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Officials Race To Contain Cholera Outbreak In Haiti

Children await treatment at a medical facility in St. Marc, northern Haiti, amid a cholera epidemic that has claimed more than 100 lives and infected more than 1,000 people over the past few days. (AFP/Getty Images)

Health officials in Haiti are working to prevent an outbreak of cholera from reaching the capital of Port-au-Prince, where an earthquake in January left more than 1 million people homeless.

The fear is that cholera could spread quickly in the camps where these people live in makeshift shelters. The camps often lack adequate sanitation or safe drinking water.

Cholera was confirmed yesterday in Artibonite, an area about 60 miles north of Port-au-Prince. So far, the disease has killed more than 100 people and sickened more than 1,000.

Hospitals near the outbreak have been overwhelmed, with some setting up outdoor treatment areas and administering intravenous fluids to people lying on blankets on the ground, says Dr. Michel Thieren from the Pan American Health Organization in Haiti.

But Thieren says at this point it's hard to know precisely how many people are sick. "What we know now is that it is an epidemic that is accompanied with a high mortality rate, about 10 percent," Thieren says.

This is not a situation completely out of control. So while I know the numbers may sound quite large, really it's quite a simple method in terms of treating and preventing.
Paul O'Brien, overseas director, Concern Worldwide

Earthquake Not To Blame

Cholera kills by causing diarrhea and vomiting so severe that people become dangerously dehydrated. It is spread when food or water becomes contaminated with a bacterium that infects the intestines.

Thieren says it's not clear why this outbreak occurred in a nation that hasn't seen cholera for decades. "It is misleading to associate the earthquake with the appearance of the disease," he says.

But now that cholera has appeared, it's clear that the people in camps around Port-au-Prince are especially vulnerable, Thieren says. Their situation is "precarious," he says. "That's never good news for waterborne disease epidemics."

Other cholera experts say the disease could move swiftly from Artibonite to the capital because so many people travel back and forth.

"Usually the contamination is in the feces of infected people, so people are very worried that it could spread to the camps and spread extremely quick within the camps," says Paul O'Brien from the organization Concern Worldwide.

Weighing Treatment, Prevention Methods

But the relief agencies that have been working in Haiti since the earthquake are well prepared to contain the outbreak, O'Brien says "This is not a situation completely out of control. So while I know the numbers may sound quite large, really it's quite a simple method in terms of treating and preventing."

Treatment usually means drinking lots of water, or fluids specifically designed to prevent dehydration. Very ill patients may need to get fluids intravenously.

Prevention involves providing clean drinking water and making sure people wash their hands and cook food thoroughly.

And there's one other option: vaccines.

There are two vaccines for cholera. and health officials are going to need to make a key decision about using them in the next day or two, says Peter Hotez, president of the Sabin Vaccine Institute and head of the microbiology department at George Washington University.

"Are they going to conduct either a nationwide vaccination campaign or a regional one?" Hotez says. "Even though this disease is not occurring in Port-au-Prince, because they're so vulnerable, do you want to go ahead and vaccinate them anyway?"

Ideally, vaccines should be administered before cholera is sweeping through an area because they take more than a week to provide protection, Hotez says.

But whether or not officials decide to use vaccines, Hotez says, health officials should be able to halt the outbreak.

"The Pan American Health Organization is one of the best-functioning health and sanitary health organizations anywhere in the world and I'm confident they'll be able to handle this and contain it," Hotez says.

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Transcript

ROBERT SIEGEL, host:

You're listening to ALL THINGS CONSIDRED from NPR News.

An outbreak of cholera has struck Haiti nine months after a devastating earthquake. More than a hundred people have died and more than 1,000 have become sick. So far, the outbreak has not reached the camps in Port-au-Prince that shelter hundreds of thousands of people who lost their homes in the earthquake.

As NPR's Jon Hamilton reports, public health officials are working hard to keep the disease from spreading to the capital.

JON HAMILTON: The outbreak began in an area about 60 or 70 miles north of Port-au-Prince. Dr. Michel Thieren is with the Pan American Health Organization in Haiti. He says hospitals near the outbreak have been overwhelmed, with some setting up outdoor treatment areas. But Thieren says at this point, it's hard to know how many people are sick.

Dr. MICHEL THIEREN (Pan American Health Organization): What we know now is that it is an epidemic that is accompanied to the high mortality rate. We have about 10 percent (unintelligible) fatality rate.

HAMILTON: Cholera kills by causing diarrhea and vomiting so severe that people become dangerously dehydrated. It is spread when food or water becomes contaminated with a bacteria that infects the intestines. Thieren says it's not clear why this outbreak occurred in a nation that hasn't seen cholera for decades.

Dr. THIEREN: It is misleading to associate this earthquake with the occurrence of the disease that have nothing to do with one or another.

HAMILTON: Thieren says now that cholera has appeared, the camps around Port-au-Prince are especially vulnerable. That's because people live in poverty and enclosed quarters, often without adequate sanitation, and sometimes, without clean drinking water.

Dr. THIEREN: The conditions are (unintelligible) of about a million, a million and a half (unintelligible) population in precarious conditions. This is never good news for waterborne disease epidemics.

HAMILTON: And Paul O'Brien from the organization Concern Worldwide says cholera could make its way to the capital quickly because so many people travel back and forth.

Mr. PAUL O'BRIEN (Overseas Director, Concern Worldwide): Usually, the contamination is in the feces of infected people. So it may not have started in the camps, but I suppose people are very worried that it could spread to the camps and therefore spread extremely quick within camps.

HAMILTON: Even so, O'Brien says the relief agencies that have been working in Haiti since the earthquake hit are well prepared to contain the outbreak.

Mr. O'BRIEN: This is not a situation completely out of control. So while I know the numbers may sound kind of quite large and the whole fear around cholera -because it can spread so quickly and because it can kill so quickly - really is actually quite a simple method in terms of treating and preventing.

HAMILTON: Treatment usually means drinking lots of water or fluids specifically designed to prevent dehydration. Very ill patients may need to get fluids intravenously.

Prevention involved providing clean drinking water and making sure people wash their hands and cook food thoroughly. And there's one other option, vaccines.

Peter Hotez is president of the Sabin Vaccine Institute and head of the microbiology department at George Washington University. He says health officials are going to need to make a key decision in the next day or two.

Dr. PETER HOTEZ (President, Sabin Vaccine Institute; Microbiology, George Washington University): Are they going to conduct either a nationwide vaccination campaign or a regional one, even though this disease is not occurring in Port-au-Prince? Because they're so decimated in Port-au-Prince and vulnerable, do you want to go ahead and vaccinate them anyway?

HAMILTON: Hotez says ideally, vaccines should be administered before cholera is sweeping through an area because they take more than a week to provide protection. Hotez says whether or not officials decide to use vaccines, it should be possible to halt the outbreak.

Dr. HOTEZ: The Pan American Health Organization is one of the best functioning health and sanitary organizations anywhere in the world. And I'm confident they'll be able to handle this and contain it.

HAMILTON: Because cholera can spread so quickly and kill so quickly, it should be clear within days whether their efforts are succeeding.

Jon Hamilton, NPR News. Transcript provided by NPR, Copyright NPR.

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