Haiti: Cholera Outbreak - 2010-2017
Since the emergence of cholera in Haiti in October 2010, the Ministry of Public Health and Population recorded 719,377 suspected cases and 8,767 cholera-related deaths as of 30 Nov 2014. Despite severe infrastructure and financial constraints, concerted Haitian and international efforts have succeeded in drastically reducing the number of reported cholera cases in Haiti – down from a peak of over 350,000 reported cases for 2011, to 21,916 reported cases for 2014, from 1 January to 30 November. The persistence of cholera in Haiti is mainly due to the lack of access to clean water and appropriate sanitation facilities, and although considerable improvements have been made in this regard, Haiti continues to host the largest cholera epidemic in the Western Hemisphere. Structural issues such as weak water, sanitation and health systems enable cholera, acute diarrhoea and other waterborne diseases to persist. (UNCT, 31 Dec 2014)
At the beginning of 2015, the number of suspected cases was 75 per cent higher than originally expected in the mid-term review of the 2014 Humanitarian Action Plan (i.e. 15,000). From 8 Nov to 31 Dec 2014, the total number of reported suspected cholera cases was 11 324, with 133 fatalities. This is an increase of 20 per cent compared to the same period in 2013. (ECHO, 16 Jan 2015)
Suspected cholera cases reported for January to March 2015 were above those observed in early 2012 (but lower than those reported in the first quarter of 2013). This was predominately due to large outbreaks in the metropolitan region of Port-au-Prince which then spread to other high-risk regions. According to the national authorities, 4,321 suspected cholera cases and 36 deaths were reported in January, 4,055 suspected cases and 46 deaths in February ,and 3,014 cases and 22 deaths in March. (UNCT, 31 Mar 2015)
For the period between Jan-Jun 2015, OCHA reported 17,949 new cases - a 273% increase compared with the same period last year. As of June 2015, cholera has caused 8,992 deaths since the outbreak in Oct 2010. (OCHA, 27 Jul 2015)
According to the cholera figures released by the Minister of Public Health and Population (MSPP), 36,045 cholera cases and 322 deaths were recorded from January to December 2015. This represents, in comparison to 2014, an increase of 24% in the number of cases. In the last three months (October, November, December 2015), the upward trend of cholera persisted in the North and West departments. (OCHA, 31 Dec 2015)
During the first two months of 2016, the cholera epidemic has had a stable development in relation to the outbreak recorded at the end of 2015. The number of cases increased slightly compared to the same period in 2015, but the trend is downward since mid February. Nevertheless the return of the rain could be an important risk factor. In addition, the number of deaths has increased alarmingly: 15% more compared to 2015. (OCHA, 18 Apr 2016)
As of July 2016, health officials have observed a resurgence of cholera cases in several towns, including in the departments of Artibonite, Center, Nippes, North and West. According to a report of MSPP, more than 823 alerts were recorded during the week of 17-23 July 2016, and about twenty towns are on red alert. The situation is reported to be more critical in the towns of Carrefour (109 cases), Port-au-Prince (83 cases), Tabarre (75 cases), Mirebalais (45 cases) and Verrettes (39 cases). (OCHA, 31 Jul 2016)
In October 2016, Hurricane Matthew devastated Haiti which saw an increase of cases in Grand’Anse (148 cases) , Sud (53), and North-Ouest (6 cases) , and Artibonite (28) in the aftermath. (WHO/PAHO, 11 Oct 2016)
On 14 October, the UN Secretary-General established the Haiti Cholera Response Multi-Partner Trust Fund to finance critical priorities of the new UN system approach to cholera in Haiti designed to support the country in overcoming the epidemic and building sound water, sanitation and health systems. (UN, 14 Oct 2016)
A new approach to cholera in Haiti was laid out in the report by the UN Secretary-General (A/71/620) published on 12 December 2016. The UN General Assembly welcomed and committed to this new approach on 16 Dec 2016.
