Latest cholera outbreak in Zimbabwe kills 10 children

A cholera outbreak occurs nearly every year during Zimbabwe's rainy season. Yet the rains are really not to blame. The lack of sanitary water and sewer systems throughout the country are the culprit.

During the rainy season, flooded waters rise up to reach areas where people had to relieve themselves. The waste is then carried downstream where it begins to infect people with cholera.

In the latest outbreak for Zimbabwe, 10 children have died from cholera. 200 children have been admitted for treatment at local hospitals. From Kenya's Daily Nation, we read this report on the latest round of cholera.

At least 10 children have died from a suspected diarrhoea outbreak which has affected over 200 children in Zimbabwe's second city of Bulawayo over the past month, a state daily said Wednesday.

"More than 200 children suffering from the disease were admitted during the month of June," The Herald newspaper quoted an official at the government-run Mpilo Hospital as saying.

"Ten children have died. Technicians at our laboratories are analysing stools to determine the cause of the disease."

An official at a private hospital in the city said at least three children had died of diarrhoea at the hospital.

New study finds a connection between weather patterns and cholera

A new scientific study looked at the history of cholera outbreaks in Tanzania and found a correlation between the outbreak and preceding weather patterns. The researches found that a slight increase in temperature or rainfall was always followed by a surge of cholera cases just a few months later.

From Reuters Alert Net, SciDev.net writer Daniela Hirschfeld unpacks the study and examines how it could improve prevention efforts.

"Our model, based on these two parameters, forecasted cases of cholera in Zanzibar well, and could act as a predictor for cholera outbreaks," Mohammad Ali, a researcher at the International Vaccine Institute in Seoul, South Korea, and one of the authors of the study, told SciDev.Net.

Monthly cholera disease surveillance reports between 1997 and 2006 allowed the researchers to map epidemics over time. These epidemics were then compared with monthly environmental data for the same period, according to the study, published in June issue of The American Journal of Tropical Medicine and Hygiene.

Cholera outbreaks were closely associated with a rise in the monthly mean of minimum daily temperatures and rainfall levels, and this data could work as a reliable forecasting system for the disease, they concluded.

This would enable public health officials to prepare efficient and cost-effective interventions, such as vaccination programmes, to stem the outbreaks before they happen.

"We believe that these two climate variables — temperature and rainfall — can be applied as predictors in other regions," said Ali. "Now, we are working with the same type of data from Bangladesh. Our initial findings suggest that the amplification of cholera in this part of the world is also temperature driven."

But reliable data on cholera incidence is lacking in some developing countries, Ali added, making it impossible to develop similar forecasting models.

"I do not foresee that such a model could be developed in all countries," Ali said. "We can say, though, that neighbouring countries of Tanzania that have similar water and sanitation infrastructures may benefit from the model."

Hard rainy season fuels cholera's spread in Cameroon

The rainy season started early and hard in Cameroon. The rains were so hard that it flooded sewerage and garbage through city streets. The filthy water has helped to fuel the spread of cholera in Cameroon's capital city of Yaounde. Since February there have been 250 deaths from cholera.

From Reuters Alert Net, writer Elias Ntungwe Ngalame describes the new humanitarian situation in Yaounde.

Diplomatic missions in Yaounde have also warned their citizens, especially those arriving for the first time, to avoid flooded and cholera-infected zones. They have been advised not to drink water from dubious sources nor eat fruit from roadside vendors, which may have been washed in contaminated water.

The city council, working in tandem with the health ministry, has been spraying anti- bacterial solution in inundated districts. Floods have turned the pit toilets and garbage heaps common in the city’s poorer neighbourhoods into ponds of raw sewage, which is seeping into nearby wells, infecting the main source of drinking water, health officials say.

The council has also banned the sale of bottled drinking water on the streets, a trade that has become popular among the growing ranks of unemployed youths.
...

The U.N. Children’s Fund (UNICEF) is helping the Cameroon government and the population by providing emergency medical kits containing surgical gloves, water treatment tablets, cholera medicine, oral rehydration salts and public education materials. The U.N. agency is concerned about the impact on children, who are particularly at risk from the killer disease.

