Eliminating Cholera Transmission from Haiti

Jean Robert, FETP resident, performing rapid diagnostic testing for cholera at a cholera treatment center in Jérémie commune, Grande Anse Department, Haiti. Photo credit: Ashley Greiner

Jean Robert, FETP resident, performing rapid diagnostic testing for cholera at a cholera treatment center in Jérémie commune, Grande Anse Department, Haiti. Photo credit: Ashley Greiner

Eliminating Cholera Transmission from Haiti: On October 21, 2010, in the aftermath of the devastating January 2010 earthquake, the Haitian Ministry of Health (MOH) confirmed cases of cholera for the first time. Since the initial outbreak, over 800,000 suspected cholera cases have been reported and 9,700 individuals have died.

CDC was on the ground within days of the initial outbreak conducting case investigations to determine risk factors for cholera transmission. CDC continues to work closely with the Government of Haiti (GOH) and partners to improve cholera surveillance, build laboratory capacity, and increase access to clean water and improved sanitation. While cholera remains a public health threat, the country is moving closer toward elimination of cholera transmission as incidence is down 99% in 2018 from 2011.

  • Surveillance: Cholera surveillance focuses on timely notification of cases and a multisectoral response to case clusters or “hot spots”. In 2011, CDC Haiti worked with the MOH to build the National Cholera Surveillance System (NCSS), a platform that produces daily reports from cholera treatment facilities of new and hospitalized cases and deaths aggregated by age groups. The NCSS facilitates timely reporting of surveillance data allowing the MOH to identify cholera “hotspots” in real time. In addition to identifying cholera outbreaks, NCSS surveillance data are critical to guiding the design of cholera prevention programs. A 2013 CDC publication in the New England Journal of Medicine entitled “Cholera Surveillance during the Haiti Epidemic — The First 2 Years” assessed surveillance efforts during the outbreak and noted the important role commune-level data played in facilitating targeted, intensified water and sanitation interventions and prioritizing sites for oral cholera vaccine campaigns.CDC continues to provide data management and analysis support to the NCSS. After Hurricane Matthew disrupted the NCSS in October 2016, CDC staff worked to re-establish the surveillance network and to identify diarrheal disease outbreaks in the hurricane-affected communes. While suspected cholera cases surged in Grand’Anse and Sud Departments in the immediate weeks following the hurricane, timely cholera case investigations led by CDC-trained FETP residents and other partners quickly contained the outbreak.
  • Laboratory: CDC works closely with the National Public Health Laboratory (LNSP) to routinely test suspected cases of cholera. To facilitate the testing of samples collected outside Port-au-Prince where regional laboratory capacity is still growing, CDC worked with the MOH to develop and operationalize the Specimen Referral Network (SRN) – a system for transporting specimens from all ten departments to LNSP for cholera culture and other laboratory testing. After suspected cholera cases spiked in southern Haiti following Hurricane Matthew, CDC worked with Les Cayes departmental hospital to train laboratory technicians to test for cholera and supplied the laboratory with the necessary testing equipment. CDC conducted an evaluation of the regional lab in Cap-Haitian in 2018 so it can be the primary cholera testing site for the north regions.
  • Oral Cholera Vaccine (OCV): Oral cholera vaccine (OCV), implemented alongside robust WASH interventions, is an effective complementary approach to preventing and controlling the spread of cholera. CDC Haiti has provided support to multiple OCV campaigns in Haiti including a 2013 campaign focused in the North and Centre departments, a subsequent vaccine effectiveness study, and a 2014 campaign focused in Centre and West departments. During the 2016 Hurricane Matthew response, CDC participated in the MOH-led OCV taskforce and worked with the MOH and partners to develop a monitoring and evaluation plan to be implemented following the OCV campaign. Approximately 1.4 million people have been vaccinated across all OCV campaigns from 2012-2017.
  • Water and Sanitation: Increasing access to clean water and improved sanitation are key to preventing the spread of cholera. CDC-trained communal rural water and sanitation technicians, known by the French acronym TEPACs, played a key role addressing access and availability to clean water during the 2016 Hurricane Matthew response.After Hurricane Matthew greatly damaged the southern claw of Haiti, the GOH relied heavily on the TEPACs to identify and access areas of need and to facilitate response activities. The TEPACs conducted an assessment of hurricane damage for all community water systems in the hurricane-affected areas which helped to target donor response efforts. Their activities also included monitoring free chlorine residual in tanker trucks and distribution points, visiting water systems with humanitarian WASH actors, and supporting the distribution of water treatment products and other hygiene kit items. Having this existing workforce in the field made the hurricane response more efficient and effective.

References:

  • Barzilay, Ezra J., et al. “Cholera surveillance during the Haiti epidemic—the first 2 years.” New England Journal of Medicine 368.7 (2013): 599-609.
Page last reviewed: October 5, 2018
Content source: Global Health