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Containment

Michael D. McDonald's picture

 

 

The mission of the containment working group is to contain the spread of disease in Haiti

through isolation, quarantine, and self-sequestering education.

Working Group email address:

containment@mphise.net

 

UN Rolls Out Aid Package for Cholera-Hit Haiti

submitted by Mike Perrett           

                      

Haiti's cholera epidemic started in 2010 and has and killed more than 10,000 people and affected 700,000.  AFP/File / by André VIOLLAZ

france24.com - AFP - by André VIOLLAZ - September 29, 2016

UNITED NATIONS (UNITED STATES) (AFP) - The United Nations will mobilize $181 million to shore up the emergency response to the cholera epidemic in Haiti and at least an equal amount for the victims and their families, a senior UN official says.

The financial package follows the United Nations's admission that it had a moral responsibility to help Haiti deal with the epidemic that broke out near a UN peacekeepers' base. . . .

. . . The new measures are on top of a bigger 10-year plan valued at $2.2 billion to help Haiti improve its sanitation infrastructure, which the United Nations launched with the Haitian government.

(READ COMPLETE ARTICLE)

Cholera - Situation Report - Anse-a-Pitres - Haitian-Dominican Border

        

Refugee Camp–Anse-a-Pitres (Photo by John Carroll)

(SEE IMPORTANT LINKS TO HEALTH AND MIGRATION INFORMATION AT THE BOTTOM OF THIS POST)

blogs.pjstar.com - by John A. Carroll, MD - December 15, 2015

. . . During the last six weeks cholera HAS hit the camps in Anse-a-Pitres.  And cholera is crossing the border into the Dominican Republic once again.

Haitian doctors and nurses on the Haitian-Dominican border have recently complained that they do not have enough IV fluid to treat their cholera patients. And their patients are dying.

A liter of intravenous Ringer’s Lactate in the United States costs $1 US.

(CLICK HERE - READ COMPLETE ARTICLE)

Fearful, Haitian Migrants Flee Dominican Republic for Camps Along Border

             

In Anse-à-Pitres, Haiti, thousands reside in camps of tents, having left the Dominican Republic by force or by fear after its government began a crackdown on illegal migrants. Poor sanitation has led to a cholera outbreak. Credit Meridith Kohut for The New York Times

nytimes.com - by Azam Ahmed - December 12, 2015

PARC CADEAU 2, Haiti — Along this arid strip of borderland, the river brings life. Its languid waters are used to cook the food, quench the thirst and bathe the bodies of thousands of Haitian migrants who have poured onto its banks from the Dominican Republic, fleeing threats of violence and deportation.

These days, the river also brings death. Horrid sanitation has led to a cholera outbreak in the camps, infecting and killing people who spilled over the border in recent months in hopes of finding refuge here.

(READ COMPLETE ARTICLE)

More Than Two Dozen Cases of Cholera Recorded at Anse-à-Pitres Special

Site Overview Parc Cadeau II  Photo: Archive GARR

       

About 26 people from Anse-à-Pitres most of which comes from the Parc Cadeau I and II sites were infected with cholera. According to officials of the Cholera Treatment Centre (CTC) in this border town, the disease has already caused the death of 7 people.

garr-haiti.org - November 11, 2015

via: Google Translate

Cholera cases continue to increase in CTC of Anse-à-Pitres. This Wednesday, November 11, 2015, the center has 23 people infected with the virus Vibrio cholerae. 3 other people who were infected have already had their medical discharge.

"We get almost to cholera cases daily. Yesterday, the center had 19 cases. After only 24 hours, we went to 23. The situation may escalate because the CTC is not really equipped to accommodate large numbers of people. Furthermore, the means are very limited to prevent the disease is spreading in different localities of the city. "Says chief physician of the center.

According to the observations, infrastructure and equipment are lacking in the center. Not enough beds and oral serum is already out of stock.

