1. Cholera Outbreak in Haiti
Update November 15th
, 2010

2. Current Situation
• Health partners in Haiti are preparing for growing number
of cases in currently affected areas, as well as in areas
not yet affected;
• The epidemic can spread very fast in the metropolitan
area of Port au Prince due to the large number of IDPs
camps and lack of access to basic sanitation in slums;
• Outbreaks in remote rural areas are a special concern,
both because they are fewer resources to treat cases
and due to the lack of infrastructure to implement
cholera prevention;

3. 12,303 79614,642 hospitalized cases, 917
deaths (MSPP,11/12/2010)

4. Current Situation (b)
• Case Fatality Proportion:
– 4% at national level, varies a lot depending of the
location, in some locations 6%;
– Should be < 1% with access to ORCs, UTCs and CTCs
and adequate Case Management.
• The attack rate could be very different depending of the
human ecosystem (rural, urban/slums, IDP camps):
– could be as high as 5% in IDPs camps and slums in
cities (Gonaives, Cap Haitien, St Marc)

5. The National Response
The National Response Strategy:
• Aims to protect families at the community level including:
– health promotion (water / food handling, hand hygiene,
how to take ORS at home, school training) ;
– management of cases at family and community levels;
– and social communication (messages through print
media, TV , radio, SMS);
• Strengthen primary care centers already operating across
the nation;
• Establish a network of CTCs and strengthen hospitals for
treatment of severe cases.

6. Re organization of Health Services
• Cholera services are being re organized at three levels:
– CTCs: average capacity of 100-300 beds (10 CTCs for
the metropolitan area);
– CTUs: in or next to health facilities, smaller capacity
than CTCs (usually 15-20 beds) can serve as a triage
unit preventing hospitals from being overwhelmed;
– Maintain and strengthen the capacity of Primary Care
network with ORCs (roughly 300 nationwide), to treat
patients with non-life-threatening conditions.

7. 12,303 79614,642 hospitalized cases, 917
deaths (MSPP, 11/12/2010)

8. Some of the priority areas for PAHO
• Surveillance / Risk Assessment: combining indicator
based and event based surveillance including information
from health partners in order to do a timely mapping of
Hot Spots and trigger the response;
• Case Management: disseminating and training on case
management protocols for all levels of health services
including dead bodies management;
• Logistics and supplies: logistics chain for ORS, IV
fluids, antibiotics, etc., PROMESS;
• Information / Communication: media, IHR
• Collaboration with Health and WASH clusters on
water, sanitation, hygiene/health promotion and social
mobilization.

9. Conclusions
What we know:
• All the population is naïve to the cholera vibrio;
• The epidemics will spread to all departments and
districts;
• Vibrio cholerae O:1 has a foothold in the environment and
could impact Haiti for a number of years;
What we don’t know:
• How long will it take before reaching the peak of the
epidemic?
• How long this first wave will last?

10. Conclusions (b)
• Ultimate control of the epidemic in Haiti will
depend on the provision of Safe Water for all
and access to basic sanitation!
• Surveillance and preparedness in Caribbean
countries with Haitian communities: Dominican
Republic, Jamaica, Bahamas, Turk & Caicos….