HealthMap provides critical reporting and response information for Haiti cholera outbreak

HealthMap is working with CrisisMappers and HumanityRoad to provide up-to-date, reliable reporting of suspected cases and clean water resources provided by groups like Water Missions International and Oxfam.

Visit http://healthmap.org/haiti/ for the latest information.

Cholera hits Haiti, Pakistan, and West Africa
Haiti: Wednesday evening (20 October 2010), English and French media reported a surge in deaths and hospitalization from diarrhea in rural Haiti. The next day officials confirmed an outbreak of cholera. Today (26 October 2010), WHO is reporting 259 confirmed cholera deaths and 3,342 confirmed cholera cases. Confirmation of new cases has slowed in the past 24 hours, but officials expect the numbers to continue to rise, and remain concerned that outbreak could enter the capital’s refugee camps. A UN official stated that if the outbreak enters Port-au-Prince, tens of thousands could become ill.

Almost all of the cases have been in Artibonite, a department north of the capital of Port-au-Prince. Haiti is divided into 10 departments, similar to states in the US or provinces in Canada. The outbreak’s source has not been identified, but the Artibonite River is widely suspected to be contaminated. Although 5 cases have been identified in the capital, all were originally infected in Artibonite. Early reports of suspected cases to the south of Port-au-Prince have not been confirmed as cholera.

Shortly after the 7.0 earthquake in January, health authorities stated their concern about the threat of cholera. Cholera is a bacterial infection which can cause severe diarrhea leading to dehydration and shock. It is transmitted in contaminated water; person-to-person transmission is rare. Distribution of clean water and effective removal of sewage were severely compromised in the earthquake’s aftermath, but a cholera outbreak requires both poor sanitation and the presence of the disease. US CDC believed an outbreak immediately following the earthquake was “"extremely unlikely to occur". Given the 10 month delay and the fact that the epicenter of this outbreak was not strongly impacted by the January earthquake, the question of “why now?” remains unanswered. An NPR piece discusses the extreme poverty of many in rural Haiti and how poor infrastructure is associated with cholera outbreaks.

Given the extensive news coverage after the earthquake and the continued strong presence of aid groups from around the world, the international attention given to Haiti’s cholera outbreak is to be expected. Hopefully, the media coverage will contribute to a rapid resolution. It is important to note, however, that two other cholera outbreaks are currently impacting tens of thousands.

Pakistan: Sindh, Punjab and Khyber Pakhtunkhwa provinces heavily affected by flooding last month have reported cases of cholera. WHO has reported 99 confirmed cases

Multiple countries in West Africa: In September, we reported on a cholera epidemic that began in Nigeria and spread to Cameroon, Chad, and Niger. At the time, Nigerian officials had assured the public that the disease was under control; the country had reported a little over 16,000 cases and under 800 deaths total for the year. In the one month since, the counts have risen to 38,173 cases and a startling 1,555 deaths for Nigeria alone, while Benin has been added to the list of countries affected. Cameroon currently reports 8,528 cases and 559 deaths since May while Chad had 3,338 cases and 128 deaths as of early October. Health officials are particularly worried about Benin, where recent flooding has left two-third of the country covered in water and over 250,000 people homeless. Just in the past two weeks, 846 cases and 7 deaths from cholera have already been reported within the country.

With proper sanitation and public health infrastructure, the disease should be largely preventable, but in Nigeria almost half of its population of 150 million lack access to these clean water. Cholera remains an imminent threat to the livelihood of the inhabitants, in particular children. Local preventive efforts have been made through chlorinating wells and public health education. Local Christian and Muslim leaders have even begun to preach on the disease in efforts to raise awareness. Experts hope that with the arrival of dry season in the region, the spread of the disease can hopefully begin to subside and the people of West Africa can finally see a turn for the better.

Leptospirosis Outbreaks, Toxic Sludge and a Historic Victory!

Spotlight News of the Week:
Leptospirosis Outbreaks around the World

Leptospirosis outbreak leads to state of emergency in Nicaragua
Nicaragua has declared a national state of emergency due to a spike in cases and deaths from leptospirosis. Leptospirosis is typically spread through contact with water or plants that have been contaminated by the urine of infected animals (most often rodents). Recent heavy rains and flooding have created ideal condition for its spread. So far, 146 cases and 16 deaths have been confirmed with more cases and deaths suspected. Untreated, it can lead to kidney damage, meningitis, liver failure, respiratory distress, and death. Leptospirosis is rare in the United States with half of the 100-200 cases each year occurring in Hawaii. In the US and Canada, leptospirosis is more often a veterinary disease; diagnoses have increased substantially in dogs during the last decade.

