In Haiti,during the fourth EW of 2011 Haiti registered a decrease in the weekly incidence rate at the national level, which went from 13.6 cholera cases per 10,000 inhabitants in EW 3 to 8.1 cases per 10,000 inhabitants in EW 4. At department level, three departments (Artibonite, Grande Anse, Nord and Sud) increased their weekly incidence rate. The in-hospital case fatality rate at the national level in EW 4 of 2011 was 1.0%.
While in the Dominican Republic, the Ministry of Public Health informed that since EW 45 of 2010 to EW 4 of 2011, there were 336 cases confirmed by laboratory and one death that happened in EW 2.
During Epidemiological Week 7 of 2011, at the national level, Haiti registered an increase in the weekly incidence rate, which increased from 5.1 cholera cases per 10,000 inhabitants in EW 6 to 10.2 cases per 10,000 inhabitants in EW 7. This was linked to an increase of 4.2% in the new cases registered as compared to the previous week. At the sub-national level, five departments (Centre, Nippes, Ouest, Sud y Nord) registered an increase in their weekly incidence rate.
While in the Dominican Republic, the Ministry of Health reported a total of 470 laboratory-confirmed cases of cholera, including four fatal cases, since the beginning of the outbreak up to EW 7.
8 June 2011: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) – situation
New Case Definition
Starting 8 June 2011, European Union (EU) Members States are reporting case according to a new case-definition.
Possible Epidemic Case: Any person who developed in or after 1 May 2011;
STEC diarrhea defined as acute inset of diarrhea or bloody diarrhea AND at least one of the following criteria:
Isolation of an E coli strain that produces Shiga toxin 2 (Stv2) or stx2 gene.
Direct detection of stx2 gene nucleic acid in feces without strain isolation.
STEC HUS defined as hemolytic uremic syndrome (HUS) defined as acute renal failure and at least one of the following clinical criteria
Microangiopatic hemolytic anemia
Probable Epidemic Case Any possible epidemic case of STEC diarrhea or STEC HUS AND during the exposure period of 14 days before the onset of illness, meeting at least one of the following epidemiological criteria:
Stay in Germany or any other country where a confirmed case has probably acquired infection;
Consumption of food product obtained from Germany;
Close contact (e.g., in a household) with a confirmed epidemic case.
Confirmed Epidemic Case Any person meeting the criteria for a possible case, AND Isolation of a STEC strain of serotype O104:H4
OR isolation of a STEC strain of serotype O104 AND fulfilling epidemiological criteria for a probable case. EU Members States are reporting number of probable and confirmed cases and deaths.
7 June 2011: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) – situation
Developed by the Robert Koch Institute to be applied to HUS-cases associated with the 2011 Germany outbreak.
HUS Clinical criteria: A clinical picture of acute enteropathogenic HUS is defined by the presence of at least two of the following three criteria:
1. Hemolytic anemia
2. Thrombocytopenia ≤ 150,000 cells/mm3,
3. Renal dysfunction
Laboratory confirmed cases: Positive result in at least one of the following tests:
Detection of Shigatoxin
Culture of the pathogen and isolation only from stool AND detection of Shigatoxin Stx2 using ELISA on the E. coli culture,
Mixed culture of the pathogen, enriched stool cultures or isolation of E. coli AND nucleic acid amplification test (e.g. PCR) for detection of the shigatoxin gene stx2 from the same sample
Indirect (serological) detection
Detection of ant-LPS-IgM-antibodies against E.coli Serogroups (once markedly increased titre/concentration, e.g., using ELISA, Western Blot)
Marked change between two consecutive samples in titreconcentrarion of anti-LPS-IgG-antibodies against E.coli serogroups e.g.; using ELISA)
Suspect HUS case: Case with a clinical picture of acute enteropahogenic HUS as assessed by the attending physician, but not formally meeting the clinical criteria (at least two of three) identified above, are classified as suspect cases regardless of laboratory confirmation.
In Haiti, the Haitian Ministry of Public Health and Population (MSPP) case surveillance system eported that as of EW 19 there was an increase in the number of hospitalized patients in Port-au-Prince and the Centre department. This increase coincides with the beginning of the rainy season in Haiti.
While in Dominican Republic, the Ministry of Public Health informs that since the beginning of the outbreak up to EW 20 of 2011 there were 1,329 laboratory confirmed cases (191 in 2010 and 1,138 in 2011), including 27 deaths. The Distrito Nacional and the provinces of Santiago, San Pedro de Macorís, La Romano and the border provinces of Independencia and Elías Piña also registered an increase in cases with respect to the previous weeks.
In Haiti,during the third EW of 2011 Haiti registered an increase in the weekly incidence rate at the national level, which went from 10.1 cholera cases per 10,000 inhabitants in EW 2 to 13.6 cases per 10,000 inhabitants in EW 3, which is an increase of 6.9% in the new case registrered when compared to the previous week. Of all the departments, six, increased their weekly incidence rate (Centre, Ouest, Nippes, Sud Est, Nord-Est, and Nord-Ouest) and four showed a decrease (Artibonite, Grande Anse, Nord and Sud). The hospitalization case fatality rate at the national level in EW 3 of 2011 was 1.5%, two decimals above the previous week.
While in the Dominican Republic, the Ministry of Public Health informed that since the beginning of the outbreak in EW 45 of 2010 to EW 2 of 2011, there were 263 cases confirmed by laboratory and one death that happened in EW 2.
The Protocol for responding to imported cases of poliomyelitis due to wild poliovirus has the following objective: Prevent the occurrence of national poliomyelitis epidemics caused by the importation of wild polio virus, prevent the outbreak from spreading among countries in the Americas and prevent renewed circulation of wild polio virus in any country that experiences an imported case.
3 June 2011: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) – situation
Haemolytic uraemic syndrome (HUS): It is a life-threatening disease characterized by acute renal failure (uraemia), haemolytic anaemia, and a low platelet count (thrombocytopenia). It results from EHEC infection, and it is estimated that up to 10% of EHEC-affected patients may develop HUS. The mortality rate has decreased during the last few years and with appropriate treatment is between the 3% and 5%.
It can cause neurological complications (such as seizure, stroke and coma) in 25% of HUS patients and chronic renal sequelae, usually mild, in around 50% of survivors. EHEC or STEC is a severe strain of E. coli bacterium that is commonly found in the gut of animals, mainly ruminants. EHEC produces toxins, known as verotoxins or Shiga-like toxins because of their similarity to the toxins produced by Shigella dysenteriae. They can cause severe foodborne disease. STEC is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk, contaminated water, direct contact with animals or contact with infected people. Symptoms of disease include abdominal cramps and diarrhoea, which may be bloody. Fever and vomiting may also occur.
Dengue and severe dengue pose a public health problem in the tropical and subtropical areas of the Region of the Americas. During 2011, Member States reported 979,774 cases of dengue, of which 15,860 presented serious forms requiring hospitalization and 692 deaths. Historical data on the number of cases and deaths registered was surpassed this year with dengue outbreaks in Paraguay, Panama and in the countries and in the non-Hispanic Caribbean, such as Aruba, the Bahamas, and Saint Lucia. The introduction of Dengue 4 was also observed in Panama and in some states of Brazil where it had not previously circulated.
In light of this situation, the Pan American Health Organization/World Health Organization (PAHO/WHO) reminds Member States, especially those located in the southern hemisphere of the recommendations to reduce morbidity, fatality and the social and economic burden generated by dengue outbreaks and epidemics.