Cholera epidemic in Haiti from 2010

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Development of the epidemic up to December 3, 2010 (number of cases). The dates indicate the date of the first registered case.

From the end of October 2010 , there was an ongoing cholera epidemic in Haiti . The Haitian government declared a sanitary emergency across the country after the first deaths of cholera sufferers. The majority of epidemiologists assume that cholera was brought into the country by Nepalese UN soldiers . On August 17, 2016, representatives of the United Nations officially recognized responsibility for the cholera outbreak for the first time.

course

The infections initially occurred in the rural Artibonite province , north of Haiti's capital Port-au-Prince . As a result of the earthquake in Haiti on January 12, 2010, extensive sanitary infrastructure was destroyed and makeshift dwellings (tent cities) without adequate sanitary infrastructure were built. The epicenter of the quake was about 25 kilometers southwest of Port-au-Prince. After that, the supply of drinking water was only made provisionally by dispensing bottled water, etc. Flooded sewers in a refugee camp were suspected to be the cause of the first cases of illness. The first cases of the disease were confirmed by the Centers for Disease Control and Prevention (CDC), an auxiliary agency in the United States.

Cholera cases in Haiti according to WHO data
year Diseases Deaths
2010 179,379 3990
2011 340.311 2869
2012 112.076 894
2013 58,809 593
2014 27,753 296
2010-2014 718.328 8642

On October 21, 2010, the cholera outbreak was officially confirmed by the Haitian health authorities. By November 19, 2010, the outbreak had reached every department in the country and by December 17, 2010 a total of 121,518 cholera cases, 63,711 hospital admissions and 2,591 registered deaths had resulted. Later publications assumed higher mortality rates.

The medical care of the affected parts of the population was made increasingly difficult by transport problems as a result of the onset of the rainy season and the flood damage in the Artibonite province after Hurricane Tomas in early November 2010.

On November 16, the first case of cholera in the Dominican Republic , neighboring Haiti , was officially confirmed. The sick person is a Haitian guest worker who was probably infected while visiting his homeland.

In addition to health education and information on hygiene measures, vaccinations against communicable diseases have also been introduced since 2012 .

According to the Haitian Ministry of Health, around 3500 deaths and more than 157,000 cases of cholera were counted by the end of 2010. Even ten weeks after the outbreak of the epidemic, the disease has not yet been contained; 22 people still died per day. On March 28, 2011, the Haitian national health ministry reported that 4,677 people had died and more than 270,996 had been infected.

Discussion about the source of infection

The suspected source of the epidemic was the Artibonite River, from which some of the people affected drank water. A UN team examined samples from a sewer pipe in a base of the Nepalese peacekeeping contingent on suspicion that this was the cause of the contamination of the river. Vincenzo Pugliese from MINUSTAH confirmed that the cholera bacterium was detected there. The American CDC said that DNA fingerprinting tests showed that various samples from Haitian patients revealed Vibrio cholerae, serogroup O1, serotype Ogawa, a strain also found in South Asia.

Three US professors at major US universities contradicted claims that Nepalese soldiers were the source of the outbreak. The experts believed that dormant cholera bacteria had been awakened by various ecological incidents in Haiti. They said a series of events, including changes in climate caused by the La Niña phenomenon and unsanitary living conditions for those affected by the earthquake, caused the bacteria to multiply.

As a result of the suspicions against the Nepalese soldiers, demonstrators demanded that the Nepalese United Nations Brigade leave the country.

A UN-convened, four-person, independent committee concluded in a report released on May 3, 2010 that the epidemic of contamination of the Artibonite River with a pathogen resembling the South Asian cholera strain Vibrio cholerae had been spread, likely from a single source. A series of molecular analyzes came to this conclusion. According to the report, the sanitary conditions in the nearby UN camp, where the Nepalese troops were stationed, were inadequate. A spread on this scale would not have occurred without the deficits in the water and health systems in Haiti. The head of the committee said the disaster may have originated from a single infected person who was not sick himself, but who passed the bacteria through their stool.

