Haiti Cholera Update #6

PAHO released its ninth situational update yesterday evening (PDF). MSPP (Ministère de la Santé Publique et de la Population) still has not updated its case figures from 30 October 2010.

Tropical Storm Tomas continues to strengthen, and is expected to cross Hispaniola beginning Friday and into Saturday morning. As of this morning, indications are it will not be a glancing blow.

James Wilson at Haiti: Operational Biosurveillance writes that there is probable massive under-reporting of cases because cholera infection is subclinical in the majority of cases; the extent of the outbreak may be more dire than thought, despite reassurances  the epidemic is under control:

As of Friday, October 29th, PAHO has reported more than 4,700 cases and more than 330 fatalities (apparent case fatality rate approximately 7%).  PAHO was unable to report updated statistics because MSPP had not released them on Monday, Nov 1st.  Statisticsquoted by the media over the weekend indicate fatalities approaching 340.  If approximately 25% of cholera cases are clinically apparent, then a highly conservative estimate places the true case count at nearly 19,000. We estimate the case counts to be closer to 40,000 based on the level of under-reporting and rural transmission occurring in areas not being serviced by responders.  Cholera epidemics often follow a waxing and waning pattern of transmission and therefore can be unpredictable.

Further:

Further evidence of cholera transmission in Cite Soleil has not been reported, which is a key sentinel site for the greater Port au Prince area.  Vigilance and sensitization for cholera in Cite Soleil has been elevated to the maximum extent possible.

We are aware of 12 confirmed cases of cholera reported within PAP but not publicly reported by officials.

(But read the whole thing.)

According to Gabriel Timothée, Director General of MSPP, the epidemic is neither “suppressed nor controlled.” Speaking at a briefing, he said, (PDF – français)

Selon M. Gabriel Timothée, aucun système de santé de la planète ne peut prétendre juguler une épidémie ou contrôler son évolution en un temps si court (10  jours). « Nous ne sommes pas encore arrivés au pic de l’épidémie a souligné Dr Timothée, précisant toutefois que des efforts sont entrain d’être déployés afin d’éviter sa propagation à travers lepays». Ainsi  invite-t-il la population à rester vigilante et à respecter les dernières consignes des autorités sanitaires.

(According to Gabriel Timothée, no health system on the planet can claim to suppress an epidemic or control its progress in such a short time. (10 days). “We have not yet reached the peak of the epidemic,” Dr. Timothée underlined, however adding “efforts are being made to prevent its spread across the country.” Consequently, he asks the public to remain vigilant, and to follow the latest instructions from health authorities. [My translation.])

CBC News reported yesterday the cholera strain found in the Haitian epidemic matches those found in south Asia.  The CDU press release is here. This will undoubtedly continue to complicate the role of MINUSTAH.

Media reports on the epidemic here.

More resources:

Haiti: Operational Biosurveillance (Twitter)

H5N1

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

Mediahacker: Independent multimedia reporting from Haiti (Twitter)

PAHO’s Haiti Cholera page. (PAHO Situation Reports and other documentation.) (Blog.)

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

Partners in Health (Twitter).

Médecins sans frontières

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