Cholera hits Haiti, Pakistan, and West Africa

Oct 26, 2010 | healthmap | Outbreak News

Haiti

Wednesday evening (20 October 2010), English and French media reported a surge in deaths and hospitalization from diarrhea in rural Haiti. The next day officials confirmed an outbreak of cholera. Today (26 October 2010), WHO is reporting 259 confirmed cholera deaths and 3,342 confirmed cholera cases. Confirmation of new cases has slowed in the past 24 hours, but officials expect the numbers to continue to rise, and remain concerned that outbreak could enter the capital’s refugee camps. A UN official stated that if the outbreak enters Port-au-Prince, tens of thousands could become ill.

Almost all of the cases have been in Artibonite, a department north of the capital of Port-au-Prince. Haiti is divided into 10 departments, similar to states in the US or provinces in Canada. The outbreak’s source has not been identified, but the Artibonite River is widely suspected to be contaminated. Although 5 cases have been identified in the capital, all were originally infected in Artibonite. Early reports of suspected cases to the south of Port-au-Prince have not been confirmed as cholera.

Shortly after the 7.0 earthquake in January, health authorities stated their concern about the threat of cholera. Cholera is a bacterial infection which can cause severe diarrhea leading to dehydration and shock. It is transmitted in contaminated water; person-to-person transmission is rare. Distribution of clean water and effective removal of sewage were severely compromised in the earthquake’s aftermath, but a cholera outbreak requires both poor sanitation and the presence of the disease. US CDC believed an outbreak immediately following the earthquake was “"extremely unlikely to occur". Given the 10 month delay and the fact that the epicenter of this outbreak was not strongly impacted by the January earthquake, the question of “why now?” remains unanswered. An NPR piece discusses the extreme poverty of many in rural Haiti and how poor infrastructure is associated with cholera outbreaks.

Given the extensive news coverage after the earthquake and the continued strong presence of aid groups from around the world, the international attention given to Haiti’s cholera outbreak is to be expected. Hopefully, the media coverage will contribute to a rapid resolution. It is important to note, however, that two other cholera outbreaks are currently impacting tens of thousands.

Pakistan:

Sindh, Punjab and Khyber Pakhtunkhwa provinces heavily affected by flooding last month have reported cases of cholera. WHO has reported 99 confirmed cases

Multiple countries in West Africa:

In September, we reported on a cholera epidemic that began in Nigeria and spread to Cameroon, Chad, and Niger. At the time, Nigerian officials had assured the public that the disease was under control; the country had reported a little over 16,000 cases and under 800 deaths total for the year. In the one month since, the counts have risen to 38,173 cases and a startling 1,555 deaths for Nigeria alone, while Benin has been added to the list of countries affected. Cameroon currently reports 8,528 cases and 559 deaths since May while Chad had 3,338 cases and 128 deaths as of early October. Health officials are particularly worried about Benin, where recent flooding has left two-third of the country covered in water and over 250,000 people homeless. Just in the past two weeks, 846 cases and 7 deaths from cholera have already been reported within the country.

With proper sanitation and public health infrastructure, the disease should be largely preventable, but in Nigeria almost half of its population of 150 million lack access to these clean water. Cholera remains an imminent threat to the livelihood of the inhabitants, in particular children. Local preventive efforts have been made through chlorinating wells and public health education. Local Christian and Muslim leaders have even begun to preach on the disease in efforts to raise awareness. Experts hope that with the arrival of dry season in the region, the spread of the disease can hopefully begin to subside and the people of West Africa can finally see a turn for the better.

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