Haiti's Artibonite River Is Suspected As Being the Source of the Cholera Outbreak

It was reported in the Miami Herald, as of Friday evening, the Haitian government reported that 2,364 Haitians have been hospitalized for cholera throughout the affected Artibonite region in central Haiti, and 194 have died. The death toll was expected to rise. Partners in Health, or PIH, reported Saturday that the number of new cases at the hospital in St. Marc -- where the ill have gone to seek treatment -- on Friday was lower than new cases on Thursday. But with only three days of data, it isn't possible to say that this represents a positive trend, Partners in Health reported. PIH also reported that at least 10 cases have been found in Gonaives, a port city in the Artibonite that's located 34 miles north of St. Marc which is also a port city. Artibonite River is suspected as being the source for the cholera outbreak in Haiti. The cities of Dessalines, Gonaives, and Saint Marc located in central Haiti were the first cities where cases were reported.

Artibonite River Has Been a Source for the Spread of Infection in the Past The Artibonite River has been the source for spread of infectious diseases in the past. In the 1980s African Swine Fever (ASF) spread to Haiti from the Dominican Republic via the Artibonite River resulting in the slaughter of the nation’s pig stock that became infected with this highly contagious disease. ASF infected approximately one-third of the nation's pigs from 1978 to 1982. Farmers slaughtered their infected animals. Fear of further infection persuaded peasants to slaughter another one-third in panic sales. A government eradication program virtually wiped out what remained of the 1.2-million pig population by 1982

Irrigation Practices Can Contribute to Contamination

The Artibonite river water used for irrigation is one way fruit and vegetables can become contaminated with food borne pathogens. With rising levels of surface water in the rainy season and the run off due to erosion and deforestation of the area, the risks of transmission from pathogenic microorganisms is aggravated. Minimally processed fruit and vegetables can be sources of disease-causing bacteria, viruses, protozoa, and helminthes. Groundwater, surface water, and human wastewater might have been used for irrigation. The risk of disease transmission from pathogenic microorganisms present in irrigation water is influenced by the level of contamination, and the persistence of pathogens in water, in soil, and on crops; and the route of exposure. Groundwater is generally of good microbial quality, unless it is contaminated with surface runoff; human wastewater is usually of very poor microbial quality and requires extensive treatment before it can be used safely to irrigate crops; surface water is of variable microbial quality. Bacteria and protozoa tend to show the poorest survival outside a human host, whereas viruses and helminthes can remain infective for months to years.

The Centers for Disease Control states cholera bacterium is usually found in water or food sources that have been contaminated by feces from a person infected with cholera. Cholera is most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

The cholera bactium may also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. Because Gonaives and Saint Marc are coastal cities, shellfish contamination could also be suspected. However, Haitians living outside of Port au Prince do not regularly consume shellfish or fish because of lack of refrigeration available.

Haiti Needs Basic Public Health Infrastructure to Prevent Future Outbreaks

The Centers for Disease Control outlines the basic strategies for prevention and control of epidemics. State and local health departments should have a functional surveillance and response unit, staffed by well-trained personnel who have adequate data-processing resources, appropriate laboratory facilities, and an adequate operating budget. The size and complexity of these units will vary by jurisdiction, depending on both the risk of transmission in the area and available resources. A functional surveillance unit at the state level should be considered an essential component of any emerging infectious diseases program. Local health department expertise and capabilities should be supported in a manner that complements statewide programmatic goals.