Monday, December 13, 2010

The case for using antibiotics in Haiti

A new debate is forming in how to treat the cholera epidemic in Haiti. People are beginning to call on the World Health Organization to begin distributing cholera vaccines in Haiti. Up until now, treatment of those already infected with re-hydration has been the action taken.

From Newsweek, a pair of health professionals give their opinion on the right response in Haiti. Dr. Farmer from Harvard Medical School and Dr. Réjouit of Zanmi Lasante make the case for antibiotic treatment.

There’s reason to fear that this outbreak is, in the words of a colleague who’s an expert on the disease, “not your grandmother’s cholera.” The strain described by epidemiologists as “an El Tor biotype of Vibrio cholerae serogroup 01” seems especially virulent and hard to slow down. In fact, if the long history of a similar El Tor strain in Bangladesh is any indication, the disease could become endemic in Haiti. That threat makes it all the more urgent for the world to renew its relief efforts in Haiti—and to resist the temptation to write off the country’s 10 million people as beyond hope.

The No. 1 priority is to deliver quality care to the sick. Although cholera’s profuse diarrhea can shrivel and kill a healthy adult in hours, early detection and expert care can save virtually anyone who contracts the disease. And in our opinion, proper care includes aggressive use of antibiotics. Some authorities recommend that treatment consist only of oral rehydration or, failing that, intravenous resuscitation. Antibiotic therapy is currently recommended only for the most severe cases, because of cost and for fear of encouraging the growth of drug-resistant microbes. In the case of Haiti’s present outbreak, we think this is a mistake. Antibiotics can shorten the course of illness, decrease the volume of diarrhea, and reduce the time that patients shed contagious organisms—all of which helps prevent deaths and limit transmission.

Oral cholera vaccines are another powerful tool against the disease, protecting as many as 90 percent of people who have been fully vaccinated. Some say this can’t work in Haiti, since at least two doses are recommended; others argue the vaccine is too expensive or in short supply. But we’ve already accomplished an even tougher feat by completing a three-course dose of the cervical cancer vaccine in Haiti for 76 percent of the girls we enrolled—about twice the rate for similar programs in the United States—and the earthquake struck between the first and second doses. Vaccines were not recommended during last year’s cholera outbreak in Zimbabwe, and 4,000 people died in a single year. With half that number of deaths in just one month, Haiti can’t afford not to consider vaccination. And the rest of the world can’t afford not to have a global vaccine stockpile.

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