Cholera: Inevitable Spread to Port-au-Prince

Though cases less severe, health care workers brace for cholera spread.

October 25, 2010, 4:45 PM

October 25, 2010— -- The radio announcements and signs appear to have done little. They urge people in Haiti to stay away from potentially contaminated water. But in rural areas north of Port-au-Prince, they still bathe in -- and drink from -- rivers suspected to be the source of the country's deadly cholera outbreak. It has already sickened more than 3,300 people and killed 259.

En route to St.-Marc, a town about 60 miles north of Port-au-Prince, ABC News chief health and medical editor Dr. Richard Besser stopped in Montrouis, where he was approached by a man who feared the spread of cholera.

Guy Fils-Aime, a Haitian native of Montrouis, told Besser the people there are used to drinking from the river, but now fear they might contract the disease. Two people from his town have died from cholera, Fils-Aime told Besser.

Still, Fils-Aime said the locals in Montrouis have no choice but to use the potentially contaminated water. No chlorine tablets have been delivered to the town, and many cannot afford to buy bottled water.

"There is nothing from anybody," he said.

Further north, St.-Marc, on the Artibonite River, is the epicenter of the cholera outbreak. Nearly 600 patients at St. Nicholas hospital in St.-Marc are triaged each day and 400 of those are hospitalized, according to Partners in Health, a nonprofit health group that operates the hospital in partnership with the Haitian Ministry of Health.

Cholera deaths in Haiti have slowed and many hospitals report no spike or decline in the number of cases each day. However, many government organizations anticipate the disease will spread to urban relief camps, including in the capital of Port-au-Prince.

"Entry of the disease into the camps will be devastating," said Dr. Louise Ivers, Partners in Health chief of mission in Haiti.

Haiti's Ministry of Health reported Monday 259 deaths from cholera and 3,342 cases of the disease. Five of the cases were confirmed in Port-au-Prince.

"I'd say everybody is [at risk in Port-au-Prince]," Mark Henderson, the water and sanitation chief for UNICEF, told ABC News. "All it takes is a sick person coming down from the outbreak area."

Many health officials also warn that the Dominican Republic, the only country which borders Haiti, may also be at risk.

"People are going back and forth [over the border]," said Dr. Jon Andrus, deputy director of the Pan-American Health Organization. Andrus said regardless of which infectious disease public health experts are trying to manage, experts should take "an island-wide approach."

"We have to think that the infection is going to hit the other side of the island," he said.

Cholera: Reminder of Earthquake Destruction

Since the earthquake shook Haiti in January of this year, public health experts expected infectious diseases to take hold as people worked to rebuild the country. Pakistan reported hundreds of cases of cholera in July during that country's flooding disaster.

"The fact that it's taken this long for anything to happen is a testament to the quality of work gone into Haiti," said Dr. Peter Hotez, chair of microbiology and tropical medicine at George Washington University Medical Center.

If cholera broke out immediately after the earthquake, "It would've been much worse," Eric Mitz, a cholera expert at the Centers for Disease Control and Prevention, told ABC News.

"We are fortunate to have this time," said Mitz.

Still, according to Frederica Nogarotto, a Doctors Without Borders coordinator in St.-Marc, health missions in Haiti seemed unprepared for cholera, since the country seemed to have eradicated the disease generations ago.

Cholera victims suffer from severe dehydration caused by diarrhea. If left untreated, it leads quickly to organ failure and death.

The Pan-American Health Organization reported Friday that it kept 750,000 rehydration salts in stock to treat 100,000 cases of acute diarrhea, IV doses to treat 4,000 cases, and 300,000 courses of antibiotics -- all previously reserved at the Port-au-Prince airport.

According to Ivers, Haiti's Ministry of Health plans to erect three posts in Port-au-Prince to combat the levels of cholera cases. One post will provide patients with mild cases of diarrhea access to oral rehydration salts. Another post will offer intravenous fluids for the next level of cases; and cholera centers will house most severe cases.

Cholera can be prevented through personal hygiene and clean sources of water. Two oral vaccines also exist to prevent the disease.

"There's no room for error here," said Hotez. "You need to intervene immediately."

The focus among many health care workers is to treat cases and enforce more simple prevention methods.

The Pan-American Health Organization is considering offering the vaccine to health care workers, Andrus told Besser on Friday.

However, Andrus said limited supply of the vaccine and limited resources to ensure the population received both doses of the vaccine would make it difficult to immunize the general population.

The cholera vaccine is administered in two doses one week apart. However it takes nearly three weeks for the vaccine to take effect, said Mitz. It's "unlikely" the vaccine will help in Haiti, he said.

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