At the University Reference Hospital (CHU) in Yaounde, patients, including children, lie contorted in agony on mattresses fouled with diarrhoea brought on by cholera.

“Children and mothers are the most vulnerable group and we have been receiving them here by the day since we opened this treatment centre on March 31,” said Gaelle Faure, head of the Medicins Sans Frontieres (MSF) mission in Yaounde, which is working alongside the government to contain the disease.

According to the international medical aid group, the makeshift unit has treated some 158 cases since April 10. It is also providing hygiene management services, including sensitising people to the importance of adequate sanitation.

The cholera problem is not limited to Cameroon. Since September, cases have occurred in other parts of Central and West Africa, including Chad, Niger and Nigeria, according to a report from the World Health Organization (WHO). The affected area is home to some 5 million people.

In Northern Nigeria and southern Niger, more than 260 deaths and over 3,300 cases have been registered. In Cameroon, 6,199 cholera cases have been recorded in the Far North and 410 people have died, the WHO said.

Around 70 percent of inhabitants in Cameroon’s Far North and border towns in Nigeria, Chad and Central African Republic have no access to potable water, according to the report.

Many also live far from medical facilities that could save their lives by helping them rehydrate and replacing the sodium and potassium lost in diarrhoea and vomit.

UN report on Haiti cholera outbreak sidesteps taking responsibility

The United Nations completed their study on what caused the cholera outbreak in Haiti. The report does agree that the a U.N. peacekeepers camp did introduce the bacteria in Haiti. However, the report does not place any blame on the peacekeepers or accepts any responsibility for the outbreak that killed 4,800 people.

From Reuters, we find out more about the report's content.

In its report published Wednesday, the U.N.-appointed panel said the outbreak was caused by "bacteria introduced into Haiti as a result of human activity; more specifically by the contamination of the Meye Tributary System of the Artibonite River with a pathogenic strain of the current South Asian type Vibrio cholerae."

Declaring this cholera strain was introduced "as a result of environmental contamination with feces," the report faulted sanitation conditions at the Mirebalais MINUSTAH camp, saying they "were not sufficient to prevent fecal contamination of the Meye Tributary System of the Artibonite River."

'EXPLOSIVE SPREAD'

Explaining the epidemic's "explosive spread" along the Artibonite River and throughout Haiti, the report said "simultaneous water and sanitation and healthcare system deficiencies" contributed to the spread. It noted Haitians used river water for washing, bathing, drinking and recreation.

Despite pointing an apparent finger at the U.N. peacekeepers' camp, the U.N.-appointed panel did not directly blame them for starting the epidemic.

"The Independent Panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances as described above, and was not the fault of, or deliberate action of, a group or individual," it said.

Repeating a longstanding U.N. position over the cholera in Haiti, a U.N. spokesman in New York said the report "does not present any conclusive scientific evidence linking the outbreak to the MINUSTAH peacekeepers or the Mirebalais camp"

"Anyone carrying the relevant strain of the disease in the area could have introduced the bacteria into the river," Michel Bonnardeaux, a spokesman for the U.N. peacekeeping department, told Reuters.

New study projects 770,000 cholera cases in Haiti this year

A new study to be published tomorrow says there could be 779,000 cases of cholera in Haiti this year. The study will be published in the medical journal The Lancet and contradicts findings made by the United Nations. The authors of the study used data from Haiti's Ministry of Health to base their projections.

From MSN Health, writer Robert Preidt unpacks the study for us.

There could be nearly twice as many cases of the potentially deadly diarrheal disease -- an estimated 779,000 -- between March and November of this year, according to researchers at the University of California, San Francisco and Harvard Medical School.

The discrepancy is important because U.N. projections determine the allocation of resources to fight the disease, said the authors of the study, published March 16 in The Lancet.

