What happened in Haiti Part I: One country’s battle against time and cholera

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Part I – Where it came from

(From left) Jim Hughes, MD, Scott F Dowell, MD, MPH, Stephen B Calderwood, MD, of Massachusetts General Hospital, and Jean William Pape, MD.

Photos of tent villages, shifty outdoor medical treatment centers, and contaminated water supplies populated the slide presentations detailing the public health response to the earthquake and subsequent cholera outbreak in Haiti Sunday morning in Boston.

Infectious diseases experts involved first-hand in the response to the cholera epidemic in the poorest Caribbean nation described the different facets of the outbreak there at the Infectious Diseases Society of America’s 49th Annual Meeting in Boston Sunday.

An infection in the small intestine that causes immense amounts of watery diarrhea, cholera accounts for four percent of global mortality – causing approximately 1.4 million deaths per year.  Childhood diarrhea contributes greatly to worldwide morbidity and mortality. Cholera bacteria grows mainly in salt water, but also in fresh water at warmer temperatures where there are higher concentrations of nutrients, said Stephen B Calderwood, MD, of Massachusetts General Hospital during his presentation. Descriptions of cholera-like epidemics date back as early as 5th century BC, he said, and we are currently in the middle of the world’s seventh cholera pandemic. Recent analysis suggests the Haiti outbreak originated from a single source in the Bay of Bengal and has spread since to distant locations.

Following the January 2010 Haiti earthquake, the outbreak of the south Asian V. cholerae 01 infection – not the South American strain of the virus as many had surmised – gained international attention in October of that year, and is now showing up in parts of the United States, Calderwood said.  An individual can die from the infection within 12 to 24 hours of exposure, although it is fully curable assuming the patient can be correctly rehydrated, he said, with mortality only related to complications or immune system weakness, like those with HIV infection.

A slide depicting the urgent need of medical supplies in Haiti health clinics in the aftermath of the earthquake in January 2010.

The World Health Organization said Friday that if current trends continue, cholera cases in Haiti will surpass 500,000 by the end of 2011.

The presenters noted that since Haiti hadn’t seen a cholera outbreak in recent years, and sanitation and water purification in the poor island nation is basically at the level most countries in Latin America experienced in the early 1990s, the environment was ripe for an outbreak.

What’s the key to turning the situation around? Improved sanitation and water purification in the small country, coupled with a mass education campaign to encourage residents to seek treatment for watery diarrhea immediately, the doctors said, and to associate the chlorinated taste of treated water with that of purification.

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