Cholera Outbreak: 15 Communes on Red Alert

                                   

reliefweb.int - CLICK HERE - Haiti Humanitarian bulletin - Issue 55, October 2015 (6 page .PDF file)

HIGHLIGHTS

Major outbreaks of cholera recorded in several communes of the country. About 15 communes are on red alert;

Sporadic floods were recorded across the country, during October, affecting over 300 families and causing extensive damage to the agricultural sector;

Bi-national crisis: the humanitarian community pursues to collect information and the humanitarian surveillance;

The drought has caused acute food crisis in 37 communes.

(READ COMPLETE ARTICLE)

UN - Cholera Surge Has Put Haiti on Course for Crisis

unmultimedia.org - May 14, 2015

A "surge" in the number of new cholera cases in Haiti has created the risk of a humanitarian crisis, the UN expert in charge of fighting the disease said Thursday.

Assistant Secretary-General and Senior Coordinator for Cholera Response in Haiti Pedro Medrano Rojas said that the last three months have seen more than 12,000 new cases of the disease and that the struggling Caribbean country is on course for 50,000 cases this year.

Mr Rojas called for help from the international community, telling Daniel Johnson that Haiti will continue to need outside help for many years after the devastating 2010 earthquake.

CLICK HERE FOR ADDITIONAL INFORMATION & LISTEN TO THE RADIO BROADCAST

CLICK HERE - RELATED ADDITIONAL INFORMATION

Haitian Baby Boy with Cholera and Hope

      

Baby Boy–April 2015 (Photo by John Carroll)

blogs.pjstar.com - by John Carroll - April 26, 2015

Several mornings ago a young mother carried her 12 month old baby boy into the pediatric clinic in Cite Soleil. (I will refer to him as “Baby Boy”). The mom and Baby Boy had been triaged to a wooden bench surrounded by about 25 other very pathetic slum babies and mothers who had made it that far in the process. However, one glance at Baby Boy was all one needed to know he was sick and that he needed to be evaluated right away. His eyes were sunk, his lips were dry, and except for quiet respirations, he wasn’t moving.

His mother stated that she recently had him in the only functioning Cholera Treatment Center (CTC) in Soleil for four days in a hospital called St.Luc’s which is about a mile from our pediatric clinic.

(READ COMPLETE ARTICLE)

Haiti: Cholera Cases Double from Previous Year

      

A father looks over his young girl as she receives an IV at a Red Cross [file]

CLICK HERE - PAHO - WHO - Epidemiological Update - Cholera in the Americas - March 3, 2015 (2 page .PDF report)

CLICK HERE - PAHO - WHO - Cholera

CLICK HERE - MSPP (MINISTERE DE LA SANTE PUBLIQUE ET DE LA POPULATION) - Cholera - Case Reports

CLICK HERE - MSPP (MINISTERE DE LA SANTE PUBLIQUE ET DE LA POPULATION)

sentinel.ht - by Samuel Maxime - March 30, 2015

PORT-AU-PRINCE, Haiti- Experts say Cholera will continue to kill and infect citizens as long as they lack access to clean water and sanitation. This information comes as suspected cases and deaths have doubled in January and February compared to the year prior and twenty of the nation's communes are on red alert.

Haiti in the Shadow of Cholera

nytimes.com - April 23, 2014

The problem of ending Haiti’s cholera epidemic does not stem from an absence of planning. There is a 10-year plan to eradicate cholera from Hispaniola, the island Haiti shares with the Dominican Republic, by 2022. Within the 10-year plan is a two-year plan to get the 10-year plan up and running.

(READ COMPLETE ARTICLE)

U.N. Struggles to Stem Haiti Cholera Epidemic

      

A young Haitian fishing in the Latem River, known to be contaminated. The country is still struggling to stem a cholera epidemic.  Ian Willms for The New York Times

nytimes.com - By RANDAL C. ARCHIBOLD and SOMINI SENGUPTA - April 19, 2014

CHAPOTEAU, Haiti — For three years, the United Nations has refused to address whether its peacekeepers brought a deadly strain of cholera to Haiti, insisting instead that it was more important to help the country stanch the disease once and for all.

But on that score, it is still very far behind. In some ways, Haiti is even less equipped to tackle cholera than it was three years ago.

