Cholera outbreak in Haiti: Lessons for Asia-Pacific’s public health responses

There have been reports of a cholera outbreak in Haiti during the past week, with over 4000 infected and 300 deaths. The epicentre of the outbreak is in the Artibonite region, north of the capital, and cases have been reported throughout other regions of the country.

Cholera is still quite common in some countries in the Asia-Pacific, with outbreaks of varying impact in the past year which have been reported to have occurred in Papua New Guinea, China, India, Nepal and the Philippines for example, despite incomplete reporting because of potential social, political, and economic costs. In developed countries, the disease is uncommon and has a very low fatality rate. In the US for instance, there have been 5 cases of cholera in the past year, and during the period from 1995 to 1999, there were 53 laboratory-confirmed cases, of which resulted in one death.

Cholera is an agonising acute bacterial infection which takes a dramatic toll on the body. The most acute cases can result in death in a matter of hours because of dehydration and loss of electrolytes from severe diarrhoea. Diarrhoeal diseases such as cholera are endemic in Africa, South and Central America and Asia and leads to 1.6 million deaths annually, of which 90% are children under 5. Cholera and other diarrhoeal diseases can be easily treated with clean water mixed with sugar and salt, and in worse cases, intravenous hydration and antibiotics; but only 39% of children with diarrhoea get the recommended treatment.

The outbreak in Haiti underlines how vital structural changes to the existing public health infrastructure, water hygiene and sanitation in developing countries need to take place in order to provide basic treatment for diarrhoeal diseases such as cholera and prevent future outbreaks. By working towards improving people’s sustainable access to safe drinking water, it would address the UN Millennium Development Goal (MDG) on that issue, and allso works towards reaching the MDG on combating HIV/AIDS, as it is likely that people weakened by HIV/AIDS are likely to suffer the most from the lack of safe water supply and sanitation, especially since diarrhoea and skin diseases are two of the more common infections.

The use of vaccines to control outbreaks should also be further examined to explore the economic viability of such measures in developing countries. Basic disaster management and response plans also need to be formulated and implemented in order to restore health services and clean water supplies to prevent the spread of diseases which can be triggered by natural disasters.

However, adequate surveillance, provision of health services, implementation of disaster response plans would not be possible without funding. International organisations and NGOs have to explore ways to collaborate with governments, local communities, and even private institutions to extend assistance to affected populations beyond the provision of aid and to explore development over the longer term. Stemming the spread of diarrhoeal diseases to bring positive lasting change in affected communities and countries therefore requires a multifaceted and all-encompassing approach.