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Cholera Outbreak in Haiti
Jon Kim Andrus, MD
Deputy Director
Pan American Health Organization
9 November 2010

 

I want to thank all of you for participating in today’s news conference. We hold these briefings to provide you an update on the ground situation in Haiti.

Dr. Jon AndrusIt is a relief to note that the impact of Hurricane Tomas was not as immediately catastrophic as we all feared, particularly if you compare it to the hurricane that struck Haiti in 2008.

The most heavily hit departments were the South and Grand’ Anse, creating important needs for food, potable water and hygiene kits in these areas.

A number of hospitals were evacuated, along with thousands of people in vulnerable areas, but they are gradually returning to their homes or their camps.

Initial assessments indicate that Haiti’s agricultural sector was the most heavily affected, with flooded fields and major losses in livestock and crops.

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.

Before we get into the actual case counts, I’d like to take a step and put the situation in context for you.

Cholera is a complex public health emergency under any circumstances. And certainly in Haiti, the hemisphere’s poorest country, the problem is even more complex.

The country’s water and sanitation infrastructure was inadequate to begin with. Then, in January of this year, an earthquake struck the nation, killing 200,000 people and forcing more than 1.3 million people into tents and displacement camps, where they still live today.

To make matters worse, the flooding and mudslides from last week’s hurricane pushed rivers over their banks, very likely spreading cholera even further.

So that is the context of the current situation.

To give some historical context: the cholera epidemic that began in Peru in 1991 spread to some 16 other countries throughout the hemisphere, from Argentina to Canada, with cases even reported in Montreal and New York City. In Peru alone, it produced more than 650,000 cases over six years.

At the time, Peru’s population was about two-and-a-half times larger than today’s Haitian population. Extrapolating from Peru’s experience, one might expect upwards of 270,000 cases if Haiti’s epidemic continues for several years, as did Peru’s.

As of yesterday, the Ministry of Health was reporting more than 9100 hospitalized cases and some 583 deaths in some 240 communities. These include 73 cases reported in Port-au-Prince. We expect these numbers to continue to rise as more cases are detected.

As I have noted in earlier briefings, you may hear different case counts from different sources.

Reconciling these numbers is an important priority for PAHO and PAHO is supporting Haiti’s Ministry of Health in this area.

Before the current outbreak, Haiti was in the process of improving its epidemiological surveillance system, that system responsible for detecting diseases and monitoring trends in diseases. This was begun after the earthquake in January. The main challenge was --and currently is-- integrating case counts from different health providers, including nongovernmental organizations like Doctors without Borders and Partners in Health, as well as bilateral partners such as Cuban health providers.

To help the Ministry better integrate these various sources, PAHO has mobilized experts in epidemiology to continue improving the surveillance system. This work also includes establishing reporting sites in all the shelter areas.

As this work progresses, there should be more consistency in the numbers. However, I want to emphasize –as I have emphasized a number of times before -- that the case numbers are not as important as the underlying trends, and our top priority is treating the sick and preventing new cases.

So what are we doing to prepare for an increase in cases that we expect? The answer is, we are doing everything we can -- to save lives.

In anticipation of the hurricane, PAHO pre-positioned cholera-related and other medical supplies in the major urban centers of the south and north, Les Cayes and Cap Haïtien; as well as Port-au-Prince and St. Marc, the epicenter of the outbreak.

From these points, NGOs and other partners are able to pick up their supplies free of charge and distribute them according to their needs.

PAHO’s PROMESS warehouse has continued to distribute medicines and supplies to hospitals and organizations in four departments.

PAHO also has deployed a team of experts to Port-au-Prince to help scale-up operations at PROMESS, the central warehouse where supplies and medicines are stored, in coordination with Haiti’s Department of Civil Protection.

We continue to work with Haiti’s Ministry of Health, NGOs, the CDC and Canada, among other partners to get needed supplies into communities and health facilities and to prepare for the expected upsurge in new cases.

One final note: the UN Stabilization Mission in Haiti, MINUSTAH, said recently that there is no objective reason to delay elections and that they are scheduled for November 28. You may recall, they were originally scheduled for last February, but they were postponed following the Jan. 12 earthquake.)

From a health perspective, there is no reason to expect the elections to have a negative impact on the cholera epidemic. And in fact, the Ministry of Health is planning to use the occasion to disseminate prevention messages to the population. It will help prevent the spread of infection.

