Hurricane Matthew’s sweep through southern Haiti last October killed hundreds; left nearly 200,000 without homes; and flooded rivers, latrines and wells, contaminating drinking water and prompting reports of increasing cholera cases in the hardest hit areas of the nation.
“It hasn’t gone away,” said Dr. J. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute. “Cholera is still in Haiti, with the U.N. acknowledging responsibility for helping put it there initially after the devastating 2010 earthquake.”
Dr. Morris and Dr. Ira Longini, a professor of biostatistics in the UF College of Public Health and Health Professions and the College of Medicine, made up part of an international committee convened to recommend strategies to limit the risk of major new cholera epidemics following Hurricane Matthew. Since the meeting, one million doses of oral cholera vaccine have reached the country, bound for its southern peninsula, which bore the brunt of the storm.
The committee, named the “Special Consulting Group to the Minister of Health and Population of Haiti, Port-au-Prince,” was called together by the National Institutes of Health to advise Haiti’s Minister of Health on ways to stop the spread of the disease. A report summarizing the meeting was published December 7 in The New England Journal of Medicine.
In addition to the Special Consulting Group’s recommendation of immediate vaccination, it also suggested long-term approaches for eliminating cholera in Haiti. The NEJM “Perspective,” titled “Eliminating Cholera Transmission in Haiti,” said, “[Comprehensive] national Oral Cholera Vaccine coverage combined with targeted water, sanitation, and hygiene interventions could eliminate the transmission of cholera in Haiti over the next three to five years.”
Within the last six months, the Emerging Pathogens Institute has received nearly $7 million from the NIH to study cholera transmission in Haiti.
“We’ll be looking specifically at how cholera is transmitted and what the risk factors are for acquiring it,” Dr. Morris said. “We will also be working to better understand environmental reservoirs and other factors that may have played a role in the persistence of the disease in Haiti since the initial 2010 epidemic.”
Dr. Longini believes a measured vaccination program, coupled with infrastructure improvements, will protect Haitians from the disease.
“It would make sense to roll out cholera vaccination to high-risk areas first in the coming years,” he said, “with evaluation of effectiveness comparing those areas that are vaccinated to those that have not yet received vaccine. This ‘stepped wedge’ strategy would work well for Haiti. At the end of the process, all the high-risk areas would be vaccinated, and we would have some measures of the effectiveness of the campaign.”