"The epidemic is not likely to be short-term," Dr. Sanjay Basu, a UCSF medical resident, said in a university news release. "It is going to be larger than predicted in terms of sheer numbers and will last far longer than the initial projections."

The cholera epidemic erupted in Haiti after last year's devastating earthquake. Cholera -- spread from person-to-person through contaminated food and water -- can be deadly if untreated. In most cases, treatment for the diarrhea caused by the disease involves rehydration with salty liquids.

Late last year, the U.N. projected that a total of 400,000 people in Haiti would eventually become infected with cholera. They reached that total by assuming that cholera would infect 2 to 4 percent of Haiti's population of 10 million. But the U.N. estimate did not take into account existing disease trends, or factors such as where water was contaminated, how the disease is transmitted, or human immunity to cholera, Basu said.

Risk of cholera still high in rural Haiti

The United Nations has made another appeal for donor countries to contribute to fighting cholera in Haiti. Along with the appeal, the UN gives us an update on the spread of the disease.

The UN says that rural areas of Haiti are still at a high risk of getting cholera. Nationwide, the contamination risk has significantly lowered since its peak of late last year.

From this Associated Press article that we found at Google News, we hear more from the UN on the Haiti's status.

The mixed picture comes from Haitian government figures citing 231,070 reported cases and 4,549 deaths since the epidemic began in October.

National mortality rates from cholera are down to 2 percent, from as high as 9 percent earlier, but in some rural areas, more than one-in-ten people who contract the disease die.

In Haiti's Sud Est region, the mortality rate hit 10.7 percent as of Feb. 9, while in Nippes it was 6.7 percent and in the Grande Anse region, 5.9 percent. The rate should be under 1 percent, according to the World Health Organization.

"It's there (in rural areas) that we absolutely have to strengthen our efforts," said Elisabeth Byrs, a spokeswoman for the U.N. humanitarian coordination office. "For that we need money."

The U.N. also is concerned about the possible spread of the disease during Haiti's upcoming Carnival season.

The U.N. has asked for $175 million to deal with Haiti's cholera outbreak, much of which is distributed to local partners and non-governmental organizations to carry out aid work. So far, however, donors have provided only $80 million.

135 Venezuelans being treated for cholera infections from the Dominican Republic

Venezuelans who were in the Dominican Republic for a wedding have brought cholera back home.Venezuelan health officials say they were infected with the Haitian strain of the disease. The Haitian cholera spilled over into the Dominican as the two nations share an island together. 135 Venezuelans are being treated for the disease.

From this AFP article that we found at Google News, we find out more about the spread of cholera from the Haiti.

"At the moment we have not had a single case of someone being contaminated in Venezuela," Health Minister Eugenia Sader told Globovision.

Authorities have said those being treated were part of a group of 452 Venezuelans who traveled to the Dominican Republic for a wedding earlier this month, and Sader said the government has been calling them "one by one."

Besides the cholera patients in Caracas, another 12 Venezuelans infected with the bacteria were still in the Dominican Republic and four others traveled on to Spain, Mexico and the United States.

The government has called on all the guests to report for testing even if they are showing no signs of the diarrheal disease, and has been warning the general public through media advertisements and a hygiene campaign.

Venezuela has had no cholera in a decade, and health officials have emphasized that it is crucial to gain control of the outbreak in the first 24 to 48 hours to prevent the imported bacteria from becoming established here.

Cholera slowing in Haiti, but could surge again this spring

The cholera epidemic in Haiti seems to be slowing. The number of new cases has fallen sharply from the height of the outbreak. Medical professionals warn that there could be another surge in  cholera cases this spring. The rainy season to come could bring flooding of dirty water contaminated with cholera. So far 4,000 people have died of this cholera outbreak.

From this Associated Press article hosted at Google News, we receive an update from Medecins Sans Frontieres doctors working in Haiti.

"The general situation is improving. It's clear," Stefano Zannini, chief of mission for the aid group Doctors Without Borders, said Sunday. "The problem is that the possible development of the epidemic is unpredictable. It is impossible to say whether the situation will continue stabilizing."

