difficult situation even worse. Cholera is mainly being spread through contaminated water, and more water supply disruptions pose additional increased risks for cholera and other waterborne diarrheal diseases.
The bad sanitary conditions in many areas, combined with what the hurricane poses as huge amounts of rain and possibly flooding, are very likely to accelerate the spread of infection, making the overall caseload increase earlier and faster.
At the request of the Haitian government, PAHO teams are currently visiting hospitals and cholera treatment centers to determine their readiness for the storm and to provide extra materials or medical supplies, or even training, where needed.
PAHO is mapping out the locations and operational capacity of these facilities, and contingency plans for the storm, and these may include the transfer of patients to secure locations, if necessary.
While many precautions have already been taken, a lot more work remains to be done.
As I mentioned in the last briefing, the strategy developed by Haiti’s Ministry of Health to guide the response focuses on three lines of action: first, protection of families at the community level; second, the strengthening of primary healthcare centers; and finally establishing Cholera Treatment Centers (CTC) and reinforcing hospitals for treatment of severe cases.
Since the start of the outbreak, PAHO has distributed over 3,500 liters of IV fluids, more than 64,000 sachets of oral rehydration salts, and more than 180,000 antibiotic tablets to treat patients suffering from the disease.
These supplies have been distributed by PROMESS, the PAHO-managed warehouse in Port-au-Prince, near the airport, that is the main source of essential medicines and medical supplies in Haiti.
PROMESS distributes its inventories free of charge or at cost to hospitals and health facilities throughout the country, including many that are staffed by international nongovernmental organizations. We now have teams from Argentina and Brazil helping the PROMESS staff with logistical challenges posed by the outbreak.
Working together with US Centers for Disease Control and Prevention (CDC) and other experts, PAHO has updated the antibiotic and treatment guidelines for cholera in Haiti. The recommended first line antibiotic for adults is doxycycline. Erythromycin or azithromycin is being recommended for children and pregnant women.
I will stop here and take questions. Thanks.