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Published Date: 2012-04-23 16:38:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2012 (13): DR, Haiti
Archive Number: 20120423.1107228

CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2012 (13): DOMINICAN REPUBLIC, HAITI
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In this update:
[1,2] Cholera - Dominican Republic (Santiago province)
[3] Cholera - Haiti: vaccination program

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[1] Cholera - Dominican Republic (Santiago province)
Date: Fri 20 April 2012
Source: Fox News [edited]
http://latino.foxnews.com/latino/health/2012/04/20/cholera-could-be-making-comeback-to-dominican-republic/#ixzz1sro705L4

The cholera epidemic may be making a comeback in the Dominican Republic. Health officials are investigating what could be a new cholera outbreak in the northern Dominican Republic, where a woman has died and more than 200 people have sought medical attention, health minister Bautista Rojas said on Thu 19 Apr 2012. He cautioned that only 6 of the more than 200 cases have been confirmed as cholera, including that of a 64 year old woman who died on Wed 18 Apr 2012. The remaining patients exhibit cholera symptoms but are awaiting confirmation through lab tests, he said.

The outbreak occurred in the northern town of Tamboril [Santiago province], where heavy rains damaged water and sewer pipes earlier this month, April 2012. Bautista said that government officials said they are disinfecting potable water with the maximum amount of chlorine allowed.

The 1st cholera outbreak in the Dominican Republic began in late 2010 with more than 22 500 cases and 163 deaths reported. The number of cases had been dwindling since August 2011. The neighboring country of Haiti, where the outbreak originated, is still struggling with cholera, which has killed more than 7000 people and sickened 530 000 more, according to Haitian health officials.

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[2] Cholera - Dominican Republic (Santiago province)
Date: Thu 19 Apr 2012
Source: Dominican Today [edited]
http://www.dominicantoday.com/dr/local/2012/4/19/43359/Six-confirmed-cholera-cases-spur-Public-Health-scramble

The Public Health Ministry yesterday [18 Apr 2012] confirmed 6 cases of cholera of 160 tested since last week [week of 9 Apr 2012] in the towns of Tamboril and Moca, near Santiago, where the population was advised to improve hygiene at home. It said lab tests on patients with symptoms including diarrhea tested positive for cholera, but affirmed that the outbreak is under control in the communities Canca, Tamboril, and Ceiba de Madera, in Moca.

In a statement, public health said dozens of patients with diarrhea had been hospitalized, but tests found other infections such as _Escherichia coli_ and amoebiasis, not cholera.

Public health minister Bautista Rojas said the Epidemiologic Vigilance System is in effect to immediately treat any of the symptoms such as diarrhea, fever, or vomiting. The official asked the population to collaborate with the authorities' preventive measures, such as using boiled or chlorinated water, washing hands thoroughly after going to the bathroom and changing babies' diapers, and by fully cooking foods.

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[3] Cholera - Haiti: vaccination program
Date: Thu 19 Apr 2012
Source: Las Vegas Sun, Associated Press (AP) report [edited]
http://www.lasvegassun.com/news/2012/apr/19/cb-haiti-cholera/

The chief advocates for a cholera vaccination program in Haiti will begin distributing the vaccine this weekend [14-15 Apr 2012] after a government ethics committee gave approval following months of delay, a project organizer said. Jonathan Lascher, Haiti program manager for the Boston-based Partners in Health [PIH], said more than 200 trained health workers will start administering the oral vaccine to almost 50 000 people outside the western port city of Saint Marc.

A Health Ministry ethics committee initially blocked the campaign because it mistook it for a research project rather than a pilot program that could be expanded throughout the Caribbean nation, Lascher said. The vaccination campaign had been planned to begin in January 2012. "We're all set to go and there are no more bureaucratic hoops to jump through," Lascher said by telephone. The ethics committee "understands that it's not a research project."

PIH and partner Gheskio Center, a Haitian nonprofit [organisation] supported by the US Agency for International Development, plan to vaccinate almost 100 000 Haitians in the Saint Marc area and in a downtrodden neighborhood of Port-au-Prince as the country's rainy season begins and threatens to spread the waterborne disease. Gheskio began administering the 1st of 2 required doses of the vaccine this week in Haiti's capital, Port-au-Prince, Gheskio director Jean William Pape wrote in an email.

The proposal for a vaccine campaign in Haiti surfaced soon after cholera emerged in October 2010, when UN peacekeepers from Nepal apparently introduced the disease inadvertently, according to several scientific studies. Since then, cholera has killed more than 7000 people and sickened 530 000 more, health officials say, giving Haiti the highest cholera infection rate in the world. It seemed obvious that Haiti would benefit from such a vaccine but there were obstacles from the beginning.

Some public health experts questioned the program because it would inoculate only 100 000 people, or 1 per cent of Haiti's population, and could deplete the world's stock of available cholera vaccine, potentially putting people at risk in other vulnerable places. At the time, there was only one cholera vaccine on the global market. A 2nd vaccine, Shanchol, wasn't approved by the WHO until September 2012.

The approval was needed so UN agencies like UNICEF could procure the vaccine.

There were other concerns about the vaccine. The humanitarian group Doctors Without Borders [Medecins sans Frontieres] argued that the money for the vaccine, whose immunity wears off within 3 years, would be better spent on improving Haiti's inadequate sanitation, a source for spreading cholera. PIH's co-founder, Dr Paul Farmer, countered that the vaccine could be distributed without compromising efforts to develop Haiti's water and sewer system.

The project is expected to cost USD 1.3 million. The American Red Cross is contributing USD 1 million of that, said Tamara Braunstein, a spokeswoman for the Red Cross.

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