ARTICLE - HIGHER TEMPS + RAINS = CHOLERA

SCIENTISTS FIND TEMPERATURE, RAINFALL CAN PREDICT CHOLERA
(VOA) - By Art Chimes

Slight rise in temperature can double number of cases

Scientists studying temperature and rainfall patterns in areas that later had cholera outbreaks say small increases in warmth and wetness are followed by a surge in cholera cases a few months later. The information could give public health authorities a new tool to help battle this serious disease.

According to the World Health Organization, more than 100,000 people die from cholera each year, despite a vaccine which can prevent infection and simple treatment that works most of the time.

Advance notice of an outbreak might help in the battle against the acute diarrheal disease.

Now, an international team working in Tanzania has found that rising temperature and increased rainfall can signal a coming surge in cholera cases.

"What these authors from the International Vaccine Institute in [South] Korea, as well as the University of North Carolina, and the Ministry of Health in Zanzibar in Tanzania have shown," says cholera expert Peter Hotez, "is that a one degree increase in temperature can ultimately result in a two-fold increase in the number of cholera cases."

Hotez is president of the American Society of Tropical Medicine and Hygiene, which published the research in its journal.

He says that previous research had established that the Vibrio cholerae bacteria can thrive in the gut of a tiny aquatic animal called a copepod.

"So the rationale for looking at temperature is because we know that increases in temperature can result in proliferation of these copepods and therefore create new niches for the Vibrio cholerae to replicate."

Cholera is typically spread through contaminated water, and with the bacteria proliferating when temperatures and rainfall increase, the number of infections also increases. As global temperatures have risen in the past decade, so have the number of cholera cases, according to the WHO. And Hotez says the nature of the outbreaks is changing, too.

"Now we're seeing long and very protracted outbreaks of cholera, like the one that's been occurring in Haiti and now the Dominican Republic. For instance, the epidemic in Zimbabwe lasted a year and caused 4,000 deaths, and we're probably seeing something of similar magnitude in Haiti.

"Lead author Rita Reyburn and colleagues point out that climate scientists are predicting a rise in global mean temperatures over the next century of between one and six degrees Celsius. The authors say that suggests the "possibility of increased cholera incidence in many resource-poor regions of the world."

ARTICLE - SEASONAL RAINS INCREASE CHOLERA

SEASONAL RAINS BRING RISE IN CHOLERA CASES IN HAITI
(PBS Newshour) - By Talea Miller

The months-long rainy season is just beginning in Haiti, boosting the number of cases of cholera just as critical sanitation services are in limbo.

Cholera is waterborne and often spreads through sewage, making it harder to contain in rainy, wet conditions. In the three weeks prior to the rains, the Partners in Health cholera center in Mirebalais, Haiti, saw 500 cases combined, but the weather has brought a new rise in cases.

"Since the rainy season began in the last two weeks, we've seen 1,000 cases," said David Walton, who runs the center.

While many of the new cases are less severe than the deadly wave that first hit the country last fall, Walton said the uptick could be an indicator of things to come.

"I worry that given what I've seen, we could be overwhelmed again at the cholera centers," he said.

The country is seeing about 2,000 new cases of cholera a week, according to the United Nations Office for the Coordination of Humanitarian Affairs, but a lack of funds for sanitation services could make the situation worse.

Just 17 percent of OCHA's $915 million appeal for Haiti is funded, said spokesperson Emmanuelle Schneider from Port-au-Prince. And while some activities are being transitioned to the Haitian government, the money available is simply "not enough," she said.

"If we are not able to keep sanitation activities in camps, latrines are going to overflow, it's going to be a source of cholera contamination -- there will be open defecation," Schneider said.

OCHA provides latrines to 1.5 million people and water to 1.2 million through free water trucking. The administration of the next president, newly-elected Michel Martelly, will have to absorb these services without additional aid, as it balances the many needs of the more than 680,000 people still living in tent camps.

"If we don't manage to make a transition that is successful, obviously we are risking...a mortality rate that is going up," Schneider said.

The mortality rate for the disease has dropped to 1.7 percent nationally, OCHA says, down from close to 9 percent, but the distribution of deaths is uneven and rural areas without access to services are still at risk.

There have been an estimated 250,000 reported cases since October, and more than 4,600 deaths, according to the Pan American Health Organization.

But new research published in the Lancet also suggests the epidemic could become much larger than the U.N. projection of 400,000 total cases over the course of the epidemic.

Sanjay Basu, a doctor and medical resident at University of California San Francisco, and Jason Andrews, a fellow at the Massachusetts General Hospital and Harvard Medical School, modeled the epidemic using data they gathered from provinces around the country.

They built in the assumption that only one of every three cases are reported in the hospital, while many would go undetected or unreported in the community. They projected 779,000 cases, and about 11,100 fatalities in the next eight months.

"In the case of Haiti it's likely to stay smoldering at a low level for at least a year," Basu said. "It's likely that you'll see small micro outbreaks in localized areas and a resurgence unless more permanent infrastructure for waste and free and clean water are developed."

The researchers are also calling for wider use of antibiotics -- which the Haitian government recommends for severe cases only -- and a cholera vaccine, which has been proposed only on a pilot level in Haiti by the PAHO.

Schneider said the study is "one perspective" and that the U.N.'s projections were made by the World Health Organization and the CDC and have been "consistent with the reality in the field."

While the scale is still being debated, all sides can agree the disease has highlighted some of the weaknesses in infrastructure that Martelly will have to address when he takes office and oversees the massive earthquake recovery.

Walton said awareness of the disease has contributed greatly to better outcomes but there is still a need for more cholera centers, better sanitation and better access to health services in general.

"With the upcoming new administration, people are extremely hopeful that there will be change for the better not only for cholera but for access to care," he said. "Haiti is and has been a hopeful place, even in the thick of the cholera epidemic."