PAHO/ Current status of cholera outbreaks: Haiti, Dominican Republic and Cuba

Since the beginning of the epidemic (October 2010) to epidemiological week (EW) 32 of 2013, the total number of cholera cases reached 669,645, of which 371,099 were hospitalized and 8,224 died. The global case-fatality rate has been 1.2% since November 2011, however, with variations for example in Sud Est (4.5%) and Port-au-Prince (0.6%).

Since October 2012, a downward trend in the nationwide number of cases and deaths has been observed. However, from EW 1 of 2013 to EW 11, the number of cases and deaths registered at a national level was greater than the respective numbers registered for the same time period of 2012.

This increase is associated to outbreaks in the Departments of Artibonite, Centre and Nord. With regards to deaths, the highest increase was registered during the first five EW of 2013. From EW 12 to EW 32 of 2013, the number of cases and deaths registered has been lower than what was registered for the same period in 2012.

Dominican Republic

Since the beginning of the epidemic (November 2010) through epidemiological week (EW) 30 of 2013 the total number of suspected cholera cases reported was 30,671 of which 454 died. During the first year, the epidemic saw an increase of cases during the rainy season. By the end of the first year of the epidemic the case-fatality rate was 1.7% and the attack rate to 0.2%.

During 2012, the trend showed a continual decline with peaks related to outbreaks in certain municipalities. By the end of 2012, the case-fatality rate was 0.8% and the cumulative attack rate was 0.3%.

In the first nine EW of 2013, the number of suspected cholera cases and deaths recorded nationwide was higher to the number for the same period of 2012; this increase is related to cholera outbreaks registered in certain provinces and at the prison of La Altagracia. Between EW 10 to EW 30 of 2013 the number of suspected cases decreased, with a decline of 73%. The case-fatality rate was 2.6% during EW 1 to EW 30 of 2013.

Authorities maintain active and strict clinical-epidemiological surveillance of acute diarrheal diseases, studying every suspected case.

Between late July and early August 2013, five cases of cholera associated with a history of travel to Cuba were confirmed, as follow:

On 24 July 2013, the National IHR Focal Point for Italy reported to WHO a confirmed case of cholera (V.cholerae serogroup O1 Ogawa) in a 47 year old male patient, with travel history to Havana from 23 June to 13 July of 2013. Relevant details of the case, including detailed travel history while in Cuba and further laboratory investigations were shared with competent local authorities in Cuba and WHO.

On 9 August 2013, the National IHR Focal Point for Venezuela confirmed two cases of cholera (V. cholerae serogroup O1 Ogawa) in persons, a 51 year old male and 55 year old female, with history of travel to Havana, Cuba.

On the same date, 9 August 2013, the National IHR Focal Point for Chile reported two cases of cholera, one laboratory confirmed (V. cholerae serogroup O1 Ogawa) and the other by epidemiological link, in persons returning from travel to Cuba.

Comments: If you are traveling to Central American countries, it would be wise to take the Oral Cholera Vaccine drops. Just two doses (given by mouth, like Polio Drops) at a gap of 15 days can provide you with a good protection against cholera for 2-3 years !