HAITI CHOLERA DEATH TOLL SPIKES BY 105: OFFICIAL
(AFP)
PORT-AU-PRINCE – The death toll from Haiti's cholera epidemic spiked to 442 on Wednesday, with 105 more deaths since Saturday and more than a 40 percent jump in new cases, officials said.
Haitian health authorities reported that an additional 1,978 people were hospitalized, raising the total number of cases to 6,742. The developments, announced at a news conference here by Health Ministry official Jocelyne Pierre-Louis, reflected a surge both in new cases, which were up 41 percent, and deaths, which climbed 31 percent.
The epidemic has waxed and waned since it first surfaced in the Artibonite Valley in northern Haiti on October 21, the impoverished country's first cholera outbreak in a century. On Monday, the US Centers for Disease Control and Prevention identified the strain of cholera in Haiti as being the same as a strain found in South Asia, deepening the mystery over the source of the island's first cholera epidemic in more than a century. Meanwhile, hospitals have been overwhelmed by cholera cases despite intensive efforts to respond to a disease that aid groups fear could spread like wildfire if it reaches densely populated Port-au-Prince.
Hundreds of thousands of people left homeless by a devastating earthquake in January live in unsanitary camps in and around the city. The World Health Organization warned last week that the outbreak is far from over and Haiti should prepare for the "worst-case scenario" -- cholera in the capital.
International aid group Save the Children said last week the outbreak was threatening some 25,000 new mothers and their babies in and around the capital. Although easily treated, cholera has a short incubation period -- sometimes just a few hours -- and causes acute watery diarrhea that can quickly lead to severe dehydration and death.
Thursday, November 4, 2010
Tuesday, November 2, 2010
ARTICLE - HAITI ADVISES EVACUATION OF CAMP
HAITI ADVISES EVACUATION OF ONCE-TOUTED RELOCATION CAMP, DECLARES IT UNSAFE IN STORM
(CP) - By Jonathan M. Katz
PORT-AU-PRINCE, Haiti — It was the jewel of Haiti's post-earthquake recovery: an organized relocation camp with thousands of tents billed as hurricane-resistant, lined up in neat rows on graded mountain soil.
Now, staring down an expected hit later this week from a hurricane, officials say Corail-Cesselesse is not safe. On Tuesday, the government advised the estimated 7,850 residents of its primary relocation camp to ride out the storm somewhere else.
"We're asking people in Corail to voluntarily move from where they are and go to the houses of family or friends. The places the government has identified are churches and schools that are available for shelter from the storm," Haiti civil protection official Abel Nazaire told The Associated Press.
Camp managers held a "loudspeaker meeting" with megaphones to tell residents about the evacuation order, said Bryant Castro, the American Refugee Committee staffer managing the camp. Residents were told to seek any home they could find and are expected to start leaving as soon as Wednesday.
A hurricane over the weekend, Tropical Storm Tomas was in the central Caribbean on Tuesday with maximum sustained winds of 40 mph (65 kph), according to the U.S. National Hurricane Center in Miami. Its centre was about 395 miles (665 kilometres) south-southwest of Port-au-Prince and moving west near 10 mph (17 kph).
Forecasters predicted it will veer north toward Haiti and perhaps regain hurricane strength by Thursday. A hurricane watch was issued for Jamaica, and the centre said the storm could dump up to 8 inches (20 centimetres) of rain on Aruba, Bonaire and Curacao.
Tomas has already killed at least 14 people and left seven missing in the eastern Caribbean nation of St. Lucia, where it caused more than $37 million in damage. In nearby St. Vincent, the storm wrecked more than 1,200 homes and caused nearly $24 million in damages to crops, especially bananas — one of St. Vincent's top commodities.
It would be the first big storm to strike Haiti since the Jan. 12 earthquake killed as many as 300,000 people and forced millions from their homes. It would also be the first tropical storm or hurricane to hit since 2008, when Fay, Gustav, Hanna and Ike battered Haiti in the space of a month, killing nearly 800 people and wiping out 15 per cent of the economy.
If it follows its predicted track it could hit every major Haitian city including Port-au-Prince, Les Cayes, Gonaives and Cap-Haitien. The U.N. Office for the Coordination of Humanitarian Affairs said rainfall of up to 5 inches (13 centimetres) could cause catastrophic floods in the severely deforested country.
Aid workers are scrambling to prepare but are badly short of supplies including shelter material because of the responses already under way to deal with the aftermath of the earthquake and an unprecedented cholera outbreak that has killed more than 330 people and hospitalized more than 4,700.
A U.S. Navy vessel, the amphibious warship Iwo Jima, was steaming toward Haiti on Tuesday to provide disaster relief.
Some of the biggest concern is for 1.3 million earthquake survivors still living under tarps and tents nearly 10 months after the disaster. The government said there are some shelters in the capital — a handful have been built in nearby Leogane and several hours north in Gonaives — but basically people will be on their own if Tomas hits.
"The government doesn't have shelters for 1,300,000 people," Nazaire said.
An enormous international aid effort flowed into Haiti in the immediate wake of the quake, but reconstruction has barely begun, in part because donors have not come through with promised funds. The United States has not provided any of the $1.15 billion in reconstruction aid it pledged last March.
