Notes on the Cholera Crisis in Haiti

As of 1800 last evening, according to the Pan-American Health Organization (PAHO), there have been 2,564 cases and 194 deaths from cholera in Haiti in the past week. This represents a crude mortality of 13.26%. With prompt treatment, mortality from cholera is around 1-2%. This morning there are reports of more than 200 dead.

The latest PAHO situation report (PDF) seems to imply its initial emergency supplies are still in a warehouse near the Port-au-Prince airport.

There may have been cases of the disease as early as the week before last, which are unconfirmed by PAHO. The present outbreak is centred north of the capital, Port-au-Prince, in the Artibonite river watershed, and unconfirmed cases were reported yesterday in Port-au-Prince. It is not known how the disease came into Haiti, as the country has not had an outbreak of cholera for a century.

Map of the outbreak. Click to enlarge.

Initial primary treatment for cholera includes rehydration using oral rehydration salts. However, these need to be reconsitituted using potable water; this seems problematic where somewhere over 70% of Haitians had no access to clean water before the earthquake. The slow international response to the devastating earthquake is being blamed for the outbreak:

Melinda Miles, Director of Let Haiti Live, expressed her frustration to UN Dispatch today, “Considering that an outbreak of this nature was predicted nine months ago, it is absolutely stunning that so little was in place to prepare for it.”

A primer on cholera by Peter Jones: think massive diarrhea and dehydration.

Cholera has been known and feared for centuries due in large part to its tendency to occur as epidemics, which afflicts thousands and at one time had case-to fatality rates of nearly 50%. Today with improved treatment strategies case-to-fatality rates can be as less than 1%.

This infectious gastroenteritis is one of the most rapidly fatal illnesses in existence, threatening to propel its victims into hypovolemic shock within only 4 hours of its onset. Vibrio cholerae, the gram negative bacteria that produces the cholera toxin, takes a mere 24 -72 hours to incubate and once symptomatic, has begun its damaging work.

MSF Treatment guidelines. Click to enlarge.

A horrendous account of conditions at l’hôpital St-Nicholas in St-Marc:

We arrived at St Marc hospital to a horror scene. I had to fight my way through the gate as a huge crowd of worried relatives stood outside, while others screamed for access as they carried dying relatives into the compound. The courtyard was lined with patients hooked up to intravenous (IV) drips. It had just rained and there were people lying on the ground on soggy sheets, half-soaked with feces.

Media following the epidemic.

Another great resource: Haiti: Operational Biosurveillance. (Twitter)

On the ground, good sources of information and of course needing donations: Partners in Health (Twitter). Médicins sans frontières.

[Cross-posted at Those Emergency Blues]

[UPDATE: minor grammatical fixes. Added words “for the outbreak” at end of para 4 for clarity.)