Any progress on controlling disease would be rare bit of good news for Haiti, which is passing through a particularly gloomy period. The country is on edge amid a political crisis over a disputed presidential election, and could see more of the violent protests that paralyzed cities and hampered cholera treatment in December. Meanwhile hundreds of thousands are still homeless from last year's earthquake, and a much-reviled former dictator suddenly returned and took up residence in the past week.

Zannini, whose group is contemplating scaling back its more than 40 cholera treatment centers, was unable to muster even cautious optimism regarding the disease. The best he could say was that he was happy new cases and deaths are decreasing to levels not seen since soon after the disease emerged in October.

"I would not be optimistic," he said in an interview with The Associated Press at his Port-au-Prince office.

For the moment, at least, the statistics are moving in the right direction. The number of new cases has dropped to about 4,700 per week, down from more than 12,000 per week in November, and the trend is downward in all 10 of Haiti's departments, or regions, according to the Health Ministry's latest bulletin, released Thursday. The only places it appears to be still rising are in a few isolated spots in the northwest and south.

Some 40 patients a day are still coming to the Doctors Without Borders treatment center in Saint Marc, where the disease first exploded, but that's a third of what it was in December and there hasn't been a death in six weeks, said field coordinator Oscar Sanchez Rey.

"Is this is the end? Nobody really knows, but the situation is better," Sanchez said as he took a break from treating patients, including a family of six that all came down with the disease together. He cautioned that even though fewer people are getting sick, the center's work is still critical: "If no one is treating patients, they are going to die, because it's a lethal disease."

Lilane Estime, 42, tried to sleep on a wooden bench as doctors attended to three of her children. She said all four had piled onto a motorcycle taxi and traveled an hour along a dusty coastal road to reach the clinic. Seemingly healthy, she said she could feel cholera inside her, though she hadn't gotten sick yet.

"If there's a disease going around killing people, you're going to be scared," Estime said.

UN announces panel to investigate source of Haiti's cholera

United Nations Secretary General Ban Ki-Moon has introduced the members of the panel who will investigate the source of the cholera outbreak in Haiti. Many Haitians and scientists believe that the source of the outbreak was from Nepalese UN Peacekeepers station in Haiti. Over 3,400 Haitians have died from the cholera epidemic.

From Reuters, writer Patrick Worsnip attended the announcement of who will be on the investigative panel.

Last month, U.S. researchers reported the cholera strain came from south Asia and mostly closely resembled one circulating in Bangladesh. The United Nations has so far said there is no scientific evidence the Nepalese battalion is responsible and all tests on its troops have proved negative.

But when he announced on December 17 the plan to create an independent panel of inquiry, Ban said, "There remain fair questions and legitimate concerns that demand the best answer that science can provide."

Ban said Thursday the panel would be chaired by Alejandro Cravioto, who is Mexican but works at the International Center for Diarrhoeal Disease Research in Bangladesh.

The other three members are Claudio Lanata of the Instituto de Investigacion Nutritional in Peru, Daniele Lantagne of Harvard University in the United States, and Balakrish Nair of India's National Institute of Cholera and Enteric Diseases.

The panel will review all information and data available to date and travel to Haiti to conduct investigations on the ground, Ban's spokesman, Martin Nesirky, said in a statement.

Overnight Links for December 30th

Water Aid Nigeria is calling on the government to do a better job on providing clean water and sanitation services. From a This Day story found at All Africa we read that the push for sanitation is following a cholera outbreak from earlier this year. 

The Inter Press Service has this story about a Vitamin A supplementation program in India. UNICEF conducts the program that helps to give Vitamin A shots to children twice a year. 


The Australian Broadcasting Corporation has a story that says that the cholera outbreak in Haiti could hurt the rice harvest this year. Farmers fear that crops near rivers and creeks may be infected with cholera.

2010 in Haiti; disasters strike fast but help arrives slowly

Throughout the year 2010, the happenings in Haiti has dominated the posts on this blog. What has happened in the little country has really touched our heart, so we have focused much of our posts on it.