When Corail opened in April, it was portrayed as a model for how camps could be built and run. A joint effort by the Haitian government and international aid groups, including U.N. peacekeepers and U.S. military engineers, it was billed as a refuge from dangerous hillside camps that Haitians had set up on their own in the days after the quake.
Corail's residents were selected from the spontaneous camp taken over by actor Sean Penn's relief organization, sprawled over a country club golf course in the capital. Residents were told they would be better off on a distant desert plain 9 miles (15 kilometres) north of the city, far from their former homes and jobs.
"I signed up. I didn't know where I was going. My home was destroyed. I had nowhere else to go," Jonel Romelus, a 36-year-old mason who moved to Corail, said Tuesday.
But an AP investigation in July revealed the site's selection was tainted by conflict of interest:
The land under it belonged to the company led by the government's chief relocation adviser, Gerard-Emile "Aby" Brun. The choice put his company in position to receive government compensation for the land.
It also promised to create a community home for thousands of people who would need jobs, a boost for the Brun company's negotiations with a South Korean garment firm, Sae-A Trading Co. Ltd., to build factories next door. In September, the company signed a memorandum of understanding with Haiti's prime minister and U.S. Secretary of State Hillary Rodham Clinton to build the factories.
The day after AP's investigation was published, torrents of water and high winds from a storm collapsed 344 tents in Corail and sent 1,700 people — a quarter of the camp — fleeing for new shelters.
The dangers have only become clearer since.
"I would say ... that insufficient analysis was done on exploring all the options before selecting the Corail site," said Castro, the camp's manager. "The Corail site is located on a flood plain, and hydrologically it's not a sound location."
Oxfam spokeswoman Julie Schindall said aid workers are concerned about delivering services to the camp if roads from Port-au-Prince flood.
"This goes back to the original thing: No, (Corail is) not a safe place to live," she said. "We knew a hurricane was going to come — this is Haiti, this always happens — and we have not had a level of reconstruction that gets people under tents into houses."
At this point there is little to be done before the storm. Romelus said his family — his wife, two daughters ages 2 and 5, a sister and nephews — will stay in the camp unless the government can provide shelter. They have nowhere else to go.
"God will protect me. I'm not going to be the only one (staying Corail). If something happens, we'll deal with it," he said. "If they could have moved more quickly and built more houses, it would have been safer."
(CP) - By Jonathan M. Katz
PORT-AU-PRINCE, Haiti — It was the jewel of Haiti's post-earthquake recovery: an organized relocation camp with thousands of tents billed as hurricane-resistant, lined up in neat rows on graded mountain soil.
Now, staring down an expected hit later this week from a hurricane, officials say Corail-Cesselesse is not safe. On Tuesday, the government advised the estimated 7,850 residents of its primary relocation camp to ride out the storm somewhere else.
"We're asking people in Corail to voluntarily move from where they are and go to the houses of family or friends. The places the government has identified are churches and schools that are available for shelter from the storm," Haiti civil protection official Abel Nazaire told The Associated Press.
Camp managers held a "loudspeaker meeting" with megaphones to tell residents about the evacuation order, said Bryant Castro, the American Refugee Committee staffer managing the camp. Residents were told to seek any home they could find and are expected to start leaving as soon as Wednesday.
A hurricane over the weekend, Tropical Storm Tomas was in the central Caribbean on Tuesday with maximum sustained winds of 40 mph (65 kph), according to the U.S. National Hurricane Center in Miami. Its centre was about 395 miles (665 kilometres) south-southwest of Port-au-Prince and moving west near 10 mph (17 kph).
Forecasters predicted it will veer north toward Haiti and perhaps regain hurricane strength by Thursday. A hurricane watch was issued for Jamaica, and the centre said the storm could dump up to 8 inches (20 centimetres) of rain on Aruba, Bonaire and Curacao.
Tomas has already killed at least 14 people and left seven missing in the eastern Caribbean nation of St. Lucia, where it caused more than $37 million in damage. In nearby St. Vincent, the storm wrecked more than 1,200 homes and caused nearly $24 million in damages to crops, especially bananas — one of St. Vincent's top commodities.
It would be the first big storm to strike Haiti since the Jan. 12 earthquake killed as many as 300,000 people and forced millions from their homes. It would also be the first tropical storm or hurricane to hit since 2008, when Fay, Gustav, Hanna and Ike battered Haiti in the space of a month, killing nearly 800 people and wiping out 15 per cent of the economy.
If it follows its predicted track it could hit every major Haitian city including Port-au-Prince, Les Cayes, Gonaives and Cap-Haitien. The U.N. Office for the Coordination of Humanitarian Affairs said rainfall of up to 5 inches (13 centimetres) could cause catastrophic floods in the severely deforested country.
Aid workers are scrambling to prepare but are badly short of supplies including shelter material because of the responses already under way to deal with the aftermath of the earthquake and an unprecedented cholera outbreak that has killed more than 330 people and hospitalized more than 4,700.
A U.S. Navy vessel, the amphibious warship Iwo Jima, was steaming toward Haiti on Tuesday to provide disaster relief.
Some of the biggest concern is for 1.3 million earthquake survivors still living under tarps and tents nearly 10 months after the disaster. The government said there are some shelters in the capital — a handful have been built in nearby Leogane and several hours north in Gonaives — but basically people will be on their own if Tomas hits.
