On Friday the Haitian Ministry of Public Health reported 796 deaths and 12,303 hospitalized cases of cholera. A complete report can be downloaded from the Pan American Health Organization (PAHO).
While the impact of Hurricane Tomas was not as immediate or severe as many had feared, Dr. Jon K. Andrus, Deputy Director of the Pan American Health Organization said, “We have every reason to expect that the widespread flooding has increased the risk of cholera spreading.” The effects of this could become apparent through a spike in cases in the coming days.
Also of concern—though not unexpected—are cases being reported in the country’s capital, Port-au-Prince, which is home to some 3 million people.
Even before the earthquake last January, the city had inadequate water and sanitation infrastructure and crowded living conditions in many areas. Now, conditions in the city are “very ripe for rapid spread of cholera.”
“We have to prepare for a large upsurge in cases,” Andrus said. “We have to be prepared with all the resources that are needed for a rapid response.”
Based on previous cholera outbreaks the PAHO projects upwards of 270,000 cases in Haiti before the epidemic is contained.
The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) has released a new response strategy for cholera response through the end of December. To implement the plan the United Nations is requesting the urgent contribution of $164 million.
Given the professional background of many HLSWatch readers, following are the planning assumptions for the new UN response plan:
In order to guide the planning process, the following assumptions were made to estimate the potential evolution of the outbreak.
- Assuming all of the population (estimated at about 10 million for the purpose of this plan) is at risk of contracting cholera, and estimating a cholera attack rate of 2% (not a conservative estimate, given the prevalence of risk factors for cholera transmission including lack of safe water supply, poor sanitation conditions and the rainy season), the estimated number of cases would be 200,000 (10,000,000 pop x 2%). Of course, the effectiveness of the control measures put in place will influence this estimated figure.
- In most cholera outbreaks, approximately 10-20% of symptomatic cases of cholera develop a severe form of the disease which requires vigorous rehydration. Therefore, approximately 20,000 cases at least would require admission for intensive rehydration treatment, and potentially antibiotics. Other symptomatic cases will have to be treated in out-patient capacities and at community level.
- A capacity of 1,000 beds has been already set up throughout the country and will be expanded rapidly to 2,000 beds. Accordingly, the agreed holding capacity of a CTC for the purpose of this plan is 50 beds. The human resources and material and logistical requirements have been estimated based on this operational figure
- For each CTC to be established, a cholera kit for 100 people may be used to initiate the response. Additional materials shall be made available as per the request of the responsible CTC coordinator, but kits should no longer be used to run operating CTCs and CTUs.
- Capacity of primary health facilities for triage, outpatient management of cholera cases, and safe referral of severe cases to CTC, in agreement with the MSPP plan, must be assessed and strengthened. Hospital readiness for surge capacity and infection control and contingency plan to be able to cope with sudden influx of cholera patients must be in place to ensure safe management of patients along with prioritization of other health activities to continuity of care to other patients suffering life-threatening conditions.
- From the WASH perspective the above scenario implies a caseload of 10 million people, i.e. those at risk of contracting cholera who need to be targeted for preventive measures. Therefore, WASH actions will need to be prioritized and strongly informed by health data, and will focus primarily on camps, high-density urban and sub-urban populations where the attack rate is difficult to slow down once the disease establishes itself.
- Particular attention should be paid to cross-border areas and to the displaced, mobile and vulnerable populations as high-risk groups for disease outbreak and the spread of cholera.
- All humanitarian organisations involved in cholera response are expected to contribute to the emergency stock and subscribe to this inter-cluster operational plan.