The Haiti Cholera Outbreak: What Happens Next?

By Elizabeth Weingarten

On Friday, officials confirmed 142 dead in Haiti from an outbreak of cholera, a diarrheal, dehydrating disease. The outbreak is officially an "epidemic," according to Dr. Michel Thieren of Pan American Health Organization. The disease is spread through contaminated water. According to reports, most of the cholera patients live near the Artibonite River, and have ingested water from it. 

But while humanitarian groups rush medical supplies, doctors and clean water to the Artibonite region -- just north of Port-au-Prince -- health experts are debating how to best contain the disease, and what triggered the outbreak. It's unclear whether a breakdown in public health infrastructure related to the January 12 earthquake was the catalyst: the Artibonite region was relatively unaffected by the quake, although thousands of refugees currently live there. 

According to Dr. Peter Hotez, president of the Sabin Vaccine Institute and chair of the George Washington University Department of Microbiology, Immunology and Tropical Medicine, the question of what caused the endemic can't be answered until experts produce the molecular typing of the bacteria. Molecular typing is a genetic technique used by scientists to map the genome of a particular bacteria, and thus learn more about it. 

The other important question, Hotez says, is whether health organizations on the ground will launch a regional --or national -- vaccination campaign.

"Giving a vaccine in a reactive situation hasn't been done a lot," Hotez says. "Ideally, you give a vaccine before an outbreak. This would be one of the first times it would be given in response to an existing outbreak, so there's not a lot of data and experience to go on."

The vaccine could be administered at about 50 cents per dose, so cost is less of a concern than logistics: the infected population lives in a mountainous, not easily accessible region of Haiti.

It's likely the disease will be contained, Hotez says, because it isn't transmitted by people: A national vaccine campaign may not be necessary.

Right now, doctors are treating victims with salt and sugar re-hydration serums that can be taken orally, or through an IV. 

This article available online at:

http://www.theatlantic.com/international/archive/2010/10/the-haiti-cholera-outbreak-what-happens-next/65026/