"The government doesn't have shelters for 1,300,000 people," Nazaire said.
An enormous international aid effort flowed into Haiti in the immediate wake of the quake, but reconstruction has barely begun, in part because donors have not come through with promised funds. The United States has not provided any of the $1.15 billion in reconstruction aid it pledged last March.
When Corail opened in April, it was portrayed as a model for how camps could be built and run. A joint effort by the Haitian government and international aid groups, including U.N. peacekeepers and U.S. military engineers, it was billed as a refuge from dangerous hillside camps that Haitians had set up on their own in the days after the quake.
Corail's residents were selected from the spontaneous camp taken over by actor Sean Penn's relief organization, sprawled over a country club golf course in the capital. Residents were told they would be better off on a distant desert plain 9 miles (15 kilometres) north of the city, far from their former homes and jobs.
"I signed up. I didn't know where I was going. My home was destroyed. I had nowhere else to go," Jonel Romelus, a 36-year-old mason who moved to Corail, said Tuesday.
But an AP investigation in July revealed the site's selection was tainted by conflict of interest:
The land under it belonged to the company led by the government's chief relocation adviser, Gerard-Emile "Aby" Brun. The choice put his company in position to receive government compensation for the land.
It also promised to create a community home for thousands of people who would need jobs, a boost for the Brun company's negotiations with a South Korean garment firm, Sae-A Trading Co. Ltd., to build factories next door. In September, the company signed a memorandum of understanding with Haiti's prime minister and U.S. Secretary of State Hillary Rodham Clinton to build the factories.
The day after AP's investigation was published, torrents of water and high winds from a storm collapsed 344 tents in Corail and sent 1,700 people — a quarter of the camp — fleeing for new shelters.
The dangers have only become clearer since.
"I would say ... that insufficient analysis was done on exploring all the options before selecting the Corail site," said Castro, the camp's manager. "The Corail site is located on a flood plain, and hydrologically it's not a sound location."
Oxfam spokeswoman Julie Schindall said aid workers are concerned about delivering services to the camp if roads from Port-au-Prince flood.
"This goes back to the original thing: No, (Corail is) not a safe place to live," she said. "We knew a hurricane was going to come — this is Haiti, this always happens — and we have not had a level of reconstruction that gets people under tents into houses."
At this point there is little to be done before the storm. Romelus said his family — his wife, two daughters ages 2 and 5, a sister and nephews — will stay in the camp unless the government can provide shelter. They have nowhere else to go.
"God will protect me. I'm not going to be the only one (staying Corail). If something happens, we'll deal with it," he said. "If they could have moved more quickly and built more houses, it would have been safer."
MAP - TOMAS' STORM TRACK
Pray for those living in the camps. The best thing would be for the storm to lose strength and to veer away from Haiti.BIOSURVEILLANCE UPDATE - 8
OPERATIONAL BIOSURVEILLANCE
USS IWO JIMA IS HEADING TO HAITI
U.S. Southern Command directed USS Iwo Jima (LHD 7) to steam toward Haiti today in preparation for the forecasted arrival of tropical storm Tomas.
Large Wasp-class ships, such as Iwo Jima (LHD 7), resemble small aircraft carriers with the ability to conduct air and naval operations. 8 CH-46 Sea Knight, medium-lift, dual-rotor helicopters, 2 MH-60 Knight Hawk helicopters and 2 amphibious landing craft units (LCU's) are on Iwo Jima to support relief and quickly move staffs and cargo making it an ideal platform to support logistics during humanitarian disasters.
1,600 military and civilian medical, engineering, aviation, logistical and other support personnel are embarked aboard Iwo Jima, including U.S. Navy engineers, a contingent of 500 Marines with logistical-support expertise, volunteers from the U.S. Public Health Service and various non-governmental organizations (NGOs), as well as medical, dental and engineering professionals from Europe, North America and South America.
TROPICAL STORM TOMAS PROJECTED THROUGH HAITI AS POSSIBLE CATEGORY 2 HURRICANE
As of Tuesday, Tropical Storm Tomas is remaining on basically the same path as has been previously forecast. It is currently approximately 300 miles south of Jacmel, Haiti.
Maximum sustained winds have increased to approximately 50 mph with gusts to 65 mph. It will start a more northwestward track late this evening through tomorrow when it is forecast to begin the northeastward track we do not want.
Forecast projections again show the strength at a possible Category 2 Hurricane with sustained winds between 96 and 110 mph at landfall sometime Friday, November 05, 2010.
Current forecast models are all in agreement of the general forecast track. Current model forecast show a potential landfall track near the southwestern side of Haiti, moving northeastward across the country, west of PAP, exiting the country near Cap Haiten.
Remember, this is only a projected path at this time and it could and will possibly very well change in the next two days. The landfall track is for informational and reference purposes at this time.
Rainfall amounts across Haiti could range from 4 to 8 inches in a period from Friday through Saturday.
Updates will follow on Wednesday, unless conditions warrant an updated forecast before that time.
