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

Good afternoon. Thanks for coming. In this briefing we want to give you an update on the situation in Haiti.

Haiti’s Ministry of Health, PAHO, and other key partners in Haiti have established a new alert and response unit to strengthen the existing surveillance system. The alert and response unit will identify and investigate hot spots of increasing cases or deaths and then help mobilize teams to respond.

We believe certain critical issues need to be addressed if our efforts to treat patients and save lives are to be successful. Safe water and sanitation are lacking. In the short term, efforts must focus on distributing chlorine tablets as well as oral rehydration salts to everyone. In the long term, we must create the systems and infrastructure to ensure equitable access to these basic services.

Official reports confirm 8 of 10 departments with cases of cholera. We know that in the other 2 departments, clusters of cases are now being investigated. So, for all intents and purposes, as we fully expected before, cholera is virtually everywhere in the country.
 Given the extremely poor sanitary conditions that existed well before the earthquake, the recent hurricane, and now the epidemic, we expect the number of cases to continue to grow. We have not yet reached a peak and we don’t know when that peak will occur.

Cases have been reported in the Dominican Republic as well as here in the United States.

The Pan American Health Organization has sent a message urging health ministries in all our member countries throughout the Americas to strengthen their contingency planning in view of the fact that cholera could spread to other countries in the hemisphere.

For many of us here, this brings up memories of the cholera epidemic that began in Peru in 1991 and spread to more than 16 countries in the Americas within two years.

Considering the intensity of travel and trade in the Americas, we know it’s difficult to prevent importations of isolated cases of cholera in other countries, but there are important steps that can be taken to prevent cholera from spreading and causing epidemics.

Our message to health authorities is that they should begin preparing now, before the appearance of cases. PAHO is recommending a series of measures that include:

  • Stepped-up surveillance to ensure that any potential cholera cases are detected rapidly. 
  • Strengthening preparedness and response plans to ensure that countries’ health systems are able to deal with any sudden surges or emergence of cholera. 
  • Improving water and sanitation services to prevent the spread.
  • And finally, increased public education about the importance of hand washing and proper disposal of feces, as well as prompt treatment with oral rehydration salts or, for severe cases, specialized medical care.

We have also offered support to countries to update and implement preparedness and response plans in surveillance, water and sanitation, and social communication. PAHO has already been working with ministries of health in Caribbean countries to strengthen their planning for the possible arrival of cholera cases on their shores.

In the capital, Port-au-Prince, workers at the Logistics Cluster and at PAHO’s PROMESS warehouse loaded some 40 metric tons of essential medicines and supplies onto trucks and helicopters as part of a three-day operation to supply the areas most heavily affected by cholera and to preposition supplies in remote areas where cholera has not yet arrived. And we just learned minutes ago that an additional 42 metric tons of supplies were included in these efforts.

In Haiti’s North Department, international staff and medical workers--including some PAHO staff--remain confined to their living quarters, following civil unrest earlier this week. We hope PAHO staff may soon be able to resume their work supporting the response to the cholera epidemic.

Since the beginning of the crisis, PAHO has distributed enough supplies to treat about 80,000 cases of cholera, including supplies like oral rehydration salts and intravenous fluids for severe cases. We have more on hand, but in the near future we will need even more supplies, cholera beds, and doctors, nurses, and people to train local doctors how to treat cholera patients. We also need more experts on social mobilization to communicate about cholera prevention.

We need to plan for enough supplies to treat as many as 400,000 cholera cases occurring over the next 12 months. We need to plan for up to half of those cases occurring over the next 3 months because of the explosive nature of this epidemic. This represents work in progress that takes into account many assumptions, for example, differences in attack rates between urban and rural areas, and no change in environmental conditions. We are working to refine these preliminary estimates with key partners in order to improve and sustain supply management for the epidemic response.

To support health promotion activities, WHO/PAHO has printed and begun to distribute 97,000 posters and 150,000 laminated pages in Creole with guidance on cholera prevention and treatment. A course was developed for community and religious leaders explaining how to manage cholera in their community. The government will deliver this training.

Another major challenge is staff. On the part of PAHO, we already had about 50 people working in Haiti and have recently deployed 50 more, including epidemiologists, sanitary engineers, logisticians, clinicians, communications experts, and others. But we will need more, and we will need more funds to pay for people and supplies. Despite substantial international support, the Haitian health system is over-stretched, especially after the major losses in the January earthquake. We hear reports from our partners like MSF and CDC, that the staffing issue is also a challenge to them.

