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Cholera Outbreak in Haiti

Seth S. Boledovic

The University of Maryland, College Park

CPGH100: College Park Scholars: Global Public Health First-Year Colloquium

Becky Shasha & Janay Johnson

October 17, 2022

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Cholera Outbreak in Haiti

Haiti suffered the deadliest cholera epidemic in the past 25 years from October 2010 to
February 2019, and once again, in 2022, another outbreak threatens the country amid an
economic and social crisis in the country’s capital of Port-au Prince. The Republic of Haiti is
found on the western third of the island of Hispaniola, and the nation shares its borders with the
Dominican Republic (Piarroux, Moore, Rebaudet, 2022). Cholera is a diarrheal disease that is
caused by virulent strains of the bacteria Vibrio cholerae. Transmitted via contaminated water
and food (and occasionally transmitted via direct contact with an infected person), the main
symptoms of cholera include watery diarrhea and vomiting that can lead to death when left
untreated. There had been no reported cases of cholera in Haiti in three years, a feat
accomplished through years of hard work. However, “On 2 October 2022, the national
authorities reported two confirmed cases of Vibrio cholera O1 in the greater Port-au-Prince
area”(WHO, 2022, Situation at a glance section). Between the dates of September 25th and
October 8th, there were 32 laboratory-confirmed cases of Vibrio cholera, with 224 suspected
cases from Port-au-Prince and Cité Soleil; more than half of the confirmed cases have been in
children under the age of 14 (UN, 2022). Port-au-Prince's city population falls slightly under 1
million people, but the metropolitan area as a whole (which includes the extremely impoverished
area of Cité Soleil) falls somewhere closer to 2.5 million people. The city, “is situated on a
magnificent bay at the apex of the Gulf of Gonâve (Gonaïves), which is protected from the open
sea by the island of La Gonâve“(Encyclopedia Britannica, 2022). To put the poverty of Haiti into
context, 70 percent of the population lives below the property line, and 50-70 percent of the
population is unemployed. This poverty is seen as one of the main reasons for the 2010-2019
outbreak, and can also be linked to the start of this Haitian cholera outbreak.
The pressing issue surrounding this cholera outbreak is it falls during a time of increasing
insecurity and an economic crisis. Port-au-Prince’s main fuel terminal has been blocked by
gangs, leading to fuel and gas shortages affecting healthcare services. Due to the gangs
controlling the areas affected, it is difficult to get up-to-date analytics since sample collection is
hindered (24,200 people have been displaced due to gang violence in the city (WHO, 2022)).
When collection is hindered it delays the laboratory processes and the trend of cases can not be
accurately presumed (UN, 2022). Currently, there have been 189 hospitalizations due to this
outbreak with 16 deaths being reported; however, this number is likely higher based on the
reasons previously given (WHO, 2022). The reason this cholera outbreak needs urgent attention
revolves around the acute malnutrition that is also currently striking the city. In Haiti, 4.7 million
people are currently facing acute hunger and 19,000 of those people are even in the “Catastrophe
phase”(UN, 2022). In the affected area of Cité Soleil, 65 percent of the population is facing high
levels of food insecurity. There are currently 100,000 children under the age of five who are
suffering from “severe acute malnutrition”(UN, 2022, Cholera, near ‘death sentence’
section)-these children are some of the most vulnerable. Malnourished children are three times
more likely to die when contracting cholera, a fact that shines a massive beam onto the reasons
why immediate action is needed to contain the disease. “‘For children who are already weak
from a lack of nutritious food, catching cholera, and suffering the effects, including diarrhea and
vomiting, is close to a death sentence”(UN, 2022, Cholera, near ‘death sentence’ section).
Cholera is normally an illness that can be controlled by the sanitation of food products
and water sources in order to remove the infectious bacteria, but this is often easier said than
done. The cholera outbreak is currently being monitored and assessed by the WHO, with them
stating that the overall risk is “very high at the national level”(WHO, 2022, WHO risk
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assessment section). The WHO has recommended increasing access to case management and to
start improving drinking water/sanitation infrastructure along with healthcare facilities(a
