Sunday 20 May 2012

Cholera Outbreak: Haiti

Susan Brannon
20 May 2012

The first cholera outbreak occurred in late October 2010 and had nothing to do with the earthquake of January 2010.  The outbreak occurred in the Artibonite valley which is around 100 kilometers north of Port-au-Prince.  According to Wikipedia there has been 7,500 deaths and 290,491 hospitalized  and 540,145 cases.

There has been a rising concern of another outbreak due to the rainy season, and infected water in 2012.  Medical organizations have been asking for funding for vaccines to help prevent and/or lower the risk of contamination to the population.  Funding and medical support has been hard to come by and it seems that the world has plain forgotten the Haitian people. 

For over 100 years Haiti has not documented a single case of cholera.

Cholera had entered the Artibonite River, Haiti's longest, 60 miles upstream ó most likely from a leaky latrine at a United Nations camp for peacekeeping troops, who carried it from Nepal. As a result, many people in Ballange got sick, and some died.

A UN team investigated samples of the sewage spill from the peacekeeping base, and Vincenzo Pugliese of MINUSTAH confirmed that the tests were negative for cholera.  However, this matter is under dispute.  The World Health Organization (WHO) said the cause of the outbreak is "not important" because they need to think of the public health response in Haiti.  WHO is not sure if they will ever investigate the cause.  The Center for Disease Control agrees with WHO and feels that they may never find out the cause of the outbreak.  However on the other side, John Mekalanos, a cholera expert feels that it is important to know the origins of the outbreak in order to identify the "strain" that is involved and how to predict its behavior.

A few weeks ago, Doctors Without Borders (MSF) has been concerned about the upcoming rain season and an increased outbreak devastating the lives of the Haitians.  As of 9 May, MSF reported that the number of cases has quadrupled in less and a month to 1,600 cases in Port-au-Prince.  "There are many meetings going on between the UN, the government and humanitarian partners but no one is coming up with any concrete solutions."  More than half of the organizations that were in the Artibonite region in 2011 are not there anymore and those that stayed are short of drugs and some staff have not been paid since January. In the meantime, cholera is entrenched in the environment.

On April 12th, Partners in Health started to immunize in the slums of Port-au-Prince and areas in the Artibonite river valley to 100,000 Haitians; only 1 percent of the population. The shots need to be given in two doses over a two week period for them to work.  Shanchol, the vaccine producer in India for this pilot project will use up almost all the current world supply of the vaccine.

The Haitian health minister, Dr. Florence Duperval Guillaume, approved the project in December whereas, the previous administration opposed the vaccination.  There are concerns regarding the vaccine because the concern is not the vaccine, but creating public awareness and education on sanitation and the use of portable water.  However, cholera won't wait for improvements that have yet to occur in that department.

At this moment there are eight million Haitians that lack potable water or proper sanitation.  This cannot be done in five years, so in the end, the vaccine is important and there is not enough to go around; this is the concern.

However according to a Haitian radio program, there are ethical concerns regarding the vaccines.  The vaccines have never been used in an ongoing outbreak situation with cholera which makes this a "trial situation" that is used on the Haitian people.  The broadcast generated the awakening of the ethics committee, yet the trial gained its approval.

Vaccines are complicated, you must give them during certain times with a specific time in between, and cannot be given in correlation with the polio vaccine for children under 10-years old.  This makes giving the vaccine complicated because they have to wait until the children has received their polio vaccine, track them down to give them the cholera vaccine.

Individuals can prevent or reduce the chance they may get cholera by hand washing, avoiding areas and people with cholera, drinking treated water or similar safe fluids and eating cleaned and well-cooked food. In addition, there are vaccines available that can help prevent cholera, although they are not available in the U.S. and their effectiveness ranges from 50%-90%, depending on the studies reported. The vaccines are oral preparations as injected vaccines have not proved to be very effective. Two vaccines (Shanchol and mORC-VAX) are composed of killed V. cholerae bacteria and without the enterotoxin B subunit. Unfortunately, both offer protection for only about two years. Both vaccines are given in two doses, about one to six weeks apart. Unfortunately, the vaccines have limited availability; their recommended use is for people going to known areas of outbreaks with the likely possibility the person may be exposed to cholera. 

In the end, cholera will again take its tool in Haiti and who knows how many more lives it will take while the rest of the world, forgets Haiti.

Related links:
Dady Chery
Medecins Sans Frontiers
IPS News 
Haiti:  Quick Facts
The Crossing Borders Facebook Group
The Crossing Borders You Tube Page
The Crossing Borders on Idealist  Looking for volunteers worldwide

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