Cholera on the March in the Caribbean and South America
June 6, 2011 • 10:14AM

With the rainy season now in full force, the number of new cholera cases continues to climb in Haiti and in the Dominican Republic, with the death count in the latter country now at 34 and 1,431 infected. According to Doctors Without Borders (MSF), the resurgence of cholera in Haiti, particularly in the capital of Port-au-Prince, is "alarming."

Romain Gitenet, head of MSF's Haiti mission, reported that during just one week since May 29, MSF treated close to 2,000 cholera patients in the capital. According to the British NGO Oxfam, clinics just in the Carrefour section of Port-au-Prince are seeing more than 300 new cases a day, triple the number seen in the Fall of 2010. Cases are also mounting in several other regions of the country, notably the West and Southeast departments.

Despite some modicum of preparation for the upsurge that was expected to occur when the rains came, Haiti is no better prepared to deal with this than it was for last October's outbreak. No vital sanitation or water infrastructure has been built; the public health system is fragile at best, and living conditions continue to be subhuman for most of the population. The spread of cholera to the Dominican Republic which shares the island of Hispaniola with Haiti, was a given. Moreover, there are now reports of suspected cholera cases in several countries of Central and South America, as well as in Mexico and in the U.S. state of Florida.

The levels of poverty and malnutrition across the region, combined with travel and migration of people across borders (especially from Central America into Mexico), leave these nations defenseless. One U.S. public health expert recently noted that the 01 Ogawa strain of cholera now present in Haiti and the Dominican Republic "is clearly dangerous, highly infectious, and is a likely pandemic agent." This expert underscored the potential for the spread of this strain "to other Caribbean and Latin American nations this year, if human movements are the key vector of 01 Ogawa's spread."

Last February, at the 2011 International Meeting on Emerging Diseases and Surveillance in Vienna, Austria, Jessica Malaty, a senior analyst at the Division of Integrated Biodefense at Georgetown University Medical Center, warned that immigration and air travel had become vectors for the spread of cholera throughout the Americas, making it a "multifocal event." She reported on the findings of a just-concluded study which predicts that, given the mobility of the cholera pathogen, an estimated 200,000 cases could arise in the Caribbean region alone over the 18 months beginning February 2011.