(READ COMPLETE ARTICLE)

Cholera Alert - Bon Samaritan Nursing Home in Ouanamithe

submitted by Albert Gomez

      

https://www.facebook.com/bill.waterman.10/posts/10202141413724766 - October 17, 2013

CHOLERA ALERT
We have had two cases of Cholera from the elderly at our nursing home Bon Samaritan. One passed away last night and the other is being treated at the cholera center. There has been at least 6 local cases I am told. Please keep all of us here in your prayers. I have had this once already and it is by far the worst you can have. We have lost four of our people in 10 days now, counting a grandchild of one of our staff. It has been a rough week for all of us.

Bon Samaritan De Ouanamithe
https://www.facebook.com/pages/Bon-Samaritain-De-Ouanaminthe/331388730236644

Cholera Kills 1, Sickens 9 in Mexico

ap.org - September 27, 2013

MEXICO CITY (AP) — Mexico's health authorities say cholera has killed one person and sickened at least another nine in central Mexico.

Mexico's Health Department says two cases were detected in Mexico City and the rest in the nearby state of Hidalgo, where one person died.

The department on Friday declared a health emergency for Hidalgo.

(READ COMPLETE ARTICLE)

Research - Clues to Cholera Resistance - Evidence that Genetic Changes May Offer Protection

CLICK HERE - RESEARCH - Natural Selection in a Bangladeshi Population from the Cholera-Endemic Ganges River Delta

(ALSO SEE RELATED LINKS BELOW)

news.harvard.edu - by Peter Reuell - July 22, 2013

Researchers have long understood that genetics can play a role in susceptibility to cholera, but a team of Harvard scientists is now uncovering evidence of genetic changes that might also help protect some people from contracting the deadly disease.

Based on genetic data gathered from hundreds of people in Bangladesh, a research team made up of Harvard faculty and scientists from the Broad Institute and the Harvard-affiliated Massachusetts General Hospital (MGH) was able to identify a number of areas in the genome — some are responsible for certain immune system functions, others are connected to fluid loss — that appear to be related to cholera resistance. Later tests showed genetic differences between people who had contracted the disease and those who had been exposed, but never became ill. The results are described in a paper published this month in Science Translational Medicine.

From IMAT - Cholera Statistics - Supplies Needed

                                              

Please see the cholera statistics below from our 3 facility locations. Any help with supplies would be greatly appreciated.

CLICK HERE - IMAT Facebook Page

Stats as of August 13:

60 in Fond Baptiste
13 in Petite Bois
48 in Williamson

ct

The Link Between Saris and Cholera

      

Rita Colwell, shown here in the laboratory, helped discover that simple filtration can be a key to reducing cholera.

cnn.com - by Kelly Murray - June 5, 2013

Dr. Rita Colwell has studied cholera for nearly 50 years, and has written more than 700 publications and received at least 40 honorary degrees. The former director of the National Science Foundation and former president of the American Association for the Advancement of Science, Colwell is currently a distinguished professor at both the University of Maryland, College Park and Johns Hopkins University's Bloomberg School of Public Health.

CNN spoke with Colwell about her research and how she and her team helped develop an incredibly simple method to help the people of rural Bangladesh have cleaner, safer drinking water. The following is an edited portion of that interview.

(READ COMPLETE ARTICLE)

UN Emergency Fund Allocates Extra $1.5 Million for Cholera Response in Haiti

      

At a camp for displaced persons in Port au Prince, Haiti, residents get bleach and water purification tablets which are used in cholera prevention. Photo: UN/MINUSTAH/Logan Abassi

un.org

18 July 2013 – The United Nations emergency relief fund will allocate an additional $1.5 million to the cholera response in Haiti, at a time when cases are set to rise due to the rainy season.

“Cholera has claimed over 8,100 lives and infected over 660,000 people since the outbreak began in Haiti in 2010,” said the Operations Director of the UN Office for the Coordination of Humanitarian Affairs (UNOCHA), John Ging.

“It is vital that we do not allow more lives to be lost.”

The latest allocation brings the total amount provided this year by the UN Central Emergency Response Fund (CERF) for emergency cholera response in Haiti to $4 million.