I will stop now and take any questions.

Last Updated on Tuesday, 16 November 2010 13:59


2014

PAHO year in review: 2014 public health highlights in the Americas (12/24/2014)

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Mesa directiva

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Water and sanitation improvements remain key to defeating cholera in Haiti and the Dominican Republic (03/21/2014)

Haiti partners see progress, challenges in cholera control (02/05/2014)

2013

Representatives from the Ministries of Health met to discuss coordination and operational aspects of cholera prevention and control in the Subregion (12/09/2013)

Poster sobre leptospirosis gana premio en el Fórum de “Una Salud” en Davos, Suiza (11/22/2013)

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Simulacro de Leptospirosis en Choluteca, Honduras (10/31/2013)

Experts urge more WATSAN investments to halt cholera in Haiti, prevent its spread to more countries (10/25/2013)

USAID and World Vision join coalition to eliminate cholera from Haiti and the Dominican Republic (06/28/2013)

Experts in leptospirosis meet in Brasilia (04/15/2013)

2012

International Health Leaders Pledge to Work Together to Eliminate Cholera in Haiti and the Dominican Republic (10/16/2012)

2011

Llamado a la acción: La Hispaniola libre del cólera (12/28/2011)

Técnicos evaluaron respuesta y desafíos a un año de la epidemia de cólera en República Dominicana (12/07/2011)

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Journalism Award Winners Focus on Drug Resistance in Latin America (08/17/2011)

Haití condecora a la OPS/OMS por labor durante brote de cólera (04/20/2011)

Experts Warn of “Untreatable Infections” (04/05/2011)

Response to Cholera in Belle Fontaine, Haiti (01/28/2011)

Water, Sanitation and Hygiene Key to Control Cholera Epidemic in Haiti (01/10/2011)

2010

Experts to Discuss Cholera Vaccination in the Americas (12/15/2010)

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National Day of Education and Prevention of Cholera in the Dominican Republic (12/01/2010)

Elections Not Expected to Increase Cholera Spread in Haiti (11/25/2010)

Cholera Outbreak in Haiti - Press Briefing by Dr. Jon Andrus, PAHO Deputy Director, 23 November 2010 (11/23/2010)

International Agencies Propose Joint Strategy to Fight Cholera in Haiti (11/16/2010)

PAHO Press Briefing on the Cholera Outbreak in Haiti, Tuesday, 16 November 2010 (11/15/2010)

PAHO Briefs NGO Partners on Cholera Outbreak in Haiti (11/15/2010)

Press Briefing on Cholera Outbreak in Haiti by Dr. Jon Andrus November 9 (11/09/2010)

Haiti’s Cholera Epidemic Likely to Grow Much Larger (11/09/2010)

Number of Cholera Cases and Deaths Still Rising in Haiti (11/02/2010)

CDC: Cholera Outbreak Strain Identified (11/01/2010)

PAHO’s Deputy Director Updates OAS’ Group of Friends of Haiti on Outbreak Situation (10/28/2010)

PAHO Position on Cholera Vaccination in Haiti (10/28/2010)

PAHO: Haiti’s Cholera Epidemic Still Trending Upward (10/27/2010)

PAHO: Haiti’s Cholera Epidemic Still Trending Upward (10/27/2010)

Press briefing on the cholera outbreak in Haiti by Dr. Jon Andrus, 27 October 2010 (10/27/2010)

PAHO: Cholera cases likely to increase in Haiti (10/25/2010)

PAHO Responds to Cholera Outbreak in Haiti (10/22/2010)

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2009

Jóvenes de los Ecoclubes difunden mensajes de prevención frente a la pandemia de influenza H1N1 (12/14/2009)

WHO Says Prompt Treatment Can Prevent Serious Cases, Deaths from H1N1 (11/12/2009)

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PAHO Unveils Two Communities of Practice on Pandemic (H1N1) 2009 (09/21/2009)

Countries of the Americas Examine Response to Pandemic H1N1 2009 and Challenges Ahead (09/11/2009)

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Pandemic (H1N1) 2009 in the Americas: What's Next? (09/02/2009)

Chile's President Urges a Collective Response to A (H1N1) Pandemic (06/24/2009)

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