Cholera Outbreak in Haiti On January 12, 2010, a 7.0 magnitude earthquake struck one of the most underdeveloped countries in the Western Hemisphere, Haiti. By January 24th, 52 aftershock quakes measuring 4.5 in magnitude, or greater, shook the area (Pan American). As the area literally calmed down, the Haitian government had estimated 315,000 people died, 300,000 were injured and 1 million were homeless (Pan American). As this country tries to recover from the devastation, people find themselves in poor living conditions. Most of them, even a year later, are living in tents provided by the Pan American Health Organization (the western hemisphere version of the World Health Organization) or in make shift shelters that they have been able to assemble themselves. Living conditions are harsh. Seventy one percent of families, living in these conditions, have at least one family member go without food for one day in the previous week (IJDH). Twenty one percent have no access to drinking water (IJDH). While living under these conditions, sanitation, including adequate bathroom facilities, have not been considered or given proper priority or proper thought this is more than understandable, when one is unsure where the next meal, or drink of water is coming from, an adequate bathroom facility is not of concern. Unfortunately, the area has now come to realize the need for proper sanitation and proper facilities. Cholera is caused by a gram negative bacterium called Vibrio cholera (Nature Review). This bacterium is differentiated serologically on the basis of the O antigen of its lipopolysacchardie (Nature Review). The Cholera toxin producing strains of the O1 and O139 serogroups cause the vast majority of the disease. O1 has 2 biotypes, Classical and El Tor, and each of these has two serotypes, Inaba and Ogawa. The symptoms of the infections are indistinguishable, but higher proportions of persons infected with El Tor biotype remain asymptomatic or only have a mild illness (CDC). Infections with V. cholera produce a large variety of symptoms. V. cholera colonizes the small intestines for twelve to seventy two hours before symptoms are exhibited. Severe symptoms include vomiting and profuse diarrhea, moderate to severe dehydration, causing hypovolaemic shock, and rice watery stools. Symptoms usually begin with stomach cramps and may progress to a loss of one liter of fluid per hour (Nature Review). With the large loss of fluid, this can cause severe fluid depletion and metabolic acidosis (Nature Review). This could lead to circulatory collapse and even death. Other symptoms include rapid heart beat, loss of skin elasticity, dry mucous membranes, low blood pressure, thirst, muscle cramps and restlessness or irritability (CDC). Patients with severe Cholera can develop acute renal failure, electrolyte imbalance and coma. Infected patients produce large amounts of infectious V. Cholera bacteria. Without adequate bathroom facilities, the bacteria contaminate water or food supplies causing more cases (CDC). Cholera transmission is closely related to poor environment management. It spreads mainly thru contaminated water, but has been found in improperly preserved or mishandled food. This includes fish, seafood, milk, ice cream and unpreserved meat. Cholera is not transmitted generally person to person, but can happen due to poor hygiene and sanitation. For rapid detection of V. cholera, dark field microscopy of a stool specimen from a Cholera patient will reveal rapid, darting or shooting-star motility. When a drop of V. cholera antiserum is put on a slide, it rapidly immobilizes the organism (Clinical Microbiology). There are also latex agglutination and PCR tests available. Definitive laboratory diagnosis of cholera requires the isolation of the organism from the patient. Most Vibrio species will grow on thiosulfate citrate bile salts sucrose agar (TCBS) (Clinical Microbiology). Treatment for patients with Cholera is actually very simple, fluid replacement. Patients are rapidly losing fluid, putting them at risk for electrolyte imbalance, and thus replacement of those fluids is extremely important. Patients that are experiencing mild symptoms can accomplish this with oral rehydration salts, where as patients experiencing severe symptoms will need intravenous fluids. Antimicrobial agents can be administered to shorten the duration of the diarrhea, and therefore reducing fluid loss (CDC). There are two different vaccinations available that provide some protection, Dukoral and Shanchol. The first one is prequalified by the World Health Organization (WHO). Dukoral, has been shown to provide short term protection for 85-90% against V. cholera O1 among all ages for 4-6 months after the vaccination is given. The second vaccine is pending WHO qualifications. Shanchol, provides longer term immunization of O1 and O139 in children under five (WHO). The WHO recommends that immunizations should be used in high risk areas along with the recommended control measures. The Center for Disease Control (CDC) recommends measures to prevent contracting and prevent the spread of Cholera. Those precautions consist of drinking and using safe water, either bottled or boiled water. Wash hands with soap frequently with safe water. Use proper facilities, or latrines (do not use open bodies of water). Cook food properly, keep it covered and wash fruits and vegetables well with safe water. Keep things clean, like the kitchen and kitchen utensils, family washing areas and clothing (CDC). With the current Cholera outbreak in Haiti, the Pan American Health Organization (PAHO) has taken action to prevent the spread of the disease. This organization has help establish 12 cholera treatment centers to support isolation and treatment of infected patients. The PAHO is also supporting the Water and Sanitation Cluster in Haiti, which is providing powdered chlorine for water purification and testing water being distributed to settlement camps. The organization is also taking special efforts to ensure safe water is available in hospitals (WHO). With more than half the deaths from Cholera in Haiti are patients that do not make it to a hospital; the PAHO is mobilizing experts in the proper disposal of bodies in Haiti. The PAHO also has a program called PROMESS- program on essential medicine and supplies-with warehouses currently stocked with medicines and other essential medical supplies, while procuring more from donations from other countries (PAHO).

Work’s Cited

Baron, Ellen Jo; Murray Patrick R.; Pfaller, Michael A.; Tenover, Fred C.; Yolken, Robert H.; “Manual of Clinical Microbiology” 6th ed. 465-471 1995

Camille, Andrew; Caldenwood, Stephen B; Harris, Jason B.; Morris, J. Glenn Jr.; Nelson, Eric J. “Cholera Transmission: The Host, Pathogen and Bacteriophage Dynamic” Nature Reviews:Microbiology Volume 7, October (2009) 693-702 Print.

Center for Disease Control, “2010 Haiti Cholera Outbreak” cdc.gov 2010 Web. 2 Feb 2011

Center for Disease Control, “Cholera; Prevention & Control:, cdc.gov 2010 Web 2 Feb 2011

“Cholera” who.org, World Health Organization n.d. Web 2 Feb 2011

Institute for Justice and Democracy in Haiti (IJDH) and The LAMP for Haiti Foundation “One year after the earthquake-Haitians still living in crisis” Web 2011

Pan American Health Organization “PAHO Responds to Cholera Outbreak in Haiti” www.new.pahp.org Web 2 Feb 2011