CHOLERA OUTBREAK: MAISSADE-HINCHE AREA
A Cholera Treatment Center (CTC) is being stood up in response to the abrupt presentation of 40 patients beginning two days ago to the hospital in Hinche from the Maissade region. MSPP is engaged with PIH, JPHRO, Medishare, and others, and the Hinche CTC will be operational by tomorrow. The Mirebalais CTC should be ready by Thursday or Friday.
HEAS SITREP 11.1.10
SUMMARY
As of Friday, October 29th, PAHO has reported more than 4,700 cases and more than 330 fatalities (apparent case fatality rate approximately 7%). PAHO was unable to report updated statistics because MSPP had not released them on Monday, Nov 1st. Statistics quoted by the media over the weekend indicate fatalities approaching 340. If approximately 25% of cholera cases are clinically apparent, then a highly conservative estimate places the true case count at nearly 19,000. We estimate the case counts to be closer to 40,000 based on the level of under-reporting and rural transmission occurring in areas not being serviced by responders. Cholera epidemics often follow a waxing and waning pattern of transmission and therefore can be unpredictable.
KEY UPDATES
Further evidence of cholera transmission in Cite Soleil has not been reported, which is a key sentinel site for the greater Port au Prince area. Vigilance and sensitization for cholera in Cite Soleil has been elevated to the maximum extent possible.
We are aware of 12 confirmed cases of cholera reported within PAP but not publicly reported by officials.
Suspect case samples have been sent from Leogane to LNSP for processing, indicative of a high index of suspicion and a highly sensitized local surveillance grid.
Field teams operating in Artibonite have reported back today that the true case counts are far higher than is officially reported due to the following factors:
1. Evidence of pervasive transmission throughout the Artibonite region along rivers and tributaries. Seeding of tributaries has been reported, which again strongly raises the question of ecological establishment, and a "rolling" pattern of transmission from village to village downriver has been reported.
2. Rural community transmission is “off the grid” and often have little to no access to safe drinking water or sanitation- conditions that existed prior to the earthquake.
3. Lack of appropriate infrastructure to support situational awareness and strongly suspected political interference to report accurate case counts.
4. Little presence of public health officials or epidemiologists in rural areas.
The Health Cluster has, to some degree of success, mobilized medical response (Cholera Treatment Centers, CTCs) for key patient catchment sites such as St Marc and Arachaie with surge capacity created in PAP, Carrefour, and Leogane. However, rural transmission continues in areas distant from these CTCs. Laboratory diagnostic capacity is severely limited and localized to main patient catchment areas, limiting an ability to rapidly confirm and plan intervention at sites throughout the countryside. We recommend a high index of suspicion and to not wait for official confirmation to respond.
The major rainy season normally peaks in October and persists through November. The prospect of Tropical Storm Tomas gaining strength to become a Category 1 hurricane before causing potential damage and heavy rain in Haiti further complicates attempts to gain control of the epidemic.
STATUS OF THE BIOSURVEILLANCE GRID
The U.S. Centers for Disease Control and Prevention have officially declined to provide funding and operational collaboration to the 400+ overlapping social networks of responders represented by the HEAS. This represents the second time CDC has declined to fund and participate. The HEAS Mid Action report based on the initial 150 days of operations post-earthquake displays the power of operational biosurveillance-facilitated distributive networking for early warning and rapid response.
The Internally Displaced Persons Syndromic Surveillance system (IDPSS) has once again been resurrected by CDC in support of MSPP to provide situational awareness response support.
This system collapsed several times and was unable to produce actionable early warning during the post-quake period. The IDPSS did not provide early warning of the current cholera epidemic and has not provided continuous situation reports or data outputs to the response community.
CDC has decided to activate a cholera-specific surveillance system predicated on commune reporting through mobile teams. It is unlikely this approach will reach operational maturity quickly enough to enable proactive and strategic response. Without integrative collaboration, both the IDPSS and the cholera-specific surveillance systems will provide only a partial view into the crisis and will not promote maximally efficient deployment of surveillance and response resources.
CONCLUSION
Current evidence of under-reporting particularly from rural areas and case foci that appear and disappear without on-site public health evaluation, lack of timely situational awareness reports from public health, and refusals to interface with medical responders indicate an overwhelmed public health capacity complicated by political sensitivities.
Continued independent "smart swarming", utilizing distributive networks for situational awareness, is strongly recommended with an expectation for a protracted period of response operations.
USS IWO JIMA IS HEADING TO HAITI
U.S. Southern Command directed USS Iwo Jima (LHD 7) to steam toward Haiti today in preparation for the forecasted arrival of tropical storm Tomas.
Large Wasp-class ships, such as Iwo Jima (LHD 7), resemble small aircraft carriers with the ability to conduct air and naval operations. 8 CH-46 Sea Knight, medium-lift, dual-rotor helicopters, 2 MH-60 Knight Hawk helicopters and 2 amphibious landing craft units (LCU's) are on Iwo Jima to support relief and quickly move staffs and cargo making it an ideal platform to support logistics during humanitarian disasters.
1,600 military and civilian medical, engineering, aviation, logistical and other support personnel are embarked aboard Iwo Jima, including U.S. Navy engineers, a contingent of 500 Marines with logistical-support expertise, volunteers from the U.S. Public Health Service and various non-governmental organizations (NGOs), as well as medical, dental and engineering professionals from Europe, North America and South America.
