Lessons from 1990s epidemic point to need for advanced preparation
Washington, D.C., November 23, 2010 (PAHO) — Countries throughout the Americas should be taking steps now to protect their populations from cholera, before the epidemic spreads further, a top Pan American Health Organization (PAHO) official said today.
In addition to Haiti, the Dominican Republic and the United States have reported confirmed cases of cholera, and the risk that it may spread to other countries cannot be discounted, said Dr. Jon K. Andrus, Deputy Director of PAHO.
"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," Andrus said. "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."
PAHO recently sent an alert to health officials in its Member States in Latin America and the Caribbean urging them to take steps to prepare for the possible arrival of cholera. Among the recommended measures were:
- 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.
- Increased public education about the importance of hand washing, proper disposal of feces, and prompt treatment with oral rehydration salts or, for severe cases, specialized medical care.
PAHO has already been helping health officials in Caribbean plan for the possible arrival of cholera on their shores. In the message to other member countries, PAHO offered support for planning and preparation in such areas as surveillance, water and sanitation, and social communication.
Modeling exercises done for planning purposes in Haiti project an estimated 400,000 cases of cholera over the next 12 months, Andrus said, with as many as half those cases possibly occurring within the next three months.
But the projections, he cautioned, "represent 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."
A central challenge—and an essential goal—for responding to the epidemic in Haiti is ensuring safe water and sanitation, and prompt treatment of cases, Andrus said.
"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."
Over the weekend, trucks and helicopters left PAHO's PROMESS warehouse in Haiti's capital with some 40 tons of essential medicines and supplies, for delivery to areas most heavily affected by cholera and for prepositioning in remote areas that have not yet been affected.
So far, PAHO has distributed supplies to treat about 80,000 patients with cholera.
"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," Andrus said. "We also need more experts on social mobilization to communicate about cholera prevention."
Violence, particularly in Haiti's North Department, has interfered with critical relief and medical work, Andrus acknowledged. PAHO has received reports of patients who have been unable to reach medical care in these areas. Today, some international staff and medical workers—including some PAHO staff—remained confined to their living quarters as a result of the continuing insecurity.
To support Haiti's response to the cholera epidemic, PAHO, other U.N. agencies, and other partners have appealed for $164 million in international aid. Andrus said that so far about 10 percent of this request had been received.
"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." He said that making Haiti self-sufficient in all these areas is an essential long-term goal.
Meanwhile, "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 of the response to this crisis."