What is cholera?

Cholera is a diarrheal illness caused by drinking water or eating food from sources that have been contaminated with the bacterium Vibrio cholerae. It is found and spread in places where people have inadequate or no access to sanitation and clean water.

More than 100,000 people die each year from the illness, and about one in 20 people infected will develop severe disease characterized by watery diarrhea, vomiting, and leg cramps, according to the Centers for Disease Control and Prevention (CDC). People with cholera can become dehydrated rapidly and go into shock—and die—if they don’t receive treatment.

Successful treatment includes immediately replacing a patient’s lost fluids and salts with an oral rehydration solution—a mixture of salt, sugar, water, and electrolytes. Fewer than 1 percent of cholera patients die when they’re rehydrated quickly, according to the CDC.

Cholera in Haiti

In mid-October 2010, staff at Zanmi Lasante (ZL), PIH’s sister organization, were among the first to see cases of cholera in the town of Mirebalais. Cholera had never previously been reported in the country or on the island of Hispaniola. PIH/ZL subsequently opened 11 cholera treatment facilities and hired and trained more than 3,300 community health workers to identify and treat cases of cholera and run public hygiene education campaigns. PIH/ZL psychosocial and mental health teams also counseled and conducted memorial services for many families who either lost loved ones to cholera or suffered from the stigma associated with the disease.

The outbreak has now killed nearly 8,000 people, sickened more than 600,000, and become one of the world’s largest epidemics in recent history. The epidemic struck at a vulnerable time, as millions remained displaced as a result of the country’s January 2010 earthquake—which further weakened Haiti's insufficient water and sanitation infrastructure.

Although the number of new cholera infections has decreased since the outbreak began, any death from cholera is unacceptable. Heavy rains and tropical storms will likely continue to trigger spikes in cholera cases and deaths.

PIH’s response

PIH/ZL has been at the forefront of advocating for a comprehensive response to the epidemic, including case-finding and treatment, improvements in water and sanitation, education, and vaccination against the disease. (For more information, see “Five Complementary Interventions to Slow Cholera: Haiti.”)

PIH/ZL community health workers, nurses, and physicians have treated about 98,000 patients from October 2010 through June 2012.

In 2012, working with the Haitian Ministry of Health, PIH/ZL vaccinated approximately 50,000 people against cholera, mostly living in the country’s Artibonite region. PIH/ZL community health workers delivered the required two doses of the vaccine to participants; 91 percent of those who received the first dose received their second two weeks later—an outstanding completion rate. Coverage in the community was high enough that even unvaccinated individuals will be somewhat protected from cholera (a phenomenon known as “herd immunity”).

Despite initial scepticism about use of the vaccine by the international community, the Pan American Health Organization issued a recommendation in August 2012 to make the vaccine universally available in Hispaniola, based in large part on their review of this collaborative project.

We remain strong advocates for improvements in Haiti’s water and sanitation systems—clean water is a basic tenet of public health. Improving these systems will reduce not just cholera but other waterborne diseases.