On 6 February, the Government of Haiti and the Humanitarian Country Team...launched an appeal for...US$ 291.5 million to cover the critical humanitarian needs of 2.4 million people, US$ 34.7 million of which would only be for cholera. (OCHA, 6 Feb 2017)
As of 31 December 2016, Haitian and international efforts have succeeded in reducing the cholera cases and fatalities in Haiti by almost 88% since the peak in 2011 (350,000 cases). From 1st January to 15 April, the MSPP registered 5,095 suspected cholera cases and 69 related deaths, in comparison to the 12,536 suspected cases and 134 deaths for the same period in 2016. This downward trend, if maintained, is an opportunity to take this year a big step towards the elimination of the transmission, in case funding is available and rapid response is accordingly intensified. (UNCT, 27 Apr 2017)
According to PAH/WHO, Haiti recorded 814,551 suspected cases of cholera with 9,693 deaths between October 2010 and 31 July 2017. However, since 2016, the epidemiological situation indicates a marked decrease in the transmission of the disease. According to the MSPP / DELR figures, EPI week 23 (2017) to date is officially the period with the lowest number of suspected cases ever since the outbreak of the epidemic in 2010. This situation is more remarkable given that the rainfall accumulated in April and May 2017 was equal to or even higher than the rainfall measured during the passage of Hurricane Matthew in October 2016. (OCHA, 17 Aug 2017)
The efforts of humanitarian partners to achieve the objective of zero cases of cholera continues with encouraging results. Thus, between January and September 2017, the country recorded a total of 10,814 suspected cases of cholera and 107 deaths against 30,211 cases and 289 deaths for the same period of 2016, a decrease of 64.2%. The highest peak in the number of cholera cases occurred in the department of Artibonite with 64.9% of the suspected cases in the month of September followed by Centre ant Ouest departments. To contain this situation, UNICEF’s partners (ACF, ACTED, Solidarités International, and French Red Cross) mobilized teams from other departments to constitute 19 teams mixed with the Rapid Response Teams (EMIRA) of the MSPP1 in the Artibonite alone. PAHO/WHO also deployed teams to outbreak areas to strengthen response either through institutional care or community activities. However, the lack of required funding for all the components of the National Elimination Plan is a handicap and a major risk for future control of the epidemic. (OCHA, 25 Oct 2017)
In Haiti, the cases reported between EW 1 and EW 50 of 2017 (13,468) represent a decrease of 68% with respect to the cases notified since EW 1 and EW 52 of 2016 (41,421) and is the lowest reported cases since the outbreak started in Haiti in October 2010 (Figure 1). Nevertheless, there are still 200–300 suspected cases reported each week. Between EW 47 and EW 50 of 2017, suspected cases were reported in 9 of the 10 Departments, although four Departments (Artibonite, Centre, Nord-Ouest and Ouest) account for 90% of the cases. In the same period, the average number of cases reported exceeded what was reported in the preceding weeks, mainly with the increases observed in the Nord (36% increase) and Nord-Ouest (19% increase) departments.
Similarly and comparatively between 2016 and 2017 the number of deaths reported decreased by 65% (from 447 to 157 deaths) and represents the lowest number of deaths reported since 2010. (WHO/PAHO, 28 Dec 2017)
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 15-21 July 2018 and includes updates on cholera, chikungunya, dengue, Vibrio growth in the Baltic Sea and West Nile virus.
Les programmes eau, assainissement et hygiène dans les écoles
D’après les données du ministère de l’éducation (plan éducation 2017-2027), les enfants scolarisés en cycle pré-scolaire, fondamental et secondaire (3 à 18 ans) représentaient, en 2015, plus de 4,1 millions d’enfants, soit un tiers de la population du pays.
Grâce à une bonne maitrise de l’épidémie sur le dernier trimestre 2017, l’année 2018 a démarré avec le plus faible nombre de cas suspects de choléra depuis le début de l’épidémie dans le pays en 2010. Une situation de basse transmission prédomine, avec moins de 100 cas par semaine depuis la semaine 3, et une épidémie qui se concentre dans son bassin habituel, les 3 départements les plus touchés (Ouest, Centre, Artibonite) représentant 73% des cas, pour environ 60% de la population du pays (IHSI).
En février 2018, 249 cas suspects et 1 décès ont été rapportés par le Ministère de la Sante Publique et de de la Population (MSPP), soit une diminution respective de 81% et de 92%, comparativement aux cas enregistrés à la même période l'an dernier. Au total, 725 cas suspects ont été signalés au cours des neuf (9) premières semaines épidémiologiques (1er janvier – 3 mars) de 2018, avec un taux d’incidence de 0,06%.
In February 2018, 249 suspected cases and 1 death were reported by the Ministry of Public Health and Population (MSPP), a decrease of 81% and 92% respectively, compared to the same period last year. Overall, 725 suspected cases were reported in the first 9 epidemiological weeks (1 January – 3 March) of 2018, with an incidence rate of 0.06%.
Epidemics are a constant threat to the well-being of communities everywhere, and more especially so in societies where resources are scarce. Managing epidemics, or preferably preventing them, is a priority for the International Red Cross and Red Crescent Movement. The role of communities in preventing, detecting and responding to local health threats is critical in improving the lives of millions across the world.
