Haiti Cholera Update #2

The Pan-American Health Organization (PAHO) reports (PDF) as of 1800 yesterday, 26 October 2010, there have been 284 deaths from cholera and 3,769 confirmed cases. This represents a crude mortality rate of  7.4%. Cholera treated promptly has a mortality rate of 1-2%. Deaths are about equally divided between hospitals and the community; 96% of the deaths are reported from the Artibonite region, where the outbreak began. However HaitiLibre reports actual figures are somewhat higher: 304 deaths and 4,774 cases. [Via]

The slowing of the death rate and the confirmed numbers of new cases has generated some optimism that the outbreak has been contained. However, this outbreak has larger implications, and vigilance will still be needed, as Haiti: Operational Biosurveillance points out:

This is the first documented cholera epidemic in the Caribbean in many years, since the last pandemic of the early 1990s.  WHO’s recent declaration that travel restrictions from Haiti will not be required raises serious questions of whether spread in the region is truly unlikely.

[snip]

This would imply this is an ordinary outbreak / epidemic of cholera.  It is not, and it represents a key epidemiological change for the Carribean region that should be monitored closely.

The Dominican Republic has closed its borders, however it is generally believed the border is highly porous.  Should the epidemic continue, we expect to see cases there eventually.  Jamaica is on high alert, as are other countries in the region.  While we do not want to cause further damage to Haiti’s economy, the question of international travel restrictions should be re-examined at frequent intervals given the volume of multi-national responders flying in to assist.

[snip]

Translocation of cholera to developing or undeveloped areas of the Caribbean, Mexico, Central or South America would likely present in a similar manner as seen in Haiti.

Noteworthy is the Dominican Republic’s decision to more closely regulate border traffic and, in at least one case, shut down a crossing altogether.

A report from the frontline in St-Marc.

Social unrest and a sense of dislocation and loss of power accompany societal crises like epidemics.  Haiti: Operational Biosurveillance documented a couple of instances of this yesterday. Protesters stoned a Médecins san frontières clinic in St-Marc intended to provide rehydration therapy for cholera victims. The local community feared the disease would be brought into their neighbourhood. The clinic was moved to another part of the city. Additionally, the UN Mission for the Stabilization of Haiti (MINUSTAH) was forced to respond to a “community outcry” and rumours that Nepalese troops had carried cholera into Haiti, based an a reported outbreak in Kathmandu on 23 September 2010.

Media reports on the epidemic here.

More resources:

Haiti: Operational Biosurveillance. (Twitter)

H5N1

HaitiLibre (English) (français) (Twitter — English and French)

On the ground, good sources of information and of course needing donations:

Partners in Health (Twitter).

Médecins sans frontières.

[UPDATE: corrected mortality rate]

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