2010–2011 Haiti cholera outbreak

2010–2011 Haiti cholera outbreak
2010–2011 Haiti cholera outbreak
Date October 2010
Location Artibonite Valley, Haiti
Casualties
6,000+ dead[1]
117,312 hospitalised[2]
344,623 total cases[1]

The Haiti cholera outbreak is an cholera outbreak that began in late October 2010 in the rural Artibonite Department of Haiti,[3] about 100 kilometres (62 mi) north of the capital, Port-au-Prince, killing 4672 people by March 2011[4] and hospitalising thousands more.[5] The outbreak followed a powerful earthquake which devastated the country on 12 January 2010.

By March 2011, some 4,672 people have died and 252,640 cases had been reported.[6] By the first 10 weeks of the epidemic, cholera spread to all of Haiti's 10 departments or provinces.[7] In November 2010, the first cases of cholera were reported in the Dominican Republic and a single case in Florida, United States; in January 2011 a few cases were reported in Venezuela. As of late September, 2011, some 6,435 deaths have been reported and is expected to continue rising.[8] Neighboring Dominican Republic has reported 135 cholera deaths as well.

Contents

Background

During the 1900s, six major cholera pandemics had spread around the world. At the time of this outbreak, the world was experiencing the seventh, caused by a new strain of the Vibrio cholerae bacterium, El Tor. Epidemics involving this strain started in 1961 in Indonesia, and spread rapidly elsewhere in eastern Asia and then to India and Bangladesh, the USSR, Iran and Iraq.[9] This was the first outbreak in Haiti in over 50 years.[10]

On October 21, the US Centers for Disease Control and Prevention (CDC) confirmed that cases of diarrheal illness that hospitals in the Artibonite region had been receiving had been identified as cholera.[11] The outbreak represented the first significant occurrence of cholera in Haiti for half a century, and as a result, it triggered panic and confusion in the populace, complicating relief efforts.[12]

According to the US CDC, in most instances cholera does not spread widely within countries where drinking water and sewage treatment are adequate. When water and sewage treatment is inadequate, as in Haiti after the 2010 earthquake, cholera can spread rapidly.[13]

Source

The suspected source for the epidemic was the Artibonite River, from which some of the affected people had drunk water.[5] A UN team investigated samples of a suspected sewage spill from a Nepali peacekeeping base that may have infected the river system. Vincenzo Pugliese of MINUSTAH confirmed that the tests were positive for cholera.[14] The US CDC said its tests of "DNA fingerprinting" showed various samples of cholera from Haitian patients were identified as Vibrio cholerae serogroup O1, serotype Ogawa, a strain found in South Asia.[13][15][16]

Gregory Hartl, a spokesman for the World Health Organization (WHO), said finding the cause of the outbreak was "not important". "Right now, there is no active investigation. I cannot say one way or another [if there will be]. It is not something we are thinking about at the moment. What we are thinking about is the public health response in Haiti."[17] Jordan Tappero, the lead epidemiologist at the CDC, said the main task was to control the outbreak, not to look for the source of the bacteria and that "we may never know the actual origin of this cholera strain."[18] A CDC spokesperson, Kathryn Harben, added that "at some point in the future, when many different analyses of the strain are complete, it may be possible to identify the origin of the strain causing the outbreak in Haiti." Paul Farmer, a co-founder of the medical organisation Partners in Health, however, said there was no reason to wait. "The idea that we'd never know is not very likely. There's got to be a way to know the truth without pointing fingers." A cholera expert, John Mekalanos, supported the assertion that it was important to know where and how the disease emerged because the strain is a "novel, virulent strain previously unknown in the Western Hemisphere and health officials need to know how it spreads."[13] The Swedish ambassador to Haiti said the epidemic had strains originating in Nepal.[19] However, Nepal's representative to the United Nations "categorically refuted" the hypothesis that Nepali peacekeepers were the source of the outbreak.[20]

Three US professors or other employees at major US universities disagreed with the contention that the Nepali soldiers were the source of the outbreak, saying that they believed it was more likely dormant cholera bacteria had been aroused by various environmental incidents in Haiti.[21] They said a sequence of events, including changes in climate triggered by the La Niña climate pattern and unsanitary living conditions for those affected by the earthquake, triggered bacteria already present to multiply and infect humans.[21] However, a later study conducted by French epidemiologist Renaud Piarroux contended that UN troops from Nepal had started the epidemic as waste from outhouses at their base flowed into and contaminated the Artibonite River.[22]

Following the claims the UN said it would investigate the source of the cholera strain.[23]

UN peacekeepers from Nepal brought the strain of cholera to Haiti responsible for an epidemic that has killed 5,500 people, according to a study published by the US Centres for Disease Control and Prevention (CDC). The study is the first to establish a direct link between the arrival of the Nepalese UN battalion near the small town of Mirebalais and the cholera epidemic that erupted in mid-October 2010.[citation needed] The UN continued to be blamed for causing the outbreak by NGOs.[24]

Domestic reactions

Protesters have demanded that the Nepali brigade of the UN leave the country.[25] There were fears that following the discovery of 15 cases in the capital, the epidemic could spread further.[26] The Pan-American Health Organisation predicted that 270,000 people would be infected within a year of the outbreak.[27]

On 15 November, a riot broke out in Cap-Haïtien following rumours that the outbreak was caused by U.N. soldiers from Nepal.[28] At least 5 people were killed in the riots, including 1 UN personnel.[29] Riots then continued for a second day.[30] Following the riots the UN said the outbreak was being staged for "political reasons because of forthcoming elections", as the Haitian government sent its own forces to "protest" the UN peacekeepers.[31] During a third day of riots UN personnel were blamed for shooting at least 5 protestors but denied responsibility.[32] On the fourth day of demonstrations against the UN presence, police fired tear gas into an IDP camp in the capital.[33]