TROPICAL STORM TOMAS PROJECTED THROUGH HAITI AS POSSIBLE CATEGORY 2 HURRICANE
As of Tuesday, Tropical Storm Tomas is remaining on basically the same path as has been previously forecast. It is currently approximately 300 miles south of Jacmel, Haiti.
Maximum sustained winds have increased to approximately 50 mph with gusts to 65 mph. It will start a more northwestward track late this evening through tomorrow when it is forecast to begin the northeastward track we do not want.
Forecast projections again show the strength at a possible Category 2 Hurricane with sustained winds between 96 and 110 mph at landfall sometime Friday, November 05, 2010.
Current forecast models are all in agreement of the general forecast track. Current model forecast show a potential landfall track near the southwestern side of Haiti, moving northeastward across the country, west of PAP, exiting the country near Cap Haiten.
Remember, this is only a projected path at this time and it could and will possibly very well change in the next two days. The landfall track is for informational and reference purposes at this time.
Rainfall amounts across Haiti could range from 4 to 8 inches in a period from Friday through Saturday.
Updates will follow on Wednesday, unless conditions warrant an updated forecast before that time.
CHOLERA OUTBREAK: MAISSADE-HINCHE AREA
A Cholera Treatment Center (CTC) is being stood up in response to the abrupt presentation of 40 patients beginning two days ago to the hospital in Hinche from the Maissade region. MSPP is engaged with PIH, JPHRO, Medishare, and others, and the Hinche CTC will be operational by tomorrow. The Mirebalais CTC should be ready by Thursday or Friday.
HEAS SITREP 11.1.10
SUMMARY
As of Friday, October 29th, PAHO has reported more than 4,700 cases and more than 330 fatalities (apparent case fatality rate approximately 7%). PAHO was unable to report updated statistics because MSPP had not released them on Monday, Nov 1st. Statistics quoted by the media over the weekend indicate fatalities approaching 340. If approximately 25% of cholera cases are clinically apparent, then a highly conservative estimate places the true case count at nearly 19,000. We estimate the case counts to be closer to 40,000 based on the level of under-reporting and rural transmission occurring in areas not being serviced by responders. Cholera epidemics often follow a waxing and waning pattern of transmission and therefore can be unpredictable.
KEY UPDATES
Further evidence of cholera transmission in Cite Soleil has not been reported, which is a key sentinel site for the greater Port au Prince area. Vigilance and sensitization for cholera in Cite Soleil has been elevated to the maximum extent possible.
We are aware of 12 confirmed cases of cholera reported within PAP but not publicly reported by officials.
Suspect case samples have been sent from Leogane to LNSP for processing, indicative of a high index of suspicion and a highly sensitized local surveillance grid.
Field teams operating in Artibonite have reported back today that the true case counts are far higher than is officially reported due to the following factors:
1. Evidence of pervasive transmission throughout the Artibonite region along rivers and tributaries. Seeding of tributaries has been reported, which again strongly raises the question of ecological establishment, and a "rolling" pattern of transmission from village to village downriver has been reported.
2. Rural community transmission is “off the grid” and often have little to no access to safe drinking water or sanitation- conditions that existed prior to the earthquake.
3. Lack of appropriate infrastructure to support situational awareness and strongly suspected political interference to report accurate case counts.
4. Little presence of public health officials or epidemiologists in rural areas.
The Health Cluster has, to some degree of success, mobilized medical response (Cholera Treatment Centers, CTCs) for key patient catchment sites such as St Marc and Arachaie with surge capacity created in PAP, Carrefour, and Leogane. However, rural transmission continues in areas distant from these CTCs. Laboratory diagnostic capacity is severely limited and localized to main patient catchment areas, limiting an ability to rapidly confirm and plan intervention at sites throughout the countryside. We recommend a high index of suspicion and to not wait for official confirmation to respond.
The major rainy season normally peaks in October and persists through November. The prospect of Tropical Storm Tomas gaining strength to become a Category 1 hurricane before causing potential damage and heavy rain in Haiti further complicates attempts to gain control of the epidemic.
STATUS OF THE BIOSURVEILLANCE GRID
The U.S. Centers for Disease Control and Prevention have officially declined to provide funding and operational collaboration to the 400+ overlapping social networks of responders represented by the HEAS. This represents the second time CDC has declined to fund and participate. The HEAS Mid Action report based on the initial 150 days of operations post-earthquake displays the power of operational biosurveillance-facilitated distributive networking for early warning and rapid response.
The Internally Displaced Persons Syndromic Surveillance system (IDPSS) has once again been resurrected by CDC in support of MSPP to provide situational awareness response support.
This system collapsed several times and was unable to produce actionable early warning during the post-quake period. The IDPSS did not provide early warning of the current cholera epidemic and has not provided continuous situation reports or data outputs to the response community.
CDC has decided to activate a cholera-specific surveillance system predicated on commune reporting through mobile teams. It is unlikely this approach will reach operational maturity quickly enough to enable proactive and strategic response. Without integrative collaboration, both the IDPSS and the cholera-specific surveillance systems will provide only a partial view into the crisis and will not promote maximally efficient deployment of surveillance and response resources.