To sum up what has happened to the country and really most disasters in the world, the disasters have been quick, but the response has been slow. The rubble is beginning to be cleared from Haiti's streets, but the process has been slow. The cholera is spreading across the country quickly but there are still no vaccines for the people.

NPR conducted this interview over the weekend with their correspondent who has been in the country all along. Jason Beaubien gives us some analysis on the slow moving recovery efforts.

HANSEN: Jason Beaubien, have the U.S. and the international community been able to live up to their promises of financial aid and assistance?

BEAUBIEN: Certainly in Haiti there's a great sense of frustration that things are moving slowly. More than $10 billion was pledged from the international community. Less than a billion of that has actually come into the country over the last year. There's very much a risk that after this anniversary, Haiti could completely fall off the radar of the international community. And there's no way that Haiti's going to rebuild without that assistance from the international community.

They're not in a position to do it on their own and certainly there's going to be other disasters, other things that are going to pop up. And I think in Haiti there's very much a sense that the pace this last year was so slow that if that continues that Haiti could be stuck in this limbo waiting for this international aid to come at a time when there really isn't that much pressure for that to happen.

HANSEN: Again, billions of dollars were pledged to help. Money has come in. Who administers the money that comes in? I mean, the Haitian government is barely functional.

BEAUBIEN: There is a large consortium. It's called the Interim Haitian Reconstruction Commission. It's being headed by former President Bill Clinton and Prime Minister Bellerive. They are administering billions of this money. They are overseeing sort of the biggest chunk. A lot of it is also in the hands of individual non-governmental organizations, aid groups.

HANSEN: The earthquake basically left whatever medical care there was in Haiti in ruins. A lot of people weren't treated for the injuries related to the quake. Then the cholera outbreak hit. I mean, what is the state of medical care in Haiti today?

BEAUBIEN: It's actually kind of strange. Medical care is actually better in Haiti now than it was before the quake. The number of international health care organizations that have come in - Doctors Without Borders and many others - are providing health care for free to the population at a level that they never were getting before the quake. So, that's sort of a perverse consequence of this.

At the same time, the cholera outbreak has put huge new strains on that system. This strain of cholera, this strain can kill people in a matter of hours. And so, now there's this need to have specialized cholera treatment facilities just about everywhere so that people, within a matter of hours, can get them. So, it's sort of a win on one hand and a loss on the other.

HANSEN: Has the cholera outbreak been curbed?

BEAUBIEN: No, and the problem is that it's clear that in a place like Haiti where the sanitation facilities are at times nonexistent, where getting clean water is one of the daily challenges that people face, that they're not going to be able to completely contain cholera and wipe it out. It's going to be in the country for years to come, people are saying.

Lynch mobs in Haiti looking for someone to blame for cholera

Lynch mobs have begun in Haiti as people are looking for someone to take the blame for the cholera epidemic. At least 40 people have been killed by the mobs so far. The mobs accuse the victims of using black magic to spread the disease.

From France 24, this wire story gives us more details.

At least 40 people have been lynched in recent weeks by angry Haitian mobs who accused their victims of spreading cholera in the poverty-stricken nation, local officials said Wednesday.

Fourteen people suspected of using black magic to spread the disease in the south-western region of Grand Anse were among those killed.

A cholera epidemic has killed more than 2,500 people since its outbreak in Haiti in October. More than 100,000 people have fallen ill from the disease and it is feared that six times as many people could become infected.
Science backs rumours

Meanwhile, scientists reported in the New England Journal of Medicine on Thursday that strong evidence suggests the disease came from South Asia.

Researchers said DNA samples from cholera bacteria recovered in Haiti were nearly identical to strains found in South Asia. The finding supports controversial theories that UN troops from Nepal or Bangladesh may have been responsible for bringing the disease to the Caribbean nation.

According to Harvard researcher Dr. Matthew Waldor, the finding indicates that cholera was introduced by people rather than arriving on ocean currents or occurring within Haiti, which also has been suggested.

