Help PIH Respond to Cholera Outbreak in Haiti

Above: A community health worker administers a cholera vaccine to a child north of St. Marc, Haiti.

Thank you for supporting Partners In Health / Zanmi Lasante through the continuing cholera outbreak in Haiti.

Haiti--particularly the Sud and Grand d'Anse, two departments in the south--saw a dramatic spike in cholera cases after Hurricane Matthew tore through the region this past fall. 

In the first week following the hurricane, the Sud reported 280 suspected cholera cases. Since then, the Sud has had 1,471 suspected cases and neighboring Grand d’Anse another 1,594. Combined, the two departments account for 49 percent of the cases reported in Haiti during that period. Normally, they account for 8 percent.

To stem the tide of infection, the Ministry of Health requested 1 million doses of the oral cholera vaccine Euvichol from the World Health Organization. Two shipments of 500,000 vials arrived in late October. The majority of vaccinations were immediately sent to Grand d’Anse and Sud, where 729,000 people—86 percent of the region’s population—received a single dose in early November. The ministry is keeping the remainder of the vaccine in cold storage so that, should cases spike again, it can respond rapidly.  

Throughout this process, PIH has remained a strong government partner. Having conducted an effective cholera vaccination campaign in 2013, PIH provided consultation and financial support to the ministry to ensure the effort in the south was a success.

Meanwhile, PIH awaits approval from the Haitian national bioethics committee to begin a study of the vaccine’s effectiveness. In partnership with the Haitian government, the Centers for Disease Control and Prevention, and the Haitian nonprofit medical organization GHESKIO, the study will look at the effectiveness of a single vaccination versus a double dose in staunching the tide of cholera infection. The results could have widespread implications for how other countries respond in the midst of an epidemic.

Haiti recently entered its seventh year battling the cholera epidemic, which has killed 10,000 people and sickened 800,000.

Above: Patients are treated at the Cholera Treatment Center in Mirebalais, Haiti, on Nov. 8, 2012.

The World Health Organization recently announced that it will send 1 million doses of cholera vaccine to Haiti, where hundreds of cases of the deadly diarrheal disease have been reported after Hurricane Matthew tore through the country in October.

Partners In Health applauds the news for a simple reason.

“Cholera vaccines save lives,” says Dr. Louise Ivers, PIH’s senior health and policy advisor.

The WHO will coordinate the use of vaccines with Haiti’s Ministry of Public Health and Population, which leads the cholera response in Haiti, Ivers says. Any decision on the final destination of the vaccines will greatly depend on need and the logistical capacity to distribute them.

Zanmi Lasante, as PIH is known in Haiti, has seen firsthand the power of cholera vaccination. In 2012, staff conducted a successful vaccination campaign that reached 45,417 Haitians in the regions of Grand Saline and Bocozel. Nearly 90 percent of patients received the recommended two dosages.

The campaign dramatically reduced the risk of cholera for those who got the vaccine, and likely for those who didn’t. As Ivers explains, cholera vaccines have an effect called “herd protection.” The more people who are vaccinated, the less cholera circulates—meaning even those who didn’t receive the vaccine have less risk of getting the disease.

Hundreds of cholera cases have already been reported just one week after the hurricane in the hardest-hit South, including Jérémie, Port Salut, and Les Cayes. Flood waters have mixed with sewage contaminated with cholera bacteria. Because fewer than half of Haitians have access to clean water, they draw from these sources and suffer the consequences. The infectious disease causes vomiting and diarrhea, and patients can die within 24 hours if the illness is left untreated.

PIH staff are now organizing mobile teams to help support partners in the South, including at the hospital in Les Cayes.

Cholera was introduced to Haiti in 2010. Shortly after the devastating January earthquake, the United Nations flew in a group of peacekeepers from Nepal, whose capital had recently suffered an outbreak of the disease, and set them up in a camp with poor plumbing. Contaminated sewage leaked into a tributary of the longest river in the country, the 200-mile Artibonite, which is a water source for countless Haitians. A cholera epidemic was born. In the six years since, nearly 10,000 Haitians have died and 800,000 have been sickened by the disease.