CONCLUSION
Current evidence of under-reporting particularly from rural areas and case foci that appear and disappear without on-site public health evaluation, lack of timely situational awareness reports from public health, and refusals to interface with medical responders indicate an overwhelmed public health capacity complicated by political sensitivities.
Continued independent "smart swarming", utilizing distributive networks for situational awareness, is strongly recommended with an expectation for a protracted period of response operations.
VIDEO - HAITI BRACES FOR STORM
To watch a video on preparations being made for those living in camps follow the link to:
www.youtube.com/watch?v=FYbLslsMlPs&feature=player_embedded
www.youtube.com/watch?v=FYbLslsMlPs&feature=player_embedded
ARTICLE - TROPICAL STORM TOMAS THREAT
TOMAS, TEMPORARILY WEAKER, STILL POSES MAJOR THREAT FOR HAITI
(Miami Herald) - By Jacqueline Charles and Curtis Morgan
PORT-AU-PRINCE -- A day after President René Préval traveled by helicopter and road to the southern and western coasts to assess hurricane preparations, Haiti stepped by evacuation plans for Tropical Storm Tomas.
The system, though slightly weaker on Tuesday, was expected to return to hurricane strength over the next few days as it turns north toward Jamaica and Haiti.
``Since 2004, we have been getting hit by hurricanes,'' Préval told The Miami Herald by phone Monday as he left the southwestern city of Les Cayes and headed to Jeremie on Haiti's western tip.
``This is why we started early, to make sure there are no deaths. We are doing everything we can to make sure there are none.''
At 5 p.m. Tuesday, the National Hurricane Center said Tomas had weakened during the day, its sustained winds dropping to 40 mph, but it remained on a track that could sweep uncomfortably close to Jamaica on Thursday and strike the southwestern tip of Haiti the next day. The Jamaican government issued a hurricane watch.
John Cangialosi, a hurricane specialist at the National Hurricane Center in West Miami-Dade, said the powerful center of the storm could shift significantly to the east toward Jamaica or west toward the Dominican Republic before it makes landfall.
Despite the weakening on Tuesday, forecasters still expected the storm to regain hurricane strength and, at the very least, dump a lot of rain on an island with denuded hillsides prone to dangerous, sometimes deadly flooding and mud slides.
FLOODING FEAR
In Haiti, however, wind speeds won't be as critical as rainfall totals. The center warned of a ``significant threat of heavy rainfall.''
Flooding from Hurricanes Hanna and Ike in 2008 killed more than 800 people and the four hurricanes that hit Haiti that year left $1 billion in damage. A tropical deluge also could overwhelm efforts to contain an outbreak of cholera, caused by drinking contaminated water, that already has killed more than 300 people.
Meeting with authorities from the surrounding vulnerable regions around Les Cayes in southwestern Haiti, Préval asked for an inventory of needs, announced that a fleet of government vehicles including evacuation buses and heavy earth-moving equipment were already on site and that shelters had been identified. The health ministry was evaluating the possibility of evacuating patients at the government-run hospital, which is prone to flooding.
``We are trying to get everyone to work together,'' Préval said. ``We began with the South, but we are not certain that is where it will do the most damage.''
Still, the southern coast's largest city -- and Haiti's fourth largest, Les Cayes -- is vulnerable to floods even with normal rainfall.
``Once a hurricane hits us, we are in a mess,'' said Pierre Leger, a Les Cayes businessman, recalling how twice in two years mud burried the city of Gonaives after hurricanes.
``We have two canals -- one on the left, one on the right. They are blocked with trash, there are houses built on them. What happened to Gonaives could happen to us.''
On Monday, U.S. officials announced that the USS Iwo Jima was on its way to Haiti. The ship, which can support helicopters, is scheduled to arrive later this week.
Prime Minister Jean-Max Bellerive said the government was calling on people in the South to evacuate if the storm poses a dangerous threat. But even as officials planned for potential disaster, concerns remained.
A recent survey of hundreds of tent cities in Port-au-Prince revealed that only 30 percent of the displaced had a place to move into, and officials were still trying to identify potential buildings that can shelter people.
``We are making buses available to evacuate people in the camps, like children. But when we say evacuate, the question is where do we take them,'' Bellerive told The Miami Herald.
As officials plan for the storm, they continue to deal with the cholera epidemic. On Monday, a government official confirmed a U.S. Centers for Disease Control and Prevention report that the cholera strain found in Haiti matched strains commonly seen in South Asia. The U.N. has denied that Nepalese soldiers at a base in the city of Mirebalais, in Central Haiti, are responsible for the outbreak.
Since the epidemic began in Haiti's lower Artibonite Valley two weeks ago, Haitian officials have been fighting to keep it from spreading. Humanitarian aid officials say rain and floods make for a ``toxic combination'' for the spread of the waterborne infection.
``This storm could not have come at a more difficult time,'' Humanitarian Coordinator Nigel Fisher said. ``Although we have made extensive preparations and prepositioned stocks across the country, some crucial supplies have been badly depleted by ongoing needs, particularly the response to the ongoing cholera epidemic.''
The U.N. has appealed to donors seeking emergency shelter, including tarps, water, sanitation supplies and oral rehydration salts for cholera treatment.
