ARTICLE - CHOLERA THROUGHOUT HAITI

CHOLERA IN HAITI HAS SPREAD TO EVERY PART OF THE COUNTRY, CDC REPORTS
(Los Angeles Times) - By Rong-Gong Lin II

ATLANTA -- The cholera outbreak has spread to every section of Haiti, sickening more than 91,000 people and killing more than 2,000, and is spreading into the Dominican Republic, the Centers for Disease Control and Prevention said Wednesday.

Nearly half of the ill were hospitalized. In some cases, the deaths are occurring as rapidly as two hours after people fall ill, according to the CDC report published in the Morbidity and Mortality Weekly Report.

Patients can lose as much as one liter of fluid an hour, said Dr. Jordan W. Tappero, director of the Health System Reconstruction Office at the CDC's Center for Global Health. "It's in all 10 [regions] of the country," Tappero told reporters from the Assn. of Healthcare Journalists on Wednesday at the CDC headquarters in Atlanta. "It’s everywhere."

Tappero said Haiti’s neighbor to the east, the Dominican Republic, is now reporting cases of cholera in its two largest cities. But he said it's hard to know how far the disease will spread there because that country has better access to sanitary water.

Cholera is caused by a bacteria, Vibrio cholerae, which causes an infection of the intestine and produces a toxin that triggers watery diarrhea that can lead to dehydration and death. The disease has largely been eliminated in countries that have access to clean drinking water, but can spread rapidly in areas where people drink tainted water. An infected human can produce the bacteria in his feces for up to two weeks, even if they don't show signs of illness.

Last week, a median of 41 people died in Haiti every day, the report said. "Further action is urgently needed to reduce cholera transmission and mortality," said the report. Some patients have had no access to medicine that can rehydrate them quickly. Out of 39 patients who died of cholera but weren’t in a hospital, 30 failed to receive a life-saving oral rehydration solution.

"Because cholera can lead to death rapidly, ideally all persons at risk for cholera should be within one hour of a location where they can receive [oral rehydration solution] and should have access to more advanced care," the report said.

The cholera epidemic has spread rapidly not only because of the poor health infrastructure and water sanitation in Haiti, but also because of some stark biological realities. Haiti hasn't seen cholera in at least a century, leaving the population without immunity to the disease.

Also, the strain of cholera is a hybrid strain of the "classic" type, which is associated with more severe illness, and the "El Tor" biotype, which is associated with staying in the environment longer, according to the CDC report. "You have a perfect storm for cholera," CDC director Thomas Frieden told reporters from the Assn. of Healthcare Journalists earlier this week.

The CDC report underscored the need to improve drinking water chlorination and access to safe drinking water. The report comes a day after the Associated Press reported that a contingent of U.N. peacekeepers was the likely source of the cholera outbreak, citing a report written by a scientist who was sent by the French government to assist Haitian health officials.

The French author of the report, epidemiologist Renaud Piarroux, could not prove there was cholera inside the base or among the soldiers, the story says. But the report said the first cases of disease came from the village of Meille from people who drank water from a tributary of the Artibonite River just downstream from a U.N. base.

The AP also reported seeing a broken pipe nearby that contained foul-smelling runoff, which the U.N. denied contained human waste. Soldiers who arrived at the U.N. base soon before the cholera outbreak came from Nepal, according to the story. Nepal has been suffering from cholera outbreaks this summer.

Tappero said the CDC was leaving the investigation of the cholera outbreak origin to other scientists and was focusing on preventing deaths in hospitals. The CDC did analyze the cholera strain in Haiti and found it to be a strain that is circulating in South Asia, Tappero told reporters Wednesday. "This was not a new strain that developed in Haiti," Tappero said.

Tappero said other scientists had made hypotheses similar to the French scientist's conclusion.

Other possible ways cholera could have entered Haiti could be from ballast water in ships carried from a cholera-endemic area, or contaminated food, Tappero said.

According to the World Health Organization, less than one in five people infected with cholera show signs of illness. The cholera outbreak is shaping up to be even worse than the Western Hemisphere's last cholera epidemic, which began in 1991 and continued for nearly 10 years. The previous epidemic began in Peru, but the death rate in the first year of the Peruvian epidemic was, 13.1 per 100,000 people. That is lower than the death rate in the first six weeks of the Haiti outbreak, 19.0 per 100,000 people.