Cholera Overview. Recent visit to Haiti to assist with community education and prevention Mirine Richey Dye, MPH, CHES

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1 Cholera Overview Recent visit to Haiti to assist with community education and prevention Mirine Richey Dye, MPH, CHES Florida Keys MRC Southern point is 90 miles from Cuba 135 miles of islands connected by bridges Hurricane sensitive area Mass migration sensitive area Rural and resource poor 74 members including MD, RN, PharmD, PA s, and public health professionals. Population ranges from 25,000 to 85,000 depending on time of year. Members encouraged to help develop outreach programs Boating safety and securing boats for hurricanes 1

2 Haiti Local RN and MRC member responded with a non-profit group 2 weeks after the January 12 th earthquake. The group set up a mobile maternity unit in a rural underserved mountain area MRC coordinator was asked to assist with public health integration of services and responded to Haiti in July and November Utilized the MRC press release area on the website to contact other MRC members/units to obtain information on the needs and experience in Haiti. Tents/cots provided by USMC Rooftop birth 2

3 These UNICEF supplies were stolen and we were unable to obtain more due to the supply camp moving out of the area Supply unit provided clean birth kits and basic medical supplies Purpose of Response 3

4 Reality of Response: Trauma victims Cholera 4

5 Violence Response Although not an official MRC deployment, the visit and information was used to train local providers on this issue and is a focus of interest for the Key West members of the MRC. An ongoing epidemic of cholera in Haiti has resulted in introduction of cholera cases to Florida. Florida has approximately 241,000 Haitian-born residents, representing 46% of the Haitian-born population residing in the U.S. Concentration of Haitians is in South Florida including Key West with travel just 1 hour and 15 min from Miami International Airport Florida DOH issued Clinical Guidance and this was merged with this field experience to provide training to our MRC members and interested public 5

6 Cholera Information Cholera is one of three diseases requiring notification to WHO under the International Health Regulations Current outbreak in Haiti - Not seen in over 100 years Vibrio cholerae O1, serotype Ogawa, biotype El Tor ( as seen in Nepal and India for over 10 years) Cholera is an acute diarrheal infection Caused by ingestion of food (seafoods) or water contaminated with the bacterium Vibrio cholerae. Short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks. Areas affected in Haiti 6

7 Guidance for Clinicians An ongoing epidemic of cholera in Haiti has resulted in introduction of cholera cases to Florida. Florida has approximately 241,000 Haitian-born residents, representing 46% of the Haitian-born population residing in the U.S Travelers who develop severe watery diarrhea, or diarrhea and vomiting, within 1 week after return from Haiti should seek medical attention immediately. Health care providers should request that stool specimens from suspected cases be cultured on media designed for isolation of Vibrio cholerae. Suspected cases of cholera should be reported immediately to the County Health Department; do not wait for laboratory confirmation. Cholera Treatment Options 80% of people can be treated successfully through prompt administration of oral rehydration salts Very severely dehydrated patients require administration of intravenous fluids. Small number of those patients also require appropriate antibiotics ( Zithromax) Mass administration of antibiotics is not recommended, as it has no effect on the spread of cholera and contributes to increasing antimicrobial Vaccine is available but not shown to be effective With proper treatment, the case fatality rate should remain below 1%. 7

8 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. 1/28/2011 Living Environment Breeding ground for fecal contamination of water Water Collection and Transport 8

9 1/28/2011 Water Collection and Transport Water Reality for Urban Dwellers 9

10 1/28/2011 Community Water Cistern Community Water 10

11 1/28/2011 Water Flow Cholera Campaign 11

12 Grass roots campaign at local farm Lectures with local residents 12

13 Summary Conditions not likely to improve in Haiti Increased travel to and from the island gives way to potential cases arriving in Florida Increase education to HCP Concern is recognition and early treatment Monitoring and reporting needed to ensure appropriate surveillance and response in the State of Florida 13