“The CERF contribution is greatly appreciated,” said acting Humanitarian Coordinator for Haiti Sophie de Caen, “but we cannot rely upon the CERF as a primary funding source. I urge donors to increase their support to these critical activities.”

Evolutionary Dynamics of Vibrio Cholerae O1 Following a Single-Source Introduction to Haiti

 mbio.asm.org - July 2, 2013

Abstract

Prior to the epidemic that emerged in Haiti in October of 2010, cholera had not been documented in this country. After its introduction, a strain of Vibrio cholerae O1 spread rapidly throughout Haiti, where it caused over 600,000 cases of disease and >7,500 deaths in the first two years of the epidemic. We applied whole-genome sequencing to a temporal series of V. cholerae isolates from Haiti to gain insight into the mode and tempo of evolution in this isolated population of V. cholerae O1. Phylogenetic and Bayesian analyses supported the hypothesis that all isolates in the sample set diverged from a common ancestor within a time frame that is consistent with epidemiological observations. A pangenome analysis showed nearly homogeneous genomic content, with no evidence of gene acquisition among Haiti isolates.

Haiti Cholera Mutations Could Lead to More Severe Disease

                                                  

submitted by Ted Kaplan

mbio.asm.org - April 16, 2013
Analysis of Vibrio cholerae Genome Sequences Reveals Unique rtxA Variants in Environmental Strains and an rtxA-Null Mutation in Recent Altered El Tor Isolates

sciencecodex.com - April 16, 2013

CHICAGO --- The cholera strain that transferred to Haiti in 2010 has multiple toxin gene mutations that may account for the severity of disease and is evolving to be more like an 1800s version of cholera, reports a new Northwestern Medicine study.

The strain, "altered El Tor," which emerged around 2000, is known to be more virulent and to cause more severe diarrhea and dehydration than earlier strains that had been circulating since the 1960s. This study reports the altered El Tor strain has acquired two additional signature mutations during the past decade that may further increase virulence.

(READ COMPLETE ARTICLE)

PLOS - Spatio-Temporal Dynamics of Cholera during the First Year of the Epidemic in Haiti

In this paper, Dr. Jean Gaudart, et al. describe and analyze the spatio-temporal dynamics and underlying factors associated with the first year of the 2010 cholera epidemic in Haiti. Environmental factors, such as rivers and rice fields, appeared to play a role in disease dynamics exclusively during the beginning of the epidemic, but varied from place to place as time passed, suggesting the need for rapid and exhaustive case tracking.

http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002145

Abstract

Background

In October 2010, cholera importation in Haiti triggered an epidemic that rapidly proved to be the world's largest epidemic of the seventh cholera pandemic. To establish effective control and elimination policies, strategies rely on the analysis of cholera dynamics. In this report, we describe the spatio-temporal dynamics of cholera and the associated environmental factors.

Methodology/Principal findings

Letter - Cholera in Haiti

nytimes.com - March 22, 2013

Letter to the Editor - by Curt Welling, President and Chief Exec. - AmeriCares

A Worsening Haitian Tragedy” (editorial, March 18) points out the sad reality that cholera is now endemic in Haiti. But it gives the impression that most aid organizations are leaving the country at a time when thousands are dying from a preventable disease.

While some aid groups have indeed left the country or are scaling back programs, others have made fighting the epidemic their top priority.

(READ COMPLETE LETTER)

Michael D. McDonald's picture

Seed Article to Catalyze Discussions on Containment

Different countries and international organizations have differing views on containment.  China, for example, sees containment of infectious disease as extremely important within their infectious disease control programs.  The U.S. generally does not aggressively pursue quarantine anymore for example. 

 

The discussion below outlines one view of containment doctrine in the current Haiti cholera outbreak.  Please provide your comments and questions.

 

xxxxxxxxx

 

The PAHO official is correct due to the following:

1.  The situation is not "contained", nor will it be in the coming weeks.  Cholera will continue to spread- and will be greatly facilitated with more episodes of heavy rain expected from now through November.  It is possible that hygiene education and the efforts of WASH may slow down the spread, but we are facing tens of thousands of cases now and more to come with a still-horrid sanitation situation in the IDP camps.  80% of these cases are unlikely to be clinically recognized because the illness is mild.  Most will shed pathogen into the environment for weeks, which means potential for pick up by indigenous plankton in fresh and marine water.

