An ongoing outbreak of infectious gastrointestinal illnesses causing severe diarrhea is occurring in Haiti.
An ongoing cholera outbreak in Haiti threatens the health of individuals across the country.
The cholera outbreak in Haiti is substantially exacerbated by the ongoing humanitarian crisis in the island nation.
The risk to America is moderate, in large part due to an exhausted healthcare system.
The risk of infection in Haiti is high, but what does that mean for America?
What is cholera?
Cholera is a severe form of acute gastrointestinal illness caused by the bacteria Vibrio cholerae. Cholera is a diarrheal infection, causing severe acute watery diarrhea that can make people very ill. If left untreated, cholera infections can cause dehydration and even death.
Primary causes of cholera outbreaks
Cholera is caused by a bacteria that can be found in the environment. Infections with cholera are usually caused by ingesting the bacteria via contaminated food or water. Maintaining clean water and safe food sources is essential to controlling the spread of cholera.
Outbreaks of cholera occur primarily in places where sanitation systems are in a state of relative disrepair. When a patient is sick with cholera, they shed the bacteria in their watery diarrhea. Without sanitation systems that include latrines or flush toilets and hand-washing facilities with clean water and soap, the spread of infection can be rapid. A patient with cholera can become ill in as little as 12 hours, up to five days, and can continue to shed the bacteria in their stool for up to ten days.
Current cholera situation in Haiti
The World Health Organization declared a cholera outbreak in Haiti on October 2, 2022. Up until the outbreak was declared, Haiti had gone over three years without reporting a case of cholera. However, this followed a lengthy period where cholera was actively reported in Haiti for nearly a decade, from 2010 to 2019.
According to the World Health Organization's most recent update, provided on December 13, 2022, 13,672 cases of suspected or confirmed cholera have been reported. Importantly, over 2% of cases, or 283 infections, have been fatal in this outbreak. The case fatality rate is highest among young children, amongst whom cholera is most dangerous, due to the risks of dehydration.
The ongoing outbreak of cholera in Haiti is directly tied to a substantial and ongoing state of crisis in Haiti. Specifically, a humanitarian crisis that involves gang violence, fuel shortages, and financial insecurity, among other concerns, is driving overall crisis conditions. During the crisis, cholera is resurging in the country due to limited healthcare and essential services, such as access to food, clean water, and sanitation stations.
Impacts of the Haitian cholera outbreak globally
The ongoing cholera outbreak presents a globally pressing situation. In countries where infrastructure is broken down and gross domestic product, commonly known as GDP, is limited, the ability to end a deadly outbreak in a timely fashion is limited. In Haiti, the humanitarian crisis that exacerbated the cholera outbreak is exactly that kind of threat.
Haiti’s ongoing cholera outbreak requires the resource investment of time, knowledge, and money from other countries. A specific example of these resources includes a reactive vaccination campaign, aiming to vaccinate high-risk individuals with the oral cholera vaccine as quickly as possible.
Despite the high risk of infection and the impacts of the outbreak on Haiti, the overall assessment of global risk from the outbreak was deemed low by the World Health Organization.
Cholera risk in America
The World Health Organization’s assessment of risk in America is moderate, given its proximity to Haiti and the movement of individuals into and out of Haiti with other countries in the Americas. Risk is deemed highest for the Dominican Republic, which shares a land border on the island of Hispaniola.
However, consideration should be given to certain risk assessment pieces when considering risk in America. America, along with many other countries in the Americas, faces a burnt out healthcare system with somewhat limited capacity to respond to another public health emergency.
On December 1, 2022, the US Department of State updated its travel guidance for Haiti to a "Level 4 - Do Not Travel" recommendation. The advisory cites both the humanitarian crisis as well as the ongoing cholera outbreak as reasons to avoid all non-essential travel to the country.
Cholera prevention and treatment
Cholera outbreaks are challenging to get control once they have begun to spread widely. The best prevention for cholera is known as a WaSH program: Water, Sanitation, and Hygiene. To limit the spread of cholera, containment of contaminated sewage and adequate hand-washing stations are essential, along with protected sources of drinking water that are not contaminated by sewage.
For patients who become infected with cholera and develop symptoms of watery diarrhea, rehydration therapy is crucial. These rehydration therapies should be administered quickly to those experiencing significant acute watery diarrhea and or vomiting, who are at risk for dehydration. When provided oral rehydration solutions, a drink filled with electrolytes and other bodily essentials, in a timely manner, cholera is a highly treatable disease.