Meanwhile, Haiti's neighbors were also preparing for Tomas. The Dominican Republic closed beaches along its southern and eastern coasts as the Emergency Operation Center warned residents to brace for 9- to 12-foot waves within the next 24-72 hours. The country's Ministry of Health also issued an infectious disease warning, saying that swollen rivers and lakes could lead to a rise in illnesses.
IN JAMAICA
Jamaica's Prime Minister Bruce Golding held an emergency meeting with his cabinet Monday and was expected to address the nation later Monday. The Meteorological Service said the country could feel the outer bands of the storm on Thursday or Friday, with periods of heavy rain and strong winds as it passes east of the island.
The government also advised fishing fleets to return to the mainland.
The storm has already been blamed for anywhere from three to 12 deaths in the eastern Caribbean, where Tomas raked across Barbados before gaining strength to hit St. Lucia and St. Vincent and the Grenadines as a Category 1 hurricane.
The Caribbean Disaster Management Agency said the storm killed at least three people in St. Lucia, injured two in St. Vincent and the Grenadines, and damaged hundreds of homes and dozens of government buildings throughout the region.
St. Lucia Tourism Minister Allan Chastanet, however, said there were at least 12 confirmed dead, the Caribbean Media Corporation reported.
(Miami Herald) - By Jacqueline Charles and Curtis Morgan
PORT-AU-PRINCE -- A day after President René Préval traveled by helicopter and road to the southern and western coasts to assess hurricane preparations, Haiti stepped by evacuation plans for Tropical Storm Tomas.
The system, though slightly weaker on Tuesday, was expected to return to hurricane strength over the next few days as it turns north toward Jamaica and Haiti.
``Since 2004, we have been getting hit by hurricanes,'' Préval told The Miami Herald by phone Monday as he left the southwestern city of Les Cayes and headed to Jeremie on Haiti's western tip.
``This is why we started early, to make sure there are no deaths. We are doing everything we can to make sure there are none.''
At 5 p.m. Tuesday, the National Hurricane Center said Tomas had weakened during the day, its sustained winds dropping to 40 mph, but it remained on a track that could sweep uncomfortably close to Jamaica on Thursday and strike the southwestern tip of Haiti the next day. The Jamaican government issued a hurricane watch.
John Cangialosi, a hurricane specialist at the National Hurricane Center in West Miami-Dade, said the powerful center of the storm could shift significantly to the east toward Jamaica or west toward the Dominican Republic before it makes landfall.
Despite the weakening on Tuesday, forecasters still expected the storm to regain hurricane strength and, at the very least, dump a lot of rain on an island with denuded hillsides prone to dangerous, sometimes deadly flooding and mud slides.
FLOODING FEAR
In Haiti, however, wind speeds won't be as critical as rainfall totals. The center warned of a ``significant threat of heavy rainfall.''
Flooding from Hurricanes Hanna and Ike in 2008 killed more than 800 people and the four hurricanes that hit Haiti that year left $1 billion in damage. A tropical deluge also could overwhelm efforts to contain an outbreak of cholera, caused by drinking contaminated water, that already has killed more than 300 people.
Meeting with authorities from the surrounding vulnerable regions around Les Cayes in southwestern Haiti, Préval asked for an inventory of needs, announced that a fleet of government vehicles including evacuation buses and heavy earth-moving equipment were already on site and that shelters had been identified. The health ministry was evaluating the possibility of evacuating patients at the government-run hospital, which is prone to flooding.
``We are trying to get everyone to work together,'' Préval said. ``We began with the South, but we are not certain that is where it will do the most damage.''
Still, the southern coast's largest city -- and Haiti's fourth largest, Les Cayes -- is vulnerable to floods even with normal rainfall.
``Once a hurricane hits us, we are in a mess,'' said Pierre Leger, a Les Cayes businessman, recalling how twice in two years mud burried the city of Gonaives after hurricanes.
``We have two canals -- one on the left, one on the right. They are blocked with trash, there are houses built on them. What happened to Gonaives could happen to us.''
On Monday, U.S. officials announced that the USS Iwo Jima was on its way to Haiti. The ship, which can support helicopters, is scheduled to arrive later this week.
Prime Minister Jean-Max Bellerive said the government was calling on people in the South to evacuate if the storm poses a dangerous threat. But even as officials planned for potential disaster, concerns remained.
A recent survey of hundreds of tent cities in Port-au-Prince revealed that only 30 percent of the displaced had a place to move into, and officials were still trying to identify potential buildings that can shelter people.
``We are making buses available to evacuate people in the camps, like children. But when we say evacuate, the question is where do we take them,'' Bellerive told The Miami Herald.
As officials plan for the storm, they continue to deal with the cholera epidemic. On Monday, a government official confirmed a U.S. Centers for Disease Control and Prevention report that the cholera strain found in Haiti matched strains commonly seen in South Asia. The U.N. has denied that Nepalese soldiers at a base in the city of Mirebalais, in Central Haiti, are responsible for the outbreak.
Since the epidemic began in Haiti's lower Artibonite Valley two weeks ago, Haitian officials have been fighting to keep it from spreading. Humanitarian aid officials say rain and floods make for a ``toxic combination'' for the spread of the waterborne infection.