To that end, we are encouraging partners to do everything possible to hire and train the Haitian people using cash-for-work programs. This is consistent with our primary objective of helping the Haitian people and the Haitian government in the response and in taking the prime ownership to this crisis. Since cholera has a foothold and will not go away in the near future, the priority of hiring and training Haitians also aligns with our long-term vision of capacity development.

We are working with other UN agencies and many NGOS to respond to the outbreak, but a lot more is needed, especially in providing safe water and adequate sanitation to Haitians particularly in Port-au-Prince and the provinces. About 58% of the population before this crisis lacked access to potable water. About 76% of Haitians earn less than $2 a day. We now know that about 1.6 million Haitians are living in precarious conditions, particularly those in the 1,300 displacement camps.

We must work together to manage the impact of this outbreak, particularly to minimize loss of life. This requires an integrated approach bringing together those who provide clean water, improve sanitary conditions, and those who provide treatment to the ill. We need more of everything: more training for staff in Haiti, more doctors, more nurses, more treatment centers, more medications, more toilets, more clean water.

We have asked for $164 million for this emergency, and so far have received about 10 percent of this amount. It is clear the country will need more funding. Our response, along with all the partners, has not been as rapid as we would like. The reason is that, even before the crisis, the country lacked the building blocks of health, which are water, sanitation, safe food, and adequate health services. Our aim is to help Haiti overcome these obstacles and build self-sufficiency in these vital areas.

Thank you. 

Last Updated on Wednesday, 24 November 2010 06:46


2014

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

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PAHO/WHO provides training in risk communication for possible Ebola introduction (12/09/2014)

Mesa directiva

Professionals from 11 countries of the Americas are in Quito, Ecuador, this week for a training workshop on risk communication organized by the Pan American Health Organization/World Health Organization (PAHO/WHO). The two-day workshop (December 9 and 10) is part of efforts to ensure that countries in Latin America and the Caribbean are prepared to respond effectively to potential imported cases of Ebola and other public health emergencies.

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Dr. Espinal, Director of the Department of Communicable Diseases and Health Analysis

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WHO statement on the second meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola Outbreak in West Africa (09/22/2014)

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PAHO urges countries to eliminate mosquito breeding sites to prevent the spread of dengue and chikungunya (09/10/2014)

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Anecdotal evidence about experimental therapies (08/25/2014)

Why the Ebola outbreak has been underestimated (08/25/2014)

Travel and Transport in Relation to Ebola Virus Disease (EVD) Outbreak (08/18/2014)

Ethical considerations for use of unregistered interventions for Ebola virus disease (EVD) (08/11/2014)

PAHO/WHO urges the countries of the Americas to be vigilant and prepared for potential introduction of Ebola virus (08/10/2014)

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Número especial en periódico internacional sobre leptospirosis en la interface animal-humano-ecosistema (07/25/2014)

Dominican Republic is first country in the Americas to publish guidelines for clinical management of chikungunya (07/17/2014)

El Instituto Nacional para Síntesis Matemática y Biológica (NIMBioS) organizó taller para modelaje matemática de leptospirosis (06/10/2014)

Polio declared public health emergency of international concern under International Health Regulations (05/05/2014)

Countries of the Americas share risk of antibiotic resistance, must act now to protect health (04/29/2014)

Países de América debaten en Buenos Aires sobre la implementación del Reglamento Sanitario Internacional (04/29/2014)

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)

Sesión sobre leptospirosis advoca por el enfoque de “Una Salud” para la reducción del impacto de los brotes (11/22/2013)

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)

Puerto Rico Presents Pilot Project for the Prevention and Control of Dengue (11/23/2011)

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)

Se prepara Plan de Contingencia ante la amenaza de un posible brote de Cólera en Guatemala (12/03/2010)

Cases Continue to Climb, But Fewer Patients are Dying from Cholera (12/02/2010)

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)

Taller analizó el impacto de la vacuna contra la influenza pandémica (09/15/2010)

WHO Declares H1N1 Pandemic Over, Urges Continued Influenza Vigilance (08/10/2010)

Facts and Myths about the Safety of the Pandemic Influenza (H1N1) 2009 Vaccine (05/26/2010)

Spain Donates Four Million Doses of Influenza A Vaccines to Latin American Countries (03/04/2010)

Nicaragua: Lista para recibir y aplicar la vacuna contra la Influenza AH1N1 en grupos priorizados (02/24/2010)

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)

Preparing Communities to Respond to Pandemic Influenza (11/03/2009)

Autoridades de Salud alertan sobre brote severo de dengue en Nicaragua (10/02/2009)

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)

Países de las Américas se organizan para adquirir la vacuna de la gripe pandémica (09/10/2009)

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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