Riots following the election were a cause for concern in the ability to contain the epidemic.[34]

Spread

By the end of October cholera had been confirmed in four of Haiti's ten departments: Artibonite, Centre, Nord and Ouest, including the capital Port-au-Prince,[5][35] and the capital's Cité Soleil slum district,[36] By 16 November it had spread throughout the country.[29] In addition to those hospitalised, other people have been unable to receive treatment due to overcrowded hospitals.[37] Health workers also feared the disease would spread after Hurricane Tomas hit the island causing more flooding.[38]

There are fears that the disease could further spread, since many people still live in unsanitary camps as a result of the earthquake earlier in the year,[39] after outbreak was reported in the camps.[40] These concerns came despite claims that the outbreak had been contained in the north and central parts of the country.[10] The first outbreak of cholera was reported in the Dominican Republic in mid-November 2010,[41] following the Pan-America Health Organisation's prediction.[27] By January 2011, the Dominican Republic had reported 244 cases of cholera.[42] The first man to die of it there died in the province of Altagracia on 23 January 2011.[42] In the United States, a woman returning from Haiti to Florida was hospitalised for five days as a result of contracting cholera. She is expected to recover fully. The Florida Department of Health also investigated several other suspected cases of the disease.[43]

On 15 November, Laura Dills, director of programming for Catholic Relief Services in Haiti, said, "Some people have been reporting that we've gotten in front of it and are in control of the spread of cholera. Actually WHO does not believe that. There's such a severe underreporting of cases that they're not sure of all of the hot spots."[44]

The Haitian government estimated that there would be at least 400,000 cholera cases in the first 12 months of the epidemic—with half of those cases occurring by mid-January 2011.[7]

In late January 2011, more than 20 Venezuelans were reported to have been taken to hospital after contracting cholera after visiting the Dominican Republic.[45][46] 37 cases were reported in total.[42] Contaminated food was blamed for the spread of the disease.[47] Venezuelan health minister Eugenia Sader gave a news conference which was broadcast on VTV during which she described all 37 people as "doing well".[42] The minister had previously observed that the last time cholera was recorded in Venezuela was twenty years before this, in 1991.[42]

On 15 March 2011, a report was issued by the University of California that predicted total infections would number up to 779,000 and total deaths up to 11,000 by November 2011, compared with earlier UN estimates that around 400,000 people would end up infected.[6] The revised numbers were based on more factors than the UN's estimates, which assumed a total infection rate of between two and four percent of the population.[6] In a statement released at the same time, the WHO said total deaths thus far had reached 4,672, with 252,640 cases reported.[6]

Controversy

A clinic located next to a school ignited protests as locals felt the schoolchildren could be vulnerable to the spread of the disease.[48]

The spread was partially blamed on the poor distribution of health supplies due to logistical problems.[7] A global medical aid agency, the Pan American Health Organization, said there was also a lack of access to untainted drinking water.[7]

Casualties

Some aid agencies have reported that the toll may be higher than the official figures because the government does not track deaths in rural areas where people never reached a hospital or emergency treatment center.[44] In 2011, reports suggested over 6,700 people had been killed during the outbreak.[49]

Political reactions

On 28 October, the head of Haiti's health department, Gabriel Thimoté, said 4,147 people were being treated. WHO's cholera chief, Claire-Lise Chaignat, said the epidemic was not contained and that she thought it had not yet "reached the peak", so Haitian authorities should be prepared for a "worst case scenario" of cholera spreading in the capital, Port-au-Prince.[50]

On 10 November, Gabriel Thimote, Haiti's senior health official, said that the outbreak was "no longer a simple emergency, it's now a matter of national security."[27]

The outbreak of cholera became an issue for candidates to answer in the 2010 general election.[51] There were fears that the election could be postponed. The head of MINUSTAH Edmond Mulet said that it should not be delayed as that could lead to a political vacuum with untold potential problems.[52]

On 12 November, the United Nations issued an appeal for around $160 million to fight the spread of the disease, saying that "all our efforts can be outrun by the epidemic" and warned of a lack of space for patients in hospitals.[53] It also denied that the Nepali contingent were responsible for the outbreak.[29] In November 2011, the UN was received a petition from 5,000 victims for hundreds of millions of dollars in reperations over the outbreak though to have been caused by UN members of MUNISTAH.[49]

See also

Portal icon Disasters portal
Portal icon Caribbean portal
Portal icon Haiti portal
Portal icon Health and fitness portal
Portal icon Medicine portal
Portal icon United Nations portal


References

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External links

v · d · eCholera
Cholera Vibrio cholerae
Cholera Bacteria
Vibrio cholerae - Strains: El Tor
Discovery:1854 Broad Street cholera outbreak - John Snow - Reverend Henry Whitehead
Treatment
Outbreaks

Cholera Pandemics: First cholera pandemic - Second cholera pandemic - Third cholera pandemic - Fourth cholera pandemic - Fifth cholera pandemic - Sixth cholera pandemic - Seventh cholera pandemic

Other outbreaks: 1854 Broad Street cholera outbreak - 2007 Central Luzon hog cholera outbreak - 2007 Iraq cholera outbreak - 2008 Congo cholera outbreak - 2008–2009 Zimbabwean cholera outbreak - 2010 Haiti cholera outbreak

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Coordinates: 19°06′N 72°20′W / 19.1°N 72.333°W / 19.1; -72.333


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