UPDATE from Operational Biosurveillance:
Current official stats are more than 18,382 cases and 1,110 fatalities. This includes more than 1,800 cases in Port au Prince with over 30 fatalities.
- Conservative estimates therefore suggest 75,000 cases of cholera in Haiti to-date, the majority of which were subclinical.
- In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics. We therefore estimate the upper bound of estimated case counts to be 250,000.
- We are now pursuing answers to the question of uptake by indigenous zooplankton and spread along oceanic currents that pass west of the Gonave Gulf, which is where the Artibonite River discharges, north and west along the northern Cuban coastline and north to the waters east of Florida.
- Tomorrow is Vertieres Day, where we may see some degree of population mixing, particularly in the north. It is unclear at this time to what degree the recent violence will affect observance of the holiday. Holidays are opportunities to spread disease further as populations intermingle.
As noted by HEAS one week ago and yesterday officially acknowledged, cholera is in the Dominican Republic. We expect to see medical clinic inundations inside DR in the near future.
As expected, Florida has reported a case of cholera in a returned traveler. There will be more cases in the United States; we believe it likely more cases are inside the US unreported. Implications for the United States are neglible.
The cholera introduced into Haiti by the UN has spread not only into the Dominican Republic but also to Florida through a traveller from Haiti. Diplomats have confirmed that the disease has come with UN troops from Nepal where the disease is endemic. It is unlikely to spread in the US since the propagation of cholera is through water or food that is contaminated by the bacterium Vibrio cholerae. For an epidemic, the source is often the feces of infected people. The New York Times reports:
The first known case of cholera in the United States linked to the outbreak in Haiti was confirmed Wednesday by health officials who said a southwest Florida woman contracted the disease while visiting family in a region at the heart of Haiti’s epidemic.
The Florida Department of Health was investigating several suspected cases of the disease elsewhere in the state. They were not believed to be connected to the verified patient, who sought treatment this month at a hospital emergency room in Collier County. The woman spent five days in hospital after developing diarrhea and dehydration, classic symptoms of cholera, following her return from Haiti, where she had spent time in the Artibonite region. She is expected to recover fully.
“We are lucky in the state of Florida, and the U.S. generally, to have a very sound infrastructure for our food, water and sewage,” said Rob Hayes, spokesman for the Florida Department of Health. “With that in place, and with our aggressive public health practices, we are not concerned about this being a significant public health threat.”
The situation is more dangerous in the Dominican Republic where conditions are more conducive to the spread of the disease. In Haiti official reports give over 1100 deaths and over 18,000 infected.
There are reports that the actual number of cases may be being grossly under-reported.
On November 14, Operational Biosurveillance said it confirmed statistics of up to 400% undercounting.
“We now have nearly 60k cases shedding pathogen into the environment. We believe the true statistic to be closer to more than 100k based on the degree of under-reporting. It is extremely difficult to estimate the true scale of this epidemic now. (It’s) grossly uncontrolled, uncontained, (and) has exceeded public health capacity to investigate and assess every site reported and every sample received.”
It seems that political considerations are now leading to all information being subject to political “spin”.
- For reasons of not upsetting the Nepalese Government and to defuse the local anger, the UN officially denies that the cholera originated with the troops from that country.
- With elections due in Haiti in just two weeks all information about the cause of the outbreak and the extent of the spread is being down-played to avoid further exploitation by some politicians and further riots.
Haiti – till now – had been free of cholera for over a hundred years. No doubt the priority now must be to treat those infected and contain the spread of the disease. But UN processes are clearly wanting and the sooner they come out of “denial” and address their own methods and processes the better.
The k2p blog 