The year 2018 started against the backdrop of the good results achieved in the cholera response in 2017. The previous year ended with the lowest number of annual suspected cholera cases recorded since the beginning of the epidemic in 2010. The incidence rate of 0.12% for 2017 brought the country closer to the objective of the medium-term cholera elimination plan (PNEC) which targets 0.1% at the end of 2018.
L’année 2018 a commencé sur les bons résultats enregistrés en 2017 qui s’est achevée avec le plus bas nombre de cas suspects de choléra enregistrés en une année depuis le début de l’épidémie en 2010. Le taux d’incidence pour 2017 a été de 0.12%, soit très proche de l’objectif du plan d’élimination moyen-terme (PNEC) qui vise 0.1% à la fin de l’année 2018.
The humanitarian context in Haiti in 2018 continues on the same course as the end of 2017. The estimated number of people in severe food insecurity stands at 1.32 million according to the October 2017 IPC report. One million out of the 2.1 million people affected by Hurricane Matthew are still in need of some form of humanitarian assistance. A total number of 37,667 displaced persons remain in 26 camps following the 2010 earthquake. The positive trend in the cholera situation continues with 432 suspected cholera cases recorded in January 2018.
En 2018, le contexte humanitaire en Haïti suit la même tendance que fin 2017. Le nombre estimé de personnes en insécurité alimentaire sévère s’élève à 1,32 million selon le rapport IPC d’octobre 2017. Sur les 2,1 millions de personnes affectées par l’ouragan Matthew, 1 million ont toujours besoin d’une assistance humanitaire. Le nombre total de personnes déplacées restant dans 26 camps suite au séisme est de 37 667. Le développement positif de la situation du choléra continue avec 432 cas suspects de choléra enregistrés en janvier 2018.
The Emergency Relief Coordinator has allocated $100 million from the Central Emergency Response Fund (CERF) for the 2018 first Underfunded Emergencies round to assist some 4.3 million people in neglected crises in nine countries. The funds will sustain life-saving relief in protracted emergencies where humanitarian suffering is alarmingly high while available resources are critically low. This funding will target:
The earthquake in Haiti was a tragedy for the hundreds of thousands of children and their families who lost everything. The nation was already the poorest and most fragile in the hemisphere. It was a challenging time for aid workers who witnessed their loss and suffering, and were involved in trying to help them.
En 2017, le plus bas nombre de cas suspects de choléra annuel a été enregistré depuis le début de l’épidémie en 2010 grâce à une réponse efficace et coordonnée des acteurs, la prise en charge et un système de surveillance épidémiologique. Cette situation a permis d’atteindre une incidence de 1,12% à la fin de l’année, plus proche de l’objectif de 0,1% fixé pour fin 2018. Au cours du mois de décembre, 776 cas ont été signalés et le total annuel est de 13 681 cas suspects de choléra et 159 décès, soit une baisse respective de -67% et -64% en comparaison avec 2016.
The year 2017 recorded the lowest number of suspected annual cholera cases since the beginning of the epidemic in 2010. This favorable development was as a result of effective and coordinated response, timely clinical care and improved epidemiological surveillance system which made it possible to reach an incidence rate of 1.12% at the end of 2017, bringing the country closer to the target of 0.1% set for the end of 2018.
Au cours de l’année 2017, le contexte humanitaire en Haïti a notamment évolué. Selon les rapports IPC publiés en février et octobre 2017, le nombre de personnes en insécurité alimentaire est passé de 2,35 millions de personnes en phase de crise à 1,32 million. Les personnes déplacées vivant dans les camps suite au séisme de 2010 ont diminué de 46 691 dans 31 camps à 37 667 dans 26 camps. De même, le nombre de personnes dans le besoin d’assistance humanitaire suite à l’ouragan Matthew qui était de 1,4 million en janvier 2017 a été réduit à 1 million en décembre 2017.
The humanitarian context in Haiti notably evolved in 2017. According to the IPC reports published in February and October 2017, the number of people living in food insecurity (crisis phase) decreased from 2.35 million to 1.32 million during these two periods. Displaced persons remaining in camps following the 2010 earthquake reduced from 46,691 in 31 camps to 37,667 in 26 camps. In addition, the number of people in need of humanitarian assistance following Hurricane Matthew reduced from 1.4 million in October 2016 to 1 million in October 2017.
Cólera en las Américas – Resumen de la situación
En la Región de las Américas, entre las semanas epidemiológicas (SE) 1 y SE 50 de 2017 se notificaron 13.582 casos sospechosos de cólera en La Española; 99% de los cuales ocurrieron en Haití (13.468 casos; incluidas 157 defunciones).