Overnight Links for December 21st

A team of medical professionals from Kentucky took a missions trip to Haiti to help meet the health needs there. From the North Platte Telegraph writer Malena Ward talked to the people who took the trip.

Al Jazeera has a series of special programs on the upcoming independence referendum vote for Southern Sudan. The "Crossroads Sudan" program concentrates on the challenge of development for the new country.

The cholera death toll continues to rise in Haiti. The AFP story that we found at Google News says that the number of people dead has now surpassed 2500.

Overnight links for December 20th

The Pan American Heath Organization is getting ready to begin cholera vaccinations in Haiti. Jane Sutton from the Scotland Herald says that the PAHO still needs to raise more money to manufacture more vaccine before they begin.   

The latest U.S. Census Bureau numbers show that the Muncie, Indiana area has a higher level of poverty than state or even national levels. Seth Slabaugh of the Muncie Star Press looks into the reasons why poverty is so high for this rural area. 

Canada will soon be withdrawing troops from Afghanistan. The country is beginning to talk about how they continue to help human rights in Afghanistan after the troops are gone. From the Globe and Mail, writer Sarah Smiles Persinger examines the new debate.   

cholera fears come with flooding in Colombia

Flooding in Colombia has brought with it fears of new cholera cases. From the Latin American Herald Tribune, we find out more about the emergency.

Several reservoirs in Colombia are at the limit of their capacity amid the worst rains on record, and one has already overflowed, while the government acknowledged Friday that it fears a possible outbreak of cholera.

The catastrophic situation that much of the country is going through, in which 271 people have died and more than 2 million are affected, according to the latest official report, has become even more threatening in the northwestern province of Cordoba.

There the Urra Dam overflowed and in turn caused the flooding of the Sinu River, which inundated the homes of at least 2,000 families in several municipalities and in Monteria, the provincial capital, according to Mayor Marcos Pineda.

President Juan Manuel Santos was to visit Friday the municipality of Lorica, Cordoba, where he plans to announce new measures as part of the emergency decreed to combat the effects of the devastating rains.

What happened at Urra could be repeated at another nine hydroelectric dams that generate 84 percent of the energy consumed by Colombians, the daily El Espectador said Friday.>

Overnight links for December 16th

The Guardian has this video on solutions to improve the water supply in Haiti. The lack of clean water in the country is really helping to spread the cholera outbreak.  

Inter Press Service writer Damakant Jayshi has this story about door to door efforts to improve maternal health in Nepal.  

Soutik Biswas of the BBC is in Andhra Pradesh to take a look at the micro-credit caused suicides in India.


Finally this audio roundup of the headlines provided by Reuters Alert Net's AudioBoo channel.

MSF moves facilities to areas of Haiti that have new cholera cases

Medecins Sans Frontieres is moving its facilities along with where the cholera outbreak moves in Haiti. More people age getting sick in the Northern and Southern portions of the country, so MSF is moving staff into those parts that are seeing surges of infections.

From this MSF press release, we find out more on the latest news from Haiti.

Since October 22, 2010, Doctors Without Borders/Médecins Sans Frontières (MSF) has treated 62,000 people with cholera symptoms in Haiti. This week, MSF's 4,000 Haitian staff and 315 international employees treated close to 2,000 patients each day in the 47 centers and cholera treatment units it has established across the country.

MSF has treated more than 15,000 people in the capital with cholera symptoms since the epidemic began. The number of patients admitted into MSF facilities in Port-au-Prince has stabilized at a daily average of 385 patients this week. The situation is also stabilizing in the Artibonite department, which has thus far been hardest hit by the epidemic and where more than 23,000 people have been treated. This week, slightly more than 1,000 people were admitted into MSF facilities there.

However, the epidemic continues to spread in Haiti's northern cities and rural areas. During the past week, more than 4,000 patients were treated in the Department du Nord, as its known locally, and 1,100 patients were treated in the Department du Nord Ouest. Despite the significant logistical challenges involved in reaching isolated parts of both departments, MSF teams are expanding the number of units, treatment centers, and rehydration points in both areas.

