The cholera outbreak in Haiti has resulted in over 664,000 cases and 8,000 deaths since 2010. Cholera spreads rapidly in areas with contaminated water and poor sanitation. Factors exacerbating the outbreak in Haiti include a lack of immunity, poverty, damage from natural disasters, and an increased virulence in the cholera strain. NGOs like Oxfam have implemented water, sanitation, and hygiene programs to control transmission, including chlorine dispensers, wells, latrines, and health education. However, ongoing issues like flooding and funding gaps increase the risk of further cholera spread.
2. Current Status of the Outbreak
⢠As of July 6, 2013, there have been 664,921
cholera cases and 8,178 cholera deaths in Haiti.
From MSPP
3. Introduction to Cholera
âIn its most severe form, cholera is one of the
swiftest lethal infectious diseases known,
characterized by an explosive outpouring
of fluid and electrolytes within hours of
infection that, if not treated
appropriately, can lead to death within
hours. In places where drinking water is
unprotected from fecal contamination,
cholera can spread with stunning speed
through entire populations. These two
characteristics of cholera have yielded a
reputation that evokes fear and often panic.
However, with prompt and appropriate
treatment, mortality can be kept low.â - UNICEF Cholera Manual
4. What is Cholera?
⢠Cholera is caused by Vibrio cholerae bacteria that act
by attaching to cells that line the intestine where it
produces a toxin that interferes with the normal
cellular processes of absorption and secretion of fluid
and electrolytes.
⢠Up to 50 per cent of infected people could develop
severe dehydration with high mortality risk if left
untreated.
7. Pregnancy and Cholera
⢠Cholera patients who are pregnant have additional risk
factors for more severe outcomes.
⢠The greatest potential impact of maternal cholera
infection affects the outcome of the newborn because
cholera infection in the third trimester poses a greater
risk of spontaneous abortion and premature delivery.
⢠Poor outcomes are due to dehydration and reduced
blood flow to the placenta.
9. Climate Change & Cholera
Climate change potentially increases the risk of
cholera in a number of ways:
⢠the growth of bacteria, like V. cholerae in the
environment substantially increases at higher
temperatures.
⢠severe natural disasters damage water and
sanitation infrastructure and create higher
transmission risk.
12. From the 2013 UN Humanitarian Action Plan
(Mid-year Review)
⢠âFollowing long periods of drought and the
destruction of harvests by Tropical Storm Isaac and
Hurricane Sandy in 2012, more than 15% of Haitians
face a significant risk of food shortages âŚâ
⢠âAs many as 81,600 children under five are acutely
malnourished; 20,000 of these suffer severe acute
malnutrition and are nine times more likely to die
than healthy children.â
⢠âThe upcoming rainy and hurricane season is likely
to bring about an increase in cholera casesâŚwhile
funding gaps have led to a serious decrease in the
capacity to respond.â
13. âWe had barely picked ourselves upâ
⢠âWe had barely picked ourselves up after the
earthquake when the cholera fell on us.â
- Jocelyne Pierre-Louis, a senior Haitian health official
⢠Haiti's outbreak "is one of the largest cholera
epidemics in modern history to affect a single
country."
- Jon Andrus, deputy director of the PAHO
14. Some Cholera Risk Factors in Haiti
⢠Low safe drinking water & improved sanitation coverage
⢠Hygiene â food handling & inadequate hand washing
⢠Natural disasters and rainy season(s)
⢠Topography is conducive to flooding
⢠Lack of pre-existing immunity at onset of outbreak
⢠Economic situation/poverty increases risk
⢠Household member with cholera increases risk of
cholera for whole family
⢠Children with malnutrition
⢠Remote areas have dramatically higher mortality risk
⢠Dramatically reduced number of cholera treatment
centers/units in 2013 increases mortality risks
27. Haiti Cholera Strain Has Increased Virulence
⢠The current cholera pandemic caused by the âEl Torâ
cholera strain has been spreading worldwide since 1960.
Subsequently studies revealed âaltered El Torâ strains.
⢠Compared to the typical El Tor pandemic strain, the
âaltered El Torâ strain in Haiti is linked to increased
production of cholera toxin and more severely
dehydrating diarrheal disease.
⢠In a CDC study in Haiti âMedian time from illness onset
to death was âŚâŚ12 hours (range 2 hoursâ8 days) for
community decedentsâ
â Routh et al. âRapid assessment of cholera-related deaths,
Artibonite Department, Haiti, 2010â Emerg Infect Dis
28. Dr. Sacks of John Hopkins:
"Cholera is an environmental bacterium. It can
persist in the environment for many, many years
without any human infection. ...â
From UCLA http://www.ph.ucla.edu/epi/snow/cholera_haiti.html
29. Cholera & IDP Camps in Port au Prince
⢠The earthquake of January 12, 2010, destroyed homes,
schools, government buildings, and roads around Port-
au-Prince; killing 230,000 persons and injured 300,000
and one and a half million residents sought shelter in
internally displaced person (IDP) camps.
⢠Drinking water systems - portable tanks filled by
trucked in water from deep boreholes and then
chlorinated in the camps - were installed by a number
of NGOs including Oxfam.
⢠When the outbreak arrived on Port au Prince, cholera
attack rates in the IDP camps were much lower than in
Artibonite and other areas (source â The CDC journal
Emerging Infectious Diseases).
47. Examples of Oxfamâs Cholera-WASH Approach
⢠Repaired gravity flow water systems (GFSs) in Artibonite
⢠E. coli (m. ColiBlue 24) & turbidity testing of water sources
to confirm appropriate locations for chlorine dispensers
⢠Installed hand drilled wells & hand pumps in Artibonite
⢠Distribution of large numbers of Aquatabs & soap
⢠Installed and monitored chlorine dispensers at
community water sources in Nippes
48. Oxfam Cholera-WASH Activities (continued)
⢠Installed in-line tablet chlorination systems in Nippes
⢠Installed latrines at schools and homes
⢠Trained & worked closely with local water committees
⢠WASH cholera prevention messaging (e.g. radio)
⢠Provided WASH supplies to cholera treatment centers
⢠Installed rainwater collection systems at CTUs
⢠Installed protected dug wells with ârope pumpsâ in
Artibonite that are easy to maintain and repair
49. ⢠Oxfam installed chlorine dispensers in Nippes (1 of 10
âDepartmentsâ in Haiti) because of high CFRs there &
because of the scarcity of other NGOs working on WASH
74. Acknowledgements
⢠Bill and Melinda Gates Foundation
⢠Innovations for Poverty Action (IPA)
⢠International Action â Haiti
⢠ECHO
⢠Hach
⢠MSPP & DINEPA
⢠UNICEF