mounting task in the current socio-economic situation). They have also mentioned that the “Oral
cholera vaccine (OCV) should be used in conjunction with improvements in water and sanitation
to control cholera outbreaks”(WHO, 2022, WHO advice section). In order to adequately protect
the people of Haiti, recommendations have been put in place in order to ramp up the early
detection of suspected cases as early and adequate treatment of cholera can lower the fatality rate
to below 1% (WHO, 2022). Mobile health clinics have been set up by the UNFPA in order to
give a place for people to go in light of the security situations and fuel shortages (UN, 2022).
Multiple other groups have begun to conduct emergency responses as well. The Incident
Management Support Team has been activated in response, alerts are being published by the
WHO, updated information on the outbreak has been given to the other Member States through
the IHR and NFPs network, and a multisectoral response plan has been created to focus of
sanitation and management-along with advocation to improve the security of buildings that
facilitate responses(WHO, 2022). In the span of a few weeks many health organizations have
mobilized to stop the spread as they see the danger of the current situation and nobody in the area
of public health wants a repeat of the 2010-2019 outbreak.
Even though the 2010-2019 cholera outbreak was a horrible time for everyone involved,
it did pave a pathway for how we can track and treat future outbreaks and health pandemics. In
light of the current outbreak, it’s important to not shy away from what worked in the past, and
update these methods to match the current situation, which is slightly more complicated when
you involve gang violence and limited access to healthcare. As helpful as providing information
to the public is, the constant assessments by the WHO and other groups are not going to solve
problems. Important information regarding testing numbers, active number of cases, and deaths
can and should be used to track locations that are highly affected in order to send the most
amount of resources to those areas.
Cholera is an easy disease to treat; many people can be cured through the administration
of an oral rehydration solution, which prevents dehydration(Piarroux, Moore, Rebaudet, 2022).
This is something that needs to be implemented starting as soon as possible to reduce fatalities,
and sending health professionals to affected areas might be the only way to ensure that
treatments actually occur. One of the most successful interventions in the 2010-2019 pandemic
occurred in 2013 when UNICEF “agreed to coordinate and fund a nationwide response strategy
based on case-area targeted interventions (CATIs) conducted by mobile rapid response
teams”(Piarroux, Moore, Rebaudet, 2022, Continuation and termination of the epidemic section).
These teams would aim to interrupt disease transmission and detect new cases as fast as possible
given the data coming in. They would go out to the affected areas and raise awareness along with
performing prevention measures such as decontaminating surfaces and providing water treatment
supplies. Nurses would also offer antibiotics to those at the highest risk (Piarroux, Moore,
Rebaudet, 2022). A system like the one put in place in 2013 could provide positive results in the
current situation. Getting treatment for people and providing ample sanitation is the only true
way to remediate an area from cholera bacteria. It should be noted that an implementation of a
strategy this size requires a lot of funding, so it's important to get the news about the outbreak out
on a global scale. In the future, more emphasis needs to be put on the continual treatment of
water in the Haitian region, as it’s clear that the country is extremely susceptible to cholera
outbreaks. Currently, there needs to be a priority on assembling intervention groups and
providing treatment to those at the most risk.
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References

‘Catastrophic’ hunger recorded in Haiti for first time, UN warns. (2022, October 14). UN News.

https://news.un.org/en/story/2022/10/1129537

Cholera—Haiti. (n.d.). Retrieved October 15, 2022, from

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON415

Piarroux, R., Moore, S., & Rebaudet, S. (2022). Cholera in Haiti. La Presse Médicale, 51(3),

104136. https://doi.org/10.1016/j.lpm.2022.104136

Port-au-prince | history, population, & facts | britannica. (n.d.). Retrieved October 15, 2022, from

https://www.britannica.com/place/Port-au-Prince

WHO supports Uganda Ebola response, faces challenges fighting Haiti cholera outbreak. (2022,

October 12). UN News. https://news.un.org/en/story/2022/10/1129497