Meanwhile, the epidemic has increased sharply in the South. Of the 475 people treated in the South for cholera since the start of the outbreak, 439 presented in the past seven days. In Jacmel, in the Departement du Sud Est, approximately 100 patients are arriving at MSF's 50-bed cholera treatment unit every day. "Our team had to handle an inflow of 260 in a single day," says Dr. Loreto Barcelo, MSF's coordinator in Jacmel. "There were people everywhere… Patients, their families… There were several hundred people at the treatment site. We had to put up to four patients in a single bed and try to save as many as possible while waiting for extra help to arrive. We now have an additional 20 nurses helping us and opened a new 100-bed treatment center, which is helping us manage the situation."

This week, new cholera treatment facilities were set up in Pignon, St Raphaël, Ranquitte (Nord), Gaspard (Nord Ouest), and Jérémie (Grande Anse). However, as the epidemic continues to spread, the response by local and international organizations remains inadequate.

Some have raised the possibility of launching a vaccination campaign. Under the circumstances, epidemiologist Kate Alberti wonders if this is appropriate. "The epidemic affects the entire country today, including the most remote areas. This isn't the time to carry out a vaccination campaign. The priority is to treat patients, provide access to chlorinated water and improve hygiene measures to prevent others from becoming ill." However, Alberti adds, "In the future, we will consider vaccination as a viable option to immunize the population and limit the appearance of a new epidemic."

MSF is treating victims of post-election violence

MSF treated 96 victims of the violence that erupted in Port-au-Prince and several other cities between December 7 and 12. Of that number, 38 had gunshot wounds. Four people died of their wounds. MSF has surgical supplies and medical teams at six facilities in Port-au-Prince and two in other regions of the country. The organization remains prepared to treat any additional wounded patients. Despite the insecurity, MSF teams have managed to ensure continuity of medical care, including responding to the cholera epidemic and treating persons wounded in the violence.

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.

WHO considers cholera vaccinations in Haiti

The World Health Organization is now looking into vaccinating people in Haiti to ward off cholera. If they begin the WHO will have to solve the problems of buying more vaccines as well as transportation and distribution issues.

From the New York Times, writer Donald G. McNeil Jr. examines the possible switch in strategy.

So far, the cholera vaccine has seen little use in Haiti, where the disease has killed more than 2,000 people and is still spreading. However, major obstacles remain, including supply shortages, transportation problems and the need to administer the vaccine several times for it to be effective.

But the Pan American Health Organization, which represents the W.H.O. in the Western Hemisphere, recently learned that there might be one million to two million doses of vaccine in the world, not just the 200,000 it originally thought, Dr. Jon K. Andrus, the Pan American organization’s deputy director, said Friday. “We recognize that it’s time to rethink our position,” he said. “We don’t want to miss an opportunity.”

His organization will hold a meeting of experts in Washington next Friday to consider whether to buy those doses and move them to Haiti.

Even if the group agrees to move forward, there would be no quick fix. Most of the doses are in bulk form, and it could take up to two months to have them ready, Dr. Andrus said. Also, the vaccines have not been tested by the W.H.O.

Also on Friday, Dr. Paul Farmer, who is well known for fighting AIDS in Haiti, endorsed broader use of the vaccine there, and called for creating emergency stockpiles of millions of doses to keep cholera from spreading to other countries.

He endorsed measures like searching Haiti’s central mountains for people too sick to reach clinics, using antibiotics even in moderate cases and rebuilding the water and sanitation networks shattered by January’s earthquake.

Overnight Links for December 10th

... or more like morning links due to our late start...

From Medecins Sans Frontieres a look at how cholera treatment is continuing on despite the political protests and unrest.


Reuters Alert Net introduces us to a new pneumonia vaccine that is about to begin distribution in Nicaragua.

The great website Wikileaks has gathered some evidence that China's aid to Africa does come with conditions. Jonathan Glennie of the Guardian examines the leaked US embassy cables.