Leptospirosis in El Eulma, Algeria *Picture Source: Sawt El Ahrar
Another leptospirosis outbreak has been reported in city of El Eulma, Algeria. To date, 4 deaths and 75 cases have been confirmed with up to 100 total cases suspected. Investigators report that rat urine was found in mixed with the groundwater in wells, including that of a mosque in the region. The epidemic has increased concern, reaching the front page of the official website of El Eulma in the form of the political cartoon at the top of our blog. The heading above repeats the finding that rat urine has been discovered in well water. The man says “well water” while the rat, which is leaving a door marked “WC,” says “house water.”

Additional News Highlights:

Toxic Sludge Disaster in Hungary
On Monday, October 4th, 2010 the villages of Kolontar and Devecser in Western Hungary were devastated by a flood of a toxic red sludge from a reservoir at the Ajkai Timfoldgyar alumina plant in Ajka. A state of emergency was declared the following day as the death count from the sludge, a waste product in aluminum production containing heavy metals, rose to three and ecological concerns increased for the Marcal, Raba, and Danube rivers. Since then, 9 people have been confirmed dead and more than 150 injured due to the toxic deluge. A team of environmental scientists and toxicologists have been deployed to aid in the clean-up efforts of over 15 sq. miles of land. While residents were allowed to return to what was left of their homes on October 15th, the alumina plant at the source of the spill reopened. The state of emergency has been extended until December 31st for the affected towns, which have been declared “ecological disaster zones.”

Rinderpest joins smallpox in history books
For only the second time in human history, a viral disease has been eradicated worldwide. The UN’s Food Animal Organization (FAO) announced last week that it would suspend tracking efforts for Rinderpest because the disease has been eradicated. Rinderpest is possibly the most important veterinary disease in history. This viral disease kills the vast majority of infected cattle. Devastating losses in the 1700s motivated France’s establishment of the world’s first school of veterinary medicine to teach control methods; most European countries quickly followed suit. When Rinderpest entered sub-Saharan Africa in the late 1800s, 80-90% of all cattle died leading to famine and destabilization that left the region “weak in the face of European colonization.” FAO launched the Global Rinderpest Eradication Programme in 1994, and the virus was last detected in 2001 in wild buffaloes in Kenya’s Meru National Park. The official declaration of eradication will come from the OIE in 2011.

Leishmaniasis in Afghanistan
On Friday, WHO officials highlighted an ongoing outbreak of Leishmaniasis in their first global report on neglected diseases. An ongoing outbreak in Herat as well as the dramatic increase of cases in Kabul has alarmed health officials. Leishmaniasis causes severe skin sores that often leave substantial scarring. The visceral form of Leishmaniasis is less common but is often fatal. It is transmitted through bites from sand flies. Leishmaniasis is extremely rare in the United States, but military personnel deployed to the Persian Gulf and to Southwest/Central Asia have been diagnosed with it after returning to the US.

Typhoon-related Melioidosis Outbreak in Taiwan results in 1 death
On October 15th, Kaohsiung City health officials reported 7 confirmed cases of melioidosis, including 1 death, in the aftermath of the Abigail van typhoon that swept through Taiwan in mid-September. The death occurred in a 82 year old with underlying conditions of hypertension and diabetes. Melioidosis is caused by the bacterium Burkholderia pseudomallei and is endemic in tropical countries in Southeast Asia. Its incidence increases during the rainy season and melioidosis often affects adults who have chronic underlying diseases, especially diabetes mellitus. Interestingly, the disease burden for Taiwan this year was relatively light compared to previous years, when between July and September 2005, 40 cases of melioidosis were identified after Typhoon Haitang swept through the region.

Update on KPC in Brazil’s Federal District
In the capital city of Brazil, the Department of Health has acknowledged an increase (English translation) of hospital related bacterial infections, triggering warnings and widespread concern amongst patients and clinics alike. The bacteria has been identified as Klebsiella Pneumoniae Carbapenemase (KPC). The Secretary of Health for the Federal District announced on October 16th that the number of suspected cases of KPC has ballooned to 135 in the Federal District alone, and now a total of 16 hospitals (9 public hospitals and 7 private hospitals) within the Federal District have been identified as hosts of KPC.

WHO’s Dengue warning to Asia, Malaria returns to Spain, and Plague near Denver

Spotlight News of the Week

WHO concerned about dengue’s spread in Asia
Earlier this week, the WHO Regional Director for the Western Pacific warned that the number of dengue cases in Asia has increased steadily over the past 10 years and over 2.5 billion people are now at risk for the sometimes fatal mosquito-borne disease. WHO attributes some of the increased risk to higher temperatures due to climate change, rising populations and greater international travel. This year’s case number are dramatically higher than last years.

