Fight against Haiti’s cholera brings new insights to battle the disease

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A medical hydration drip for cholera patients hopes to save lives 9 months after the devastating earthquake in Port-au-Prince.
Medical hydration IV drips for women cholera patients hopes to save lives 9 months following the devastating earthquake that hit Port-au-Prince, Haiti in January 2010. Image: Nick Hawkins/Microbiology2010

(WNN) Port-au-Prince, HAITI, AMERICAS – CARIBBEAN: New insights are coming in with the fight to stop cholera in Haiti says PLOS – Public Library of Science, a consortium of global experts on science and health. Even after consorted efforts to block the spread of the disease in Haiti following the January 2010 earthquake in Haiti’s capital city of Port-au-Prince, cholera has continued to plague the region.

“Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by the feces of an infected person or by untreated sewage. Food is often contaminated by water containing cholera bacteria or by being handled by a person ill with cholera,” says the U.S. based CDC – Center for Disease Control and Prevention.

Some of those in Haiti who have been the most vulnerable to complications from the disease have been pregnant women and young infants who, according to Doctors Without Borders/Médecins Sans Frontières (MSF), can end up dying due to severe dehydration or acidosis following diarrhea as cholera takes its course.

Outlining how a disease like cholera can migrate within a region, a new and fascinating study co-sponsored by the French Embassy in Haiti and Assistance Publique-Hôpitaux de Marseille (APHM) has assessed that the cholera strain responsible for the outbreak in Port-au-Prince may be lying dormant in higher numbers in rural areas versus urban areas.

This is because this strain of cholera in 2013 is not showing as prevalent in what has been determined as “significant levels” during a careful watch made in February and March 2013 inside Port-au-Prince urban communities and/or waterways. Instead the disease has been predominately located outside of the city. It is also now considered to be transmitted by dry, not wet, contamination to people who come down with the disease.

“Suspected cases were concentrated in a small number of urban and rural areas, almost all of which were located in the northern half of the country and often in inland locales. In these areas, community health activities appeared insufficient and were often inappropriately targeted,” outlined the study.

As medical assessment and intervention of cholera has been more focused almost exclusively on urban Port-au-Prince, targeting the disease properly has been an important part of the challenge, with much of the work to stop the disease focused, for now, on urban areas surrounding Port-au-Prince. A surprising key find in the study revealed that contaminated water may not be the main source of contagion for people contacting the disease most recently. Lack of body and food sanitation may be the primary culprit instead.

As the study reveals, “…the toxigenic V. cholerae O1 strain responsible for the outbreak did not settle at a significant level in the Haitian aquatic environment.”

Bringing science into the fight against the disease during the dry season in Haiti, this recent study can help identify source areas for the disease that may cause a resurgence of cholera to reappear later this year back into Port-au-Prince.

“…we hypothesize that some areas of lingering cholera transmission during the dry season could play an important role in the re-emergence of outbreaks during the rainy season.”

According to Haiti’s Ministry of Public Health and Population (MSPP), 652,730 cases of cholera have been reported since the epidemic began in Haiti in ????.  Out of this number 8,060 deaths have been reported with 55.3 percent, 360,934, of reported cases needing  hospitalization.

Additional data also shows that 176,100 cases have been reported inside the city parameter of Port-au-Prince since the beginning of the outbreak. These cases were counted from reports made from the urban neighborhoods of Cite Soleil, Delmas, Kenscoff, Petion Ville, Carrefour, Port-au-Prince and Tabarre.

“Out of 49 analyzed foci, only 10 had benefited from at least one intervention involving the distribution of water treatment products together with an awareness campaign since December 2012,” continued findings in the study.

“Cholera continues to affect Haiti as observed in early 2013; however, activities implemented to interrupt cholera transmission appear insufficient and poorly suited. This deficiency in the fight against cholera, especially at a period when transmission is weak, may explain the persistence of cholera even in the absence of significant aquatic reservoirs in Haiti,” the study adds.

As Doctors Without Borders works closely with those who have come down with the disease, an important part of their assistance efforts has been to educate the Haitian public on the importance of sanitation to prevent the dangers of cholera exposure from fecal matter. Hand washing and washing of vegetables, fruit and other foods before consumption is part of this education. Helping those who are in danger of contacting the disease to be aware of waterborne contagion with the need to boil all water for personal use is also part of MSF’s work to fight cholera in the region.


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