The 2010 Haiti earthquake was a catastrophic quake, with an epicenter near the town of L?©og??ne, approximately 25 km west of Port-au-Prince, Haiti’s capital. Cholera cases became an immediate epidemic, and now New York is revealing incidence since the outbreak of the disease in Haiti last year. This update has been confirmed Saturday by city officials.
Since October, an epidemic cholera strain has been confirmed in Haiti, causing the first cholera outbreak in Haiti in at least 100 years. The first reported cases have now been identified in the Big Apple, New York City after travelers to a wedding in the Dominican Republic have been engaged by the bacterium.
A commercial laboratory notified health officials on Friday that three New Yorkers had developed diarrhea and dehydration, classic symptoms of the disease, after returning from a wedding on Jan. 22 and 23 in the Dominican Republic, where the government has been trying to prevent the disease from spreading from neighboring Haiti.
Dr. Sharon Balter, a medical epidemiologist for the city Department of Health and Mental Hygiene states the following based on her findings:
“We work closely with the C.D.C. on these cases, so we know about the outbreaks and we expected cases. We may see more cases. We probably will see more cases. And we always see cases related to travel.”
City health officials are now working with the Centers for Disease Control and Prevention in Atlanta to determine what the New York victims ate and to see if the strain of the disease they contracted is linked to the cholera epidemic that has ravaged Haiti, killing thousands since October and infecting many more.
Candice Burns Hoffmann, a spokeswoman for the C.D.C . adds:
“We’re providing support to the state, with lab testing, in determining which strain is at issue. I know there is an investigation in the Dominican Republic, as well, for that wedding, and the C.D.C. is there to support the state health department and also international organizations.”
Officials at the C.D.C. have noted a few cases of cholera in the past three or four months from travelers who arrived in the United States from Haiti or the Dominican Republic.
While cholera can spread swiftly where sanitation is poor and clean drinking water is unavailable, the possibility of transmitting the disease in New York is considered low.
More than four thousand Haitians have died of cholera since the outbreak. The disease, which is a potentially fatal bacterial infection that causes severe diarrhea and dehydration, has spread across all 10 provinces of Haiti, infecting over 200,000 people. Of the patients hospitalized, over 120,000 have been successfully treated. Artibonite, the northern province, accounts for 852 cholera deaths, while 632 fatalities have been registered in Ouest province, including Port-au-Prince, where hundreds of thousands stay in camps more than a year after the devastating earthquake that claimed some 300,000 lives.
The recent outbreaks of cholera in Haiti, Pakistan, and Zimbabwe suggest that current global action plans against cholera are failing; however studies have found a benefit to vaccination before and after outbreaks. In Hanoi, administration of 1 or 2 doses of the vaccine was found to provide approximately 76% protective efficacy.
For this more recent study, scientists modeled 50% and 75% vaccine coverage, with completion of vaccination ranging from 10 weeks after an outbreak was first reported to a completion of vaccination 33 weeks after an outbreak is first reported. They found that even delayed responses could have benefit, and their model neither included herd effect modifiers, nor the effect that vaccination could have on subsequent disease burden after the initial outbreak has waned into an endemic situation.
Dr. Edward T. Ryan of Massachusetts General Hospital and Harvard University, “The Cholera Pandemic, Still with Us after Half a Century: Time to Rethink,” comments on the significance of the works, especially in light of recent events in Haiti:
“By the time the vaccine was distributed, it was thought that the window of possible benefit would have passed. However, Vibrio cholerae, the causative agent of cholera, has undergone a number of mutations in the last few years, and is now associated with longer outbreaks, and more severe clinical disease, leading to higher case totality rates and increased drug resistance. Although everyone agrees that the ultimate prevention and control of cholera will require provision of clean water and adequate sanitation to the world’s population, the simple fact is that this will not be a reality for decades for the world’s most impoverished, as well as for those affected by civil unrest and natural disasters. Less clear is the role that cholera vaccine could play once an outbreak has started. Classically, cholera would cause intensive and short outbreaks.”
This outbreak is of particular concern given the current conditions in Haiti, including poor water and sanitation, a strained public health infrastructure, and large numbers of people displaced by the January earthquake and more recent flooding.
Sources: Public Library of Science and The New York Times
Article updated: 20 February 2011
Sy Kraft, B.A.