• India is facing a 20 year high. Some athletes competing at the Commonwealth Games among the 4300 infected in Mumbai alone.
• Malaysia has reported a 53-percent rise in dengue-related deaths this year and even considered releasing genetically modified mosquitoes with engineered shorter lifespans to reduce to mosquito population. Malaysia has criticised the WHO for not doing more to help.
• Taiwan set a single week record for Dengue cases (111 cases reported) last week. The Taiwanese Department of Health Minister said “dengue fever as ‘the biggest threat’ to Taiwanese among all infectious diseases”
• Hong Kong has already had 65 cases this year with 4 of them acquired locally. Last year, all 43 cases were imported.
• In September, China’s Guangdong province saw 11 cases of dengue in Dongguan, host to the Asian Games alter this year..
• The Philippines have had 98,934 cases nationwide compared to only 42,075 last year.

Additional News Highlights

Super Bacteria KPC in Brasilia
Brasilia, Brazil’s capital, has 187 cases of infections from the “super bacteria”, KPC. 163 of these are confirmed while the other 24 are under investigation. In the last week, 18 deaths from this deadly bacteria have been confirmed. Officials are continuing to investigate these cases and the bacteria in order to prevent further infections and deaths.

First Case of Malaria in Spain in 50 years

The first case of Malaria since 1961 was confirmed in Aragón, Spain. The patient was infected with this disease from a Anopheles atroparvus mosquito who was carrying the parasite. The patient is responding to the treatment and recovering well.

Plague in prairie dogs near Denver
Hundreds of prairie dogs are suspected to have died from plague in Broomfield, Colorado. Prairie dogs are extremely sensitive to plague and die-offs are not uncommon. Despite the scary nature of some of the headlines, the organism that causes plague, Yersinia pestis, is found throughout the western US. Earlier this year, a California park was closed after a plague-infected squirrel was discovered.

Salmonella, Chikungunya, and Measles Make Headline News

Oklahoma salmonella
What started as an isolated salmonella outbreak at a Mustang, Oklahoma school has now become a multi-state outbreak investigation. In late September, 10 cases of salmonella were reported from a Mustang city school district in Oklahoma. By the end of the month 15 cases had been identified from three different counties (Canadian county, Oklahoma county, and Carter county). Several days later, the outbreak investigation had expanded to the states of Iowa and Nebraska who were each reporting several cases of a similar strain of salmonella. The strain identified in the Oklahoma cases has been confirmed as Salmonella Java. Recent news reports state that there are now 14 confirmed cases from Mustang city schools, 3 additional suspect cases throughout the state, and several being investigated in Iowa and Nebraska. The source of the outbreak has not yet been identified.

U.S. 1940’s Syphilis in Guatemala
From 1946 to 1948, the U.S. conducted a NIH-funded study of the effectiveness of penicillin in Guatemala by knowingly infecting 700 Guatemalans (mental patients, soldiers and prison inmates) with venereal diseases. Syphilis was among these venereal disease. Susan M. Reverby, a professor at Wellesley College in Massachusetts, brought attention to this unethical experiment through her research paper. Secretary of State Hillary Clinton and President Obama have officially apologize to the Guatemalan government for this experiment.

Chikungunya Virus Outbreak in Southern China
At least 10 confirmed cases and 91 suspect cases of the mosquito-borne Chikungunya Virus have been identified in Xincun community of Dongguan, a city in China’s southern province Guangdong and may be the country’s first ever locally-acquired cases. In China, Chikungunya is transmitted via two mosquito species - the Aedes albopictus and the Aedes aegypti. While most of the patients have recovered and no severe cases or deaths were reported, the risk of transmission remains high since a mosquito can acquire the virus from an oftentimes asymptomatic individual and go on to infect another person. This is particularly worrisome among individuals with underlying conditions such as diabetes or heart disease, as a relatively innocuous Chikungunya infection can lead to the onset of more severe illnesses.

Brazilian Outbreaks:
In Brazil, a measles outbreak continues through the state of Paraíba, in the cities of: João Pessoa (32 confirmed cases), Santa Rita (3 confirmed cases), Conde (1 confirmed case) and Bayeux (1 confirmed case) , with a total of 37 confirmed cases and 86 suspected cases. Measles is highly contagious and the outbreak has placed Pernambuco state (Paraíba’s neighbor to the south) and Rio Grandedo Norte (Paraíba’s neighbor to the north) on high alert.

An outbreak of Chicken Pox continues through the Federal District of Brazil in addition to the cities of Araraquara, Guarujá, Riberão Preto, São Paulo in São Paulo state, worrying the interior municipalities of the state of São Paulo.

In Bahía state, meningitis C caused the death of a ten-year old girl in Porto Seguro.