The Cholera Epidemic in Haiti Continues

For the last six years, Haiti has been fighting a severe cholera epidemic and it is unlikely that the fight will end soon. Cases were first documented in 2010 after an earthquake in January of that year. At that time, peacekeepers who were sent by the United Nations (UN) from Nepal, went to Haiti to assist in relief efforts. They set up camp alongside the Meille River, which fed into the Artibonite valley. Early reports stated, “Multiple lines of evidence indicate that Vibrio cholerae was newly introduced into Haiti [potentially, by the peacekeepers]. Cholera had not been documented in Haiti for at least several generations.” The report continues to assert, first cases occurred in the upper Artibonite valley.

Initial research, conducted in part by the Centers for Disease Control and Prevention (CDC), called it “one of largest cholera epidemics ever recorded.” In the study conducted by Doctors without Borders and published in the CDC’s Emerging Infectious Diseases journal, researchers suggested that crude mortality rates were closer to "19.1—35.4 deaths/1,000 person-years," a substantial difference over the initial baseline mortality reporting, which was closer to "9 deaths/1,000 person-years."

The end of the first wave of the epidemic was mid-April 2011; by then there were approximately 283,000 cases and of those cases, approximately 4,800 deaths were reported. However, when researchers reassessed active case findings in November 2010, they estimated that around 87% of deaths that occurred from cholera were never recorded as such in hospital records.

Speaking with Contagion, Larry I. Lutwick, MD, FACP, professor of medicine and biomedical sciences, infectious diseases, microbiology and immunology at Stryker School of Medicine, Western Michigan University and a moderator for the Program for Monitoring Emerging Diseases said, “underreporting is not a surprise, many countries record ‘acute watery diarrhea’ as the cause of illness, not ‘cholera’ as well as many cases and deaths are not seen by the health care system but, even with underreporting it is still a substantial number of cases.”

A recent article published in the NY Times claims that the UN has begun to acknowledge its role in the epidemic. The article reports that through an email statement, deputy spokesman for the secretary general, Farhan Haq, said, “over the past year, the UN has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera. A new response will be presented publicly within the next two months, once it has been fully elaborated, agreed with the Haitian authorities and discussed with member states.”

According to the NY Times article, this statement came as a response to a report given by Philip Alston, a New York University law professor and special rapporteur for the UN. In it, Alston told Secretary General Ban Ki-moon that the cholera epidemic, “would not have broken out but for the actions of the United Nations.” According to Haiti’s Ministère de la Santé Publique et de la Population (MSPP), nearly 780,000 people have been infected with cholera to date. More than 9,000 deaths have also been reported.

Dr. Lutwick says, “There were cases in Dominican Republic, in Mexico, and Cuba, even the United States but, it didn’t stick because in these countries, [except] for Dominican Republic (which shares a river with Haiti) [because] the infrastructure is better; there is hot and cold, clean, running water.” He continued, “Is it so entrenched that it is never going away? No, not necessarily, but without clean, running water it’s going to be a while,”

The MSPP continues to actively address the burdens cholera has had in Haiti. They hope to eliminate cholera in Haiti by 2022. They are currently focusing efforts on finding donors to help them raising the necessary funds needed to continue their fight.