2.  The Haiti-DR border is highly porous, and if there was a thriving trans border economy, the additional economic strain being placed on Haiti introduces an impetus to form trans border black market.  Trans border traffic of people is unstoppable in our opinion.  

3.  Surveillance and situational awareness is badly broken, and there is strong political opposition to fixing this issue. 

Thus, when considering points 1 through 3, it should be no surprise to eventually see cholera in DR.  I would go so far to say we expect it.  We received a query from a DR embassy representative asking about who was doing the cholera testing and how might they obtain results.  It shows the clear level of challenge in coordinating the flow of critical elements of information.

We have, for reasons that truly defy logic, gross resistance by CDC and PAHO to funding improvements in surveillance.  Their approaches from a forecasting and early warning operational perspective have failed repeatedly since the earthquake, and yet none seem to be able to hold them accountable.  Without effective near-real time anticipation and early warning, coupling to rapid response (i.e. mitigation of spread) is impaired and time-delayed.  The likely results of this strategy, besides the delayed warning of the current cholera epidemic (and untold numbers of Haitians dead as a result) include the following:

1.  Tens of thousands of more cholera cases in Haiti with approximately a 2.5-5% CFR, meaning many more fatalities in the weeks to come mainly in the rural areas.  Absolutely unpredictable what these numbers will look like if transmission ensues uninterrupted in places like Cite Soleil and Leogane.

2.  Population shifts as new foci of transmission appear in areas without adequate medical care (i.e. migration to areas with adequate medical care).  We are not clear if this represents a trans border issue or not for the more rural areas of Haiti where Haitians routinely cross the border for work in DR.

3.  Ecological establishment in Haiti with spillover to the ocean- still need to cross check ocean currents

4.  Eventual introduction to DR and induction of outbreak or epidemic conditions, with subsequent socio-economic impact- most notably to DR's tourism industry

Haiti's problems are most assuredly DR's problems.  Hispaniola's problems have implications for all of the Caribbean.

Cheers,
Jim

AlMac99's picture

R+D Needed

Several years ago there was a Haiti epidemic in other nations of Central America, with fears it would get to Haiti, but it did not.  Now the fears are the opposite direction.  Some of this fear is fueled by lack of public health education how people can catch this disease.  Some nations with good sanitation systems, and good public education on food preparation, are not at risk, even with human carriers and other sources in their midst.

If Dominican Republic has good sanitation systems, and good public health education, then there should not be much to fear.  The people there will know to properly prepare food, protect it from insects.  Is this the reality?

Do Haiti and DR share ground water, rivers which cross the border? 

Contamination could flow from Haiti to DR not by people, but the environment.

If so, is there anything which can be done to a river, to filter out the contamination?  For a large river, a dam, in which something is done to the water that left Haiti, before it gets into DR farmland irrigation, and other uses.

I think there will be a need for a cheap test, which is easy to administer, fast to get results, which can be used by border security, and other places to determine "This person MAY be a carrier of the bacteria" so they should be directed to medical personnel for the better testing.  WHO will need to oversee this.

Maybe if they recognized the serious nature of Cholera in Africa, Asia, it could be labeled a Pandemic of Poor nations, nations which do not have the economic and financial strength to have quality sanitation systems.

Good sanitation is the ultimate cure for many public health risks. 

This topic is also a subset of the world wide crisis in water management.  I believe there is more than enough water on our planet Earth to meet all needs of the people, the environment, the problem is in the economics and environmental implications of desalinization of sea water (what to do with the brine).  Look at Australia, a first world well developed nation.  They have rivers which dry up before they get to the ocean, due to over-use.  They use grey water heavily, and yet they are hurting for enough water.  How then can poorer nations get affordable solutions?

Further, wise water management is a sub-set of international climate change politics, which are highly controversial, and could explain how come CDC cannot work constructively in areas where the US political parties are deeply divided on these policy issues.

