Fadéla Chaib press notes on Haiti - Fadéla Chaib, WHO spokesperson

Report
from World Health Organization
Published on 14 Oct 2016

Hurricane Matthew and cholera in Haiti

The storm’s impact has been heaviest on the Grande Anse, South, and South-East departments.

PAHO/WHO expects an important upsurge in cholera cases after Hurricane Matthew, given the context of flooding and the storm’s impact on water and sanitation infrastructure. So far, 75% of the cholera treatment facilities that have been assessed were destroyed or damaged in the two most affected departments. In Grand Anse province for instance,, 50% of the health facilities suffered damages.

The impact of the hurricane has increased the already high risk of waterborne diseases, particularly cholera, which was already present in several of the most affected areas before Hurricane Matthew hit. Natural water sources in the southern departments have been contaminated by storm water and sewage overflow.

  • Since October 2010, Haiti has reported more than 800,000 cases of cholera, including 9,300 deaths. At its peak in 2011, cholera cases were reaching an average of 6,766 cases every week.
  • During 2016, an average of 771 new cases of cholera was being reported every week, with 28,559 total cases so far. Multiple localized outbreaks resulted in Red Alert notifications for 12 municipalities in the four departments of Grande Anse, Ouest, Artibonite and Nord.
  • In the last four days, PAHO/WHO field teams have reported 477 suspected cases of cholera in the Southern Peninsula.
  • Water distribution systems have almost entirely collapsed in the affected cities of the southern area, including in Jérémie and Les Cayes.

Health concerns

There is a risk of drastic increases in the number of cholera cases in the affected Southern Peninsula, as well as spread of cases to other parts of the country as people move around. Though cholera was an important issue in Haiti prior to the hurricane, it now poses a serious threat to vulnerable populations as the overcrowding of shelters, the rapid deterioration of sanitary conditions and the displacement of affected populations can facilitate the transmission of disease within the areas as well as its spread to other parts of the country. This situation is compounded by the reduced health care delivery capacity to treat cases due to significant loss of medical items and physical damages to the health infrastructure, especially the cholera treatment facilities.

Natural disasters can contribute to the transmission of some diseases when the causative agent is already in the environment. In the case of Haiti, this includes vector-borne diseases as well as cholera and other infectious diseases such as Typhoid. Camps or shelters for Internally Displaced Persons are also prone to outbreaks of Respiratory Infections such as influenza.

PAHO/ WHO support for the response

The priorities are: Restore health care delivery capacity and access to health services in the most affected areas; Increase epidemiological surveillance to support early detection and timely management of disease outbreaks; Intensify vector-control and protective environmental health measures in impacted areas; Ensure rapid and effective response to cholera outbreaks in affected communities.

PAHO/ WHO is supporting the Ministry of Health in identifying areas at high risk of cholera outbreaks, to enhance surveillance in these areas, and to implement targeted interventions to minimize any surge in cholera cases. These high-risk areas are areas with poor access to water and sanitation, where there are high attack rates and high case-fatality rates. PAHO is deploying field epidemiologists from its HQ and other field offices in the region with cholera experience to track and control the outbreaks. More than 80 experts are already on the ground (epidemiologists, clinicians, logisticians, ). These are experts from Geneva, or the Regional office but also experts mobilised through GOARN (Global Outbreak and Action Network).

PAHO is also supporting the use of oral cholera vaccine, which remains in limited supply globally as well as in Haiti. Since 2013, 400 000 Haitians were vaccinated against cholera.

Securing 1 million doses of cholera vaccine in such a short time is a remarkable achievement while the global supply is limited. It was made possible thanks to efforts of WHO partners, including GAVI.

Gavi, the Vaccine Alliance announced recently funding support for a vaccination campaign in Haiti.

WHO, together with other technical partners, has deployed teams across Haiti to investigate the scale and nature of several cholera outbreaks that have occurred since Hurricane Matthew struck on 4 October. This assessment will help shape an effective strategy for the emergency vaccination programme. WHO, the Haitian government, and other partners will work to map out where cholera is most present, and which population should be targeted by vaccination and how to solve the logistical issues.

Basic facts on cholera:

  • Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.
  • Researchers have estimated that each year there are 1.3 to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to cholera1.
  • Most of those infected will have no or mild symptoms, and can be successfully treated with oral rehydration solution.
  • Severe cases will need rapid treatment with intravenous fluids and antibiotics.
  • Provision of safe water and sanitation is critical to control the transmission of cholera and other waterborne diseases.
  • Oral cholera vaccines are an additional way to control cholera, but should not replace conventional control measures.
  • Safe oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.

More information, visit: http://who.int/emergencies/haiti/en/

Best regards, WHO Media Team

Please note Christian Lindmeier ( WHO Communications officer) is in Haiti and can be reached at:
Lindmeierch@who.int
Mob: +41-79-5006552