``This storm could not have come at a more difficult time,'' Humanitarian Coordinator Nigel Fisher said. ``Although we have made extensive preparations and prepositioned stocks across the country, some crucial supplies have been badly depleted by ongoing needs, particularly the response to the ongoing cholera epidemic.''
The U.N. has appealed to donors seeking emergency shelter, including tarps, water, sanitation supplies and oral rehydration salts for cholera treatment.
Meanwhile, Haiti's neighbors were also preparing for Tomas. The Dominican Republic closed beaches along its southern and eastern coasts as the Emergency Operation Center warned residents to brace for 9- to 12-foot waves within the next 24-72 hours. The country's Ministry of Health also issued an infectious disease warning, saying that swollen rivers and lakes could lead to a rise in illnesses.
IN JAMAICA
Jamaica's Prime Minister Bruce Golding held an emergency meeting with his cabinet Monday and was expected to address the nation later Monday. The Meteorological Service said the country could feel the outer bands of the storm on Thursday or Friday, with periods of heavy rain and strong winds as it passes east of the island.
The government also advised fishing fleets to return to the mainland.
The storm has already been blamed for anywhere from three to 12 deaths in the eastern Caribbean, where Tomas raked across Barbados before gaining strength to hit St. Lucia and St. Vincent and the Grenadines as a Category 1 hurricane.
The Caribbean Disaster Management Agency said the storm killed at least three people in St. Lucia, injured two in St. Vincent and the Grenadines, and damaged hundreds of homes and dozens of government buildings throughout the region.
St. Lucia Tourism Minister Allan Chastanet, however, said there were at least 12 confirmed dead, the Caribbean Media Corporation reported.
ARTICLE - CHOLERA STRAIN IDENTIFIED
CHOLERA IN HAITI MATCHES STRAINS SEEN IN SOUTH ASIA, U.S. SAYS
(AP) - New York Times
PORT-AU-PRINCE — A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the United States Centers for Disease Control and Prevention said Monday.
Researchers identified the strain by analyzing DNA patterns that can be compared with those from other regions of the world, according to Dr. Christopher Braden, a C.D.C. epidemiologist.
The finding does not identify the source, nor does it explain how cholera — a disease never confirmed to have existed in Haiti — suddenly erupted in the vulnerable country’s rural center.
But it eliminates some possibilities, including any connection to a 1990s South American outbreak.
The finding also intensifies the scrutiny of a United Nations base built on a tributary to the Artibonite River. Cholera has been detected in the waterway, and most of the cases have been among people who live downriver and drank from the Artibonite.
Speculation among Haitians has increasingly focused on the base and troops there from Nepal, where cholera is endemic and which saw outbreaks this summer before the current contingent of troops arrived in Haiti. Most people infected by the microbe never develop symptoms but can still pass on the disease.
On Friday, hundreds of demonstrators waving tree branches and carrying anti-United Nations banners walked from the central plateau city of Mirebalais several miles to the gates of the base.
“Like it or not, they must go,” they chanted.
The United Nations has defended its sanitation practices and denied that the base could be a source of the infection. A spokesman said the agency was looking into the matter on Monday following the C.D.C.’s announcement.
In the coming weeks, additional laboratory testing, including whole genome DNA sequencing, will be conducted, but investigating officials note that such testing may never fully explain how cholera was introduced into Haiti.
“Our primary focus here is to save lives and control the spread of disease,” said Dr. Jordan Tappero, the epidemiologist who is leading the C.D.C.’s cholera response team in the country.
“We realize that it’s also important to understand how infectious agents move to new countries.
However, we may never know the actual origin of this cholera strain.”
(AP) - New York Times
PORT-AU-PRINCE — A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the United States Centers for Disease Control and Prevention said Monday.
Researchers identified the strain by analyzing DNA patterns that can be compared with those from other regions of the world, according to Dr. Christopher Braden, a C.D.C. epidemiologist.
The finding does not identify the source, nor does it explain how cholera — a disease never confirmed to have existed in Haiti — suddenly erupted in the vulnerable country’s rural center.
But it eliminates some possibilities, including any connection to a 1990s South American outbreak.
The finding also intensifies the scrutiny of a United Nations base built on a tributary to the Artibonite River. Cholera has been detected in the waterway, and most of the cases have been among people who live downriver and drank from the Artibonite.
Speculation among Haitians has increasingly focused on the base and troops there from Nepal, where cholera is endemic and which saw outbreaks this summer before the current contingent of troops arrived in Haiti. Most people infected by the microbe never develop symptoms but can still pass on the disease.
On Friday, hundreds of demonstrators waving tree branches and carrying anti-United Nations banners walked from the central plateau city of Mirebalais several miles to the gates of the base.
“Like it or not, they must go,” they chanted.
The United Nations has defended its sanitation practices and denied that the base could be a source of the infection. A spokesman said the agency was looking into the matter on Monday following the C.D.C.’s announcement.
In the coming weeks, additional laboratory testing, including whole genome DNA sequencing, will be conducted, but investigating officials note that such testing may never fully explain how cholera was introduced into Haiti.
“Our primary focus here is to save lives and control the spread of disease,” said Dr. Jordan Tappero, the epidemiologist who is leading the C.D.C.’s cholera response team in the country.
“We realize that it’s also important to understand how infectious agents move to new countries.
However, we may never know the actual origin of this cholera strain.”
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