-

Alister Wm Macintyre

semi-retired geek

Could AEM made from EM•1® be used to safely inoculate Waters and

I am trying to get a R&D project approved by UNESCO tomorrow and could use your help.

Dear People,Hopefully I can explain myself well enough to transmit the urgency of these test I am proposing as I am, myself, 90% sure that AEM (Activated Effective Microorganisms) made from EM•1® could be used to safely inoculate Waters and populated areas of Cholera. We have not yet carried out actual tests on Cholera infested waters but I am trying to initiate a project through UNESCO or UNICEF (meeting this Tuesday) called "AEM(Activated Effective Microorganisms) Inoculation of Environments" Appeal # 926

Let me explain in steps:
1/            "EM•1® Microbial Inoculants use beneficial microbes and soil organisms to encourage plant, human and animal health. Introduced in 1982, EM Technology® is widely used in over 100 countries to promote healthy soil organisms for healthier plants and crops, clean water, odor control, waste management, and healthier people and animals. The original authentic Effective Microorganisms® product, EM•1®, is a liquid Microbial Inoculant product that includes three groups of naturally occurring beneficial bacteria: Yeast, Photosynthetic Bacteria, and Lactic Acid Bacteria. EM•1® works together with microbes in the area to which it is added to promote a healthy environment for beneficial microorganisms and larger forms of life including insects and worms, pets, livestock and people."2/            AEM at ratios of 1:8,000-10,000 of water/ month is sufficient to clarify water, ponds and lakes of putrefying bacteria in 3-4 weeks and it is used in fisheries where it produces healthier and bigger fish than in fisheries that use antibiotics and hormones.

3/            Pro EM•1®  which has less Photosynthetic Bacteria is for human consumption and should also be tested to see if an influx of those bacterium could inoculate humans more efficiently and quickly than antibiotics because cholera attacks from the stomach.

Please encourage UNESCO to approve this project. Product cost per 8,000gals. of treated water should be $3.00 depending on transportation and tariffs, EM•1® will be ordered from Costa Rica. I can bring enough EM•1® with me to be able to test on the infested waters and we would need 2-4 weeks trial.


Also, by making Bokashi Balls out of Biochar instead of rice bran husks (for treating lakes ponds and rivers) we can extend reapplication times to 4-6 months
I have worked in rugged conditions, speak French and am able work with Haitians. Please help me initiate this project. Hesake Environments Inc. is registered with ASAID, UN, CIDI, CCR and the International Red Cross.

Please contact me for further information or contact UNESCO or UNICEF and tell them to approve my project.

Jean-Luc Giraud
HeSaKe Environments Inc.
Tel: (954) 401-8458

We at Hesake Environments Inc. strive to heal the world using natural solutions.
Michael D. McDonald's picture

Cholera Spread By Wind?

It is clear that cholera is spread by storms.  Flooding is the obvious environmental contributor.  Evidence may indicate that cholera, under certain circumstances, may also be spread by wind.  There apparently have been cases in which cholera blooms may have spread from one location to other environmental circumstances by high winds. 

 

Could Hurricane Tomas have spread vibrio cholerae by winds within or beyond Haiti?

AlMac99's picture

Insects travel how far?

I am just speculating here, I lack a good understanding of the risks.

Wind direction is normally, if I understand correctly such that Haiti is in mountain shadow of Dominican Republic, so mountainous nature of the island means we might not expect the wind to carry blooms the same kind of distance as storms other places.

Environmental understanding may have been neglected.

I had seen some speculation that Haiti's problems with diseases which spread by mosquitoes could mean an increase in those same diseases elsewhere in the Caribbean, but we have no idea how far insects travel,  I would be more likely to believe they ride in human vehicles, as stowaways, than fly all the way to Florida.

However, the killer ant problem supposedly got from Columbia to Hispaniola via illegal drug smuggling.

Bird Flu is now world wide, because of migratory bird patterns.

-

Alister Wm Macintyre

semi-retired geek

Michael D. McDonald's picture

Blown Micro-organisms and Insects Carrying Microorganisms

Microorganisms and insects carrying microorganisms can be blown quite far in storms (eg., Hurricane Tomas).  Thinking about Cuba.

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