BIOSURVEILLANCE UPDATE - 18

OPERATIONAL BIOSURVEILLANCE

Current official stats are more than 18,382 cases and 1,110 fatalities. This includes more than 1,800 cases in Port au Prince with over 30 fatalities.

Conservative estimates therefore suggest 75,000 cases of cholera in Haiti to-date, the majority of which were subclinical.

In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics. We therefore estimate the upper bound of estimated case counts to be 250,000.

Although PAHO projections use an attack rate of 2% of a total estimated Haiti population of 10 million to estimate 200,000 total clinically apparent infections, the true community load will be closer to 800,000 if subclinical infections are counted.

We err on the side of over-estimating because this is a "virgin soil" epidemic and expected to aggressively spread throughout the country and across the border into the Dominican Republic.

We are now pursuing answers to the question of uptake by indigenous zooplankton and spread along oceanic currents that pass west of the Gonave Gulf, which is where the Artibonite River discharges, north and west along the northern Cuban coastline and north to the waters east of Florida.

Tomorrow is Vertieres Day, where we may see some degree of population mixing, particularly in the north. It is unclear at this time to what degree the recent violence will affect observance of the holiday. Holidays are opportunities to spread disease further as populations intermingle.

As noted by HEAS one week ago and yesterday officially acknowledged, cholera is in the Dominican Republic. We expect to see medical clinic inundations inside DR in the near future.

As expected, Florida has reported a case of cholera in a returned traveler. There will be more cases in the United States; we believe it likely more cases are inside the US unreported. Implications for the United States are neglible.

SUSPECT CASES SOUTH OF FOND PARISIEN / LA SOURCE NEAR DR BORDER

We have report of two fatal cases with cholera-like symptoms from mountain towns south of Fond Parisien / La Source near the Jimani DR border crossing. One patient was reportedly transferred to the Tabarre CTC in Port au Prince.

CHOLERA IN PIGNON

The HEAS has been monitoring the situation in Pignon for about a week now. Pignon is south of Milot (location of Hopital Sacre Coeur), where Milot itself has also been reporting cholera.

One week ago Pignon started to see cases from out of town, seeing a total of 20. This week they have seen 38 cases, with 24 current in-house patients and 10-12 fatalities so far. Personnel and supplies are meeting demand for the time being.


CHOLERA 500M FROM THE US EMBASSY: ST DAMIEN'S

500 meters from the United States Embassy in Tabarre / Port au Prince is St Damien, a private Catholic hospital. So far they've seen 200 cholera patients and 10 fatalities, most of whom were dead upon arrival.

They are prepared for more patients with 1000 total beds available. They have asked for more body bags. This, in addition to over 2000 patients seen in MSF's Port au Prince facilities, is further indication of the dire situation Port au Prince is in.

UPDATE: EMERGENCY SITUATION IN ST LOUIS DU NORD / IDIS CAT 5

Coastal communities along the highway between Port de Paix, La Pointe, and St Louis du Nord are experiencing significant, ongoing medical response strain now as communities in the mountainous region to the south walk up to eight hours for care and are often near-death upon arrival. Many cannot be saved.

In St Louis du Nord, a community with an estimated total population of 20,000, has one medical facility at the North West Haiti Christian Mission that has been supported by medical teams from groups such as MTI and MMRC Global. The situation there is now imminent collapse of medical response capacity as patient demand has exceeded staffing and materiel availability.

The team consists of one medical student and five nurses managing patient flow across 3 buildings:

1. critical care, where IV therapy is performed (currently @65 patients in-house)
2. oral rehydration (currently @35-40 patients)
3. pre-discharge monitoring (currently @35-40 patients)

Length of stay for the typical critically ill presenting patient is 72-96 hrs in critical care followed by 24 hrs in oral rehydration, followed by 24 hrs in pre-discharge observation. They are stepped back up if condition deteriorates. Most patients stay in-house for 48-96 hrs.

The team is seeing persistently elevated patient flow of 150 per day, many of whom have walked up to 8 hrs down from the mountains for care. The latter group is usually the most critically ill. Approximately 50% of the patients they see require IV therapy. Daily mortality has ranged from zero to 11 deaths. The team does not turn people away, and they are about to open a fourth area / tent to house another 25 patients.

To-date, the team estimates they have used approximately 8,000 liters of IV fluid since their arrival a week ago Monday (10 days), which represents 8 shipments. Currently, they are using approximately 450 liters of IV fluid daily and producing 2 to 3 dump trucks of medical waste daily.

The team is now at its limit with no backup support identified yet. They have been working 20-24 hr shifts for the last 10 days. There is serious concern they will make mistakes due to fatigue, and one medical responder was possibly infected and treated already. The floors are constantly wet from vomiting, diarrhea, and bleach.

The HEAS has sent out an emergency request for medical personnel and materiel. Landing pad for helo is available on-site.