Controlling Cholera in Haiti: No Easy Task
Adrienne Lefevre, MPH, CHES
When a 7.0 magnitude earthquake struck Haiti in 2010, approximately 230,000 people died and over a million were displaced. Approximately 9 months after the earthquake, the Haitian Ministry of Public Health and Population (MSPP) confirmed cases of cholera for the first time. Since the emergence of cholera, Haiti has reported about 805,000 suspected cases and nearly 9,500 deaths. In 2016 alone, Haiti reported 41,421 suspected cholera cases and 447 cholera deaths.
Cholera is an acute, diarrheal illness caused by the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. A person can get cholera by drinking water or eating food contaminated with the bacteria. The majority of cholera cases are caused by the ingestion of water or food contaminated with the feces of a cholera-infected individual. The infection is often mild or without symptoms but can sometimes be severe, leading to swift dehydration and shock. It can be deadly within hours if not appropriately treated with oral or intravenous (IV) rehydration.
Cholera persists in Haiti primarily because many Haitians lack access to clean water and proper sanitation. Although improvements have been made, such as increases in household water treatment and storage through the availability of liquid chlorine products, the cholera epidemic in Haiti—the largest documented cholera outbreak in recent history—remains ongoing.
Cholera was prevalent in the U.S. in the 1800s for the same reasons it is prevalent now in Haiti. The U.S. eliminated cholera through constructing and improving water and sewage treatment systems. According to David Fitter, MD, country director for the U.S. CDC’s office in Haiti, it will take a multipronged approach to eliminate the risk of cholera in Haiti, including further development of water, sanitation and hygiene infrastructure, and the selective use of oral cholera vaccines. “CDC’s assistance for cholera has focused on surveillance, diagnosis, treatment, and prevention, as well as on building the capacity of DINEPA to improve monitoring systems and increase water treatment and sanitation services.”
Hurricane Matthew, a category 4 storm, hit the country in October 2016, hampering Haiti’s ongoing efforts to control cholera. At least 500 Haitians lost their lives [LA((1] and about 140,000 were displaced[LA((2].
In response to Hurricane Matthew, CDC’s Haiti and Atlanta offices supported the efforts of MSPP, the National Potable Water and Sanitation Directorate (DINEPA), and other partners to respond to the hurricane. CDC teams helped with several activities:
- Conducting rapid assessments of damaged water systems and increasing availability of clean water by facilitating distribution of chlorine powder - Investigating outbreaks of diarrheal disease - Evaluating health facilities in hurricane-affected departments and assisting with continuity of key programs such as HIV and TB treatment - Restoring functionality to public health surveillance systems - Providing cholera culture training to lab technicians in Les Cayes (Sud Department)
CDC continues to assist MSPP and DINEPA. The CDC Haiti office works with MSPP to support field surveillance and to build laboratory capacity. CDC also continues to deploy experts to Haiti to help with specialized areas of cholera control, such as properly chlorinating community water supplies.
The response to Hurricane Matthew benefited from earlier responses following the earthquake and cholera outbreak in 2010. For example, household water treatment products, such as chlorine tablets, that have been distributed to citizens for years were well accepted and properly used in hurricane-affected areas because Haitians were familiar with these items.
The battle against cholera in Haiti has demonstrated the value of building partnerships before a crisis. CDC Haiti built a strong relationship with MSPP and DINEPA for many years before Hurricane Matthew based on trust and mutual respect. It produced familiarity with each other’s strengths, understanding of each other’s perspectives, and the ability to translate scientific knowledge into effective actions within local communities. This enabled the public health agencies to provide a well-coordinated response.
Restoring infrastructure and access to healthcare services is a crucial part of the long-term cholera response. Many partners worked together to repair damaged community water systems and to repair or reconstruct health facilities and cholera treatment centers. While Haiti continues to struggle with cholera, the combined efforts of MSPP, DINEPA, UNICEF, PAHO/WHO, CDC, USAID, and other organizations are strengthening the country’s capacity to combat cholera and other infectious diseases. Haiti’s improved capacity will help with preparedness and response to future public health threats in the country. Without the combined efforts by countless partners, the cholera epidemic could have claimed many more lives.
A CDC blog on this can be found **here for more information on cholera in Haiti.**