Haiti is experiencing a resurgence of Cholera, with the outbreak initially reported on 2 October 2022 after more than three years with no reported cases of the disease, according to a press release issued by the World Health Organization on 13 December 2022. The epidemic appears to be evolving rapidly, and spreading to all parts of the country. There is also an ongoing complex humanitarian crisis that is rapidly deteriorating due to gang violence, socio-political conflicts, insecurity, fuel shortages, and economic instability. This has resulted in limited access to healthcare and essential services, including water, food, sanitation, and supply services. This situation makes the population of Haiti highly vulnerable to the ongoing Cholera outbreak.
Between 2 October and 6 December 2022, a cumulative total of 13 672 suspected Cholera cases, including 283 deaths (giving a case fatality rate of 2.05%) have been reported by the Haiti Ministry of Public Health and Population from all ten departments in the country. Eighty-six percent of all reported cases (11 751 people) have been hospitalised. The Ouest Department accounts for the highest percentage (89%) of suspected cases (12 112 individuals). Of the 13 672 suspected Cholera cases reported, 59% are male and the most affected age groups are children aged 1 to 4 years (19%), followed by adults aged 20 to 29 years (15%) and 30 to 39 years (15%).
A total of 1193 confirmed cases have been reported. Three departments account for 94% of these: Ouest (79% or 943 cases), Centre (13% or 156 cases), and Artibonite (2% or 28 cases). Laboratory confirmation was by rapid diagnostic test and stool culture was done for identification of Vibrio cholerae. Of the confirmed Cholera cases with available information, 57% (680) are male and the most affected age groups are those aged 1 to 4 years (19%) followed by 30 to 39 years (15%) and 5 to 9 years (14%).
By November 2022, a total of 368 suspected cases, including 14 confirmed cases and 14 deaths had been reported from the Port-au-Prince Prison. These cases are included among the cases reported in the Department of Ouest. Additionally, on 21 November 2022, the Ministry of Public Health of the Dominican Republic it had reported two confirmed imported cases of Cholera, both from Haiti.
Cholera was first reported in Haiti in October 2010. Nationally, a total of 820 000 cases of cholera including 9792 deaths were reported between October 2010 and February 2019. The last confirmed case in this outbreak was reported in January 2019 in I’Estère in the Artibonite Department of Haiti. The country did not report a single case of Cholera in the three years from January 2019 to January 2022. The current outbreak is also occurring in the context of a complex Humanitarian crisis that is exacerbating the burden of disease and hindering response measures.
Cholera is an acute enteric infection caused by ingesting the Bacterium Vibrio cholerae, a Gram-negative, comma-shaped Gammaproteobacteria, related to other pathogenic Bacteria such as Yersinia pestis (Bubonic Plague), and Esherchia coli (food poisoning), which present in contaminated water or food. It is mainly linked to insufficient access to safe drinking water and inadequate sanitation. It is an extremely virulent disease that can cause severe acute watery diarrhoea resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population and the setting. Cholera affects both children and adults and can be fatal if untreated.
The incubation period is between 12 hours and five days after ingestion of contaminated food or water. Most people infected with Vibrio cholerae do not develop any symptoms, although the Bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. Cholera is an easily treatable disease. Most people can be treated successfully through prompt administration of oral rehydration solution.
Cholera can be endemic or epidemic. A Cholera-endemic area is an area where confirmed Cholera cases were detected during the last three years with evidence of local transmission (cases are not imported from elsewhere). A Cholera epidemic can occur in both endemic countries and in non-endemic countries. Uninfected dead bodies have never been reported as the source of epidemics.
The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps – can increase the risk of Cholera transmission, should the Bacteria be present or introduced.
A multi-sectoral approach including a combination of surveillance, improving access to clean water, sanitation, and hygiene promotion, rapid access to treatment, risk communication and community engagement and oral Cholera vaccines is essential to control cholera outbreaks and to reduce deaths.
The current cholera outbreak in Haiti, combined with the ongoing crisis related to gang violence, social unrest, and insecurity, has strained the health system’s response capacity. The overall risk for this outbreak in Hispaniola is assessed as very high, due to the current socio-economic situation, ongoing humanitarian crisis, food insecurity and poor health conditions are affecting a large proportion of the population, leaving them vulnerable to the risk of Cholera infection and recurrence of Cholera, the limited access of the general population to safe drinking water and to sanitation facilities, the violence and insecurity prevalent in many parts of Haiti, which leaves the public health system and international partners with limited human resources, reducing the capacity to respond to the crisis, and the lack of access to fuel and insecurity lead to difficulties to import supplies and challenges to access the affected areas.
These challenges further increase the risk of undetected cases and delayed response efforts. The insecurity and access to fuel hinders the population's access to health care, leading to delayed treatment and potentially severe outcome. Considering the magnitude and widespread nature of the Cholera epidemic that is ongoing in Haiti, in conjunction with the complex Humanitarian crisis the country is currently facing, the limited resources to control the epidemic, as well as the constant migration flows towards the Dominican Republic, the risk in Hispaniola is assessed as very high.
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