Cholera

What is Cholera?

Cholera is a waterborne illness spread by drinking water containing the organism Vibrio cholera. In the absence of latrines or public sewage systems, the world’s poor often drink from the same river or stream used for defecation – infecting water supplies. While boiling water kills these bacteria, many people cannot afford the necessary fuel and supplies.

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People infected with cholera develop profuse, watery, high-volume diarrhea often within 12 to 24 hours of drinking contaminated water. Symptoms are rapidly dehydrating and can cause patients to go into shock and die if lost fluids are not replaced. Only about 10 percent of those who drink contaminated water fall ill, though it is particularly fatal for young children, the elderly and malnourished.

Oral rehydration solution – an easy-to-make solution of salt, sugar and water – is the simplest treatment for cholera. Intravenous fluids are used if a patient is unable to drink because they are vomiting or semi-conscious, and antibiotics can decrease the volume of diarrhea.

Understanding how cholera spreads.

The Current Situation in Haiti

With the epidemic now nearly 18 months old, it is clear that cholera will be in Haiti for the foreseeable future. The bacteria have contaminated the lakes, rivers and canals that millions of people use each day for drinking, cooking and bathing. Though fewer new infections were reported in October than anytime since the outbreak began, this does not mean that cholera is leaving Haiti. The epidemic is connected to weather patterns; heavy rains and tropical storms will continue to trigger spikes in cholera cases and deaths.

PIH staff continues to treat the sick, conduct research, build latrines, and distribute soap, bleach and water-purification tablets. We also reiterate the need to continue training health workers, scale up the availability and access to the best treatments – including, oral rehydration salts, antibiotics and IV fluids – and improving public water systems and sanitation infrastructure.

In the past year, PIH has hired and trained 2,378 community health workers to conduct public hygiene education campaigns that includes radio messages and community trainings on detection, proper hygiene and sanitation using updated training manuals. Funded by the World Bank, these short-term (6-13 month) positions are an essential tool in PIH’s continued fight against cholera. PIH is also conducting support groups for people affected by cholera and memorial services for those who've lost family and friends.

As of mid-February, 2012:

The nationwide case fatality for cholera is 1.3%; at PIH/ZL facilities it is 0.48%.
PIH/ZL facilities have treated at least 18% (94,150) of the total cholera cases (525,000) in Haiti.
PIH/ZL trained over 1,800 community health workers to provide cholera services in only six months during 2011.
In 2011, PIH/ZL reached over 500,000 individuals — over a third of our total catchment area — with water purification supplies and cholera prevention education.

Haiti Ministry of Health's updated cholera numbers.

Next Steps

In early 2012, PIH will introduce an oral cholera vaccine as part of a comprehensive package of prevention and treatment. We have purchased 200,000 available doses of the safe, effective oral cholera vaccine called Shanchol – which received WHO prequalification on September 29, 2011. In February PIH/ZL staff began registering patients in the regions where the vaccination will first be delivered. In late February/early March, Patients will receive two doses of the vaccine, administered 2 weeks apart. The vaccination costs of $1.85 per dose, or $3.70 per patient.

This oral cholera vaccination is 70 percent effective and protects recipients for upwards of 36 months. Additional community protection – a so-called “herd immunity” – occurs when a majority of a population is vaccinated. It is estimated that 10 percent coverage would avert 63,000 cases and 900 deaths in Haiti, while 30 percent coverage would lead to a 55 percent reduction in cases, potentially saving thousands of lives.

PIH has teamed up with GHESKIO, a longtime partner based in Port-au-Prince, to plan a 100,000-patient (200,000 dose) pilot vaccination campaign targeting vulnerable populations in both Port-au-Prince and rural communities near the town of St Marc, where the outbreak first began.

Second, we must continue advocating for the construction of drinking water and sewage treatment facilities throughout Haiti.

Woch nan Soley: The Denial of the Right to Water in Haiti

The History of an Outbreak

When hundreds of people suffering from cholera symptoms began to flood Hôpital Saint Nicolas in St. Marc in late October 2010, it was the first time since the 1960s that the disease threatened Haiti. And it struck at a vulnerable time, as millions remained displaced as a result of the January 2010 earthquake. Haiti's already insufficient water and hygiene infrastructure was further weakened by that event.

The death toll rose as the disease spread to thousands and health workers scrambled to educate people on the importance of drinking clean water. By January it appeared epidemic deaths had been curbed, but flooding during Haiti’s rainy season hindered transportation to the sick and complicated treatment, allowing the numbers to again spike.

PIH and its partner organizations have worked tirelessly both to relieve the suffering of those afflicted and to strengthen the infrastructure necessary to provide clean water and basic hygiene for Haitians most vulnerable to the outbreak.

In 2008, PIH, NYU School of Law’s Center for Human Rights and Global Justice and the Robert F. Kennedy Memorial Center for Human Rights released a report of the denial of water security as a basic right in Haiti. Secure and free access to clean water is a basic human right that should be delivered through the public sector. The international community’s failure to assist the government of Haiti in developing a safe water supply violates this basic right.