Cholera confirmed in Florida woman who traveled to Haiti

Nov 19 2010

"The first known case of cholera in the United States linked to the outbreak in Haiti was confirmed Wednesday by health officials who said a southwest Florida woman contracted the disease while visiting family in a region at the heart of Haiti's epidemic," the New York Times reports.

The woman experienced diarrhea and dehydration upon her return from Haiti's Artibonite region and then spent five days in the hospital. "She is expected to recover fully," the newspaper writes. There are several other suspected cholera cases - that are "not believed to be connected to the verified patient" - in other parts of the state, according to the New York Times. The Florida Department of Health is investigating (Goddard, 11/17). "New cases are expected in Florida, because the state has about 241,000 Haitian-born residents, many of whom travel back and forth frequently, particularly since the Jan. 12 earthquake," the Miami Herald notes.

"The illness is spread through infected fecal matter, making the threat less of a concern in Florida, where sanitation systems are more developed than on Hispaniola. ... A Centers for Disease Control and Prevention report says there were 40 cases of cholera in the United States from 1996 to 2006," according to the newspaper (Tasker/Robles, 11/17).

"We are lucky in the state of Florida, and the U.S. generally, to have a very sound infrastructure for our food, water and sewage," said Rob Hayes, spokesman for the Florida Department of Health. "With that in place, and with our aggressive public health practices, we are not concerned about this being a significant public health threat," he said, the New York Times writes. 

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "One should never say, 'No problem, no big deal, forget about it,' because that looks cavalier." He added, "Though we shouldn't be careless, it's extremely unlikely - vanishingly unlikely - that we will have a cholera problem in Florida" (11/17).

The spread of the disease is more worrying in the Dominican Republic, which confirmed its first case on Tuesday. To address the situation, the country "banned Haitian street vendors in border markets from selling food, juice and used clothes. Mats soaked in bleach were placed at the border entry so that people's feet and car tires would be sanitized upon entering," according to the Miami Herald. "The chaotic border market in Dajabon was moved to a lot equipped with latrines, sinks and soap. Health experts are boarding Dominican-bound buses and asking riders: Are you sick?"

"Several weeks into this, we have just one imported case,'' said the Dominican Health Minister Bautista Rojas Gomez. "If we stay vigilant, we should be able to have just isolated cases" (11/17).

Meanwhile, "[a]nti-U.N. rioting fueled by cholera fears scaled down in northern Haiti on Wednesday, but a third demonstrator was killed in clashes and small-scale demonstrations took to the streets of the capital," the Associated Press/Seattle Times reports, noting that "protests were distinctly calmer Wednesday than in the first two days, though flaming barricades remained and protesters threw rocks at police trying to remove them."

Rioting has interfered with efforts to treat and prevent cholera, according to aid workers. "The U.N. canceled flights carrying 3 metric tons of soap along with medical supplies and personnel because of violence in Haiti's north," the news service writes, noting that more than 16,700 people have been hospitalized with suspected cholera so far (Katz, 11/17).

"Local media reported bodies of cholera victims - a major infection threat - being left in the streets of the city of [Cap-Haitien], where aid agencies are battling to contain the fiercest spike of the month-old Haitian cholera epidemic," Reuters reports.  

"We have to get aid to these people right away and this unrest is delaying that," said Julie Schindall, a spokeswoman for Oxfam. "Every day we lose means hospitals go without supplies, patients go untreated and people remain ignorant of the danger they are facing," according to a statement from Nigel Fisher, the U.N. humanitarian coordinator in Haiti (Delva, 11/17).

NPR Blog Looks At Why Oral Cholera Vaccine Has Not Been Used To Combat Haiti's Outbreak

NPR's "Shots" blog examines whether the two existing oral cholera vaccines "that cost as little as $1 a dose" could help treat and prevent death in the Haitian outbreak. Jon Andrus, deputy director PAHO, said the organization "'spent a lot of time discussing with some of the best experts in the world' whether to deploy cholera vaccine in Haiti and the Dominican Republic. There is a public health rationale for it, they decided." But the discussion was dropped after experts learned there were only 500,000 doses of the vaccine available in the world. Young children require three doses, while others require two doses. "There just wouldn't have been the supply. The question is: Who would you vaccinate?" Andrus said.

In addition, "[m]any public health experts say you can't use cholera vaccine during an epidemic to contain it. It moves too fast, they say. There are three infected-but-asymptomatic people for every obviously sick person, so you can't tell whom it's too late to vaccinate. It takes several weeks to vaccinate susceptible people and achieve effective immunity," according to "Shots."

"There are a lot of assumptions made by people who say you can't really contain cholera with a vaccine," said John Clemens, director-general of the International Vaccine Institute, which developed an oral cholera vaccine. "In fact, it's never been tried so we really don't know," he said, noting that current vaccines offer significant protection after one dose.

But after the outbreak phase passes, the "vaccine could really make a difference," according to the blog. "But using vaccines to limit the disaster would require a massive increase in production of the two vaccines - Dukoral, made by a Dutch company, and Shanchol, a newer vaccine made by an Indian firm, Shanthal, that last year announced it was ready to turn out five million doses." Though bulk quantities of Shanchol could be shipped, it would take "uncharacteristically fast footwork by the World Health Organization," in addition, the vaccine has not been "prequalified," which is a required approval for the vaccine to be purchased by agencies like PAHO (Knox, 11/17).