In a public statement on August 17, 2016, the deputy spokesman for Secretary-General Ban Ki-moon stated that the United Nations (UN) had come to the conclusion in recent years that it was more in favor of "because of its involvement in the outbreak" Sick people would have to do. The declaration was the first in which the UN acknowledged (joint) responsibility for the epidemic outbreak, but it did not contain a formal admission of guilt and the spokesman emphasized that the legal position of the UN on this issue had not changed. In 2013, the UN was sued by human rights lawyers for damages amounting to 2.2 billion US dollars for the up to 679,000 people affected (sick, relatives, economically injured, etc.).

In a scientific study published in January 2016, epidemiologists from Yale University concluded that the cholera outbreak could have been avoided if UN soldiers from cholera-endemic areas (such as Nepal) had received chemoprophylaxis with antibiotics . The cost of this prophylaxis has been put at less than $ 1 per person.

Medical background

Cholera is a serious, bacterial infectious disease that mainly affects the patient's small intestine . Detection of the bacterium Vibrio cholerae is the cause and decisive for the diagnosis . The infection usually occurs through contaminated drinking water or infected food. The bacteria can cause extreme diarrhea and severe vomiting , which can lead to rapid dehydration ( desiccosis ) with loss of electrolytes. The dysregulation of the circulatory system can lead to death.

The treatment includes the compensation of the water and electrolyte loss as well as the administration of antibiotics .

Most cholera infections (around 85%) proceed (initially) without symptoms (fever, headache, malaise). The mortality of the disease, if left untreated, is between 20 and 70% depending on the type of pathogen and the amount absorbed. Of the approx. 3–5 million cases of cholera worldwide annually , 100,000–120,000 lead to patient death.

See also

literature

Web links

Individual evidence

  1. ↑ cf. Haiti declares a sanitary emergency ( memento from October 24, 2010 in the Internet Archive ) at tagesschau.de, October 23, 2010 (accessed on October 23, 2010)
  2. ↑ Jonathan M. Katz: UN Admits Role in Cholera Epidemic in Haiti. The New York Times, August 17, 2016, accessed August 18, 2016 .
  3. ↑ Global Health Observatory (GHO) data: Number of reported cholera cases. WHO, accessed on August 21, 2016 .
  4. ↑ Global Health Observatory (GHO) data: Number of reported deaths due to cholera. WHO, accessed on August 21, 2016 .
  5. ↑ CDC: Update on Cholera - Haiti, Dominican Republic, and Florida, 2010 . Morbidity and Mortality Weekly Report (MMWR) . December 24, 2010/59 (50); 1637-1641.
  6. ↑ "Tomas" wreaked havoc ( Memento from November 7th 2010 in the Internet Archive ) at tagesschau.de
  7. ^ First cholera case in the Dominican Republic. ( Memento from November 20, 2010 in the Internet Archive ) Süddeutsche Zeitung , November 17, 2010, 8:30 a.m., or the situation report No. 14.
  8. ^ AS Vicari, C. Ruiz-Matus et al. a .: Development of a cholera vaccination policy on the island of hispaniola, 2010-2013. In: The American journal of tropical medicine and hygiene. Vol. 89, number 4, October 2013, pp. 682-687, ISSN  1476-1645 . doi : 10.4269 / ajtmh.13-0200 . PMID 24106195 . PMC 3795098 (free full text).
  9. ↑ Der Standard : Around 3,500 cholera deaths in Haiti as of January 5, 2011.
  10. ↑ Cholera deaths rose to 4,766, Latina-press.com (accessed May 8, 2011).
  11. ↑ Cholera cases found in Haiti capital . MSNBC. October 23, 2010. Retrieved November 9, 2010.
  12. ↑ UN investigates Haiti outbreak . Al Jazeera English . October 28, 2010. Retrieved November 9, 2010.
  13. ↑ MyHealthNewsDaily Staff: Haiti's cholera strain likely came from South Asia, CDC says . MSNBC. November 1, 2010. Retrieved November 9, 2010.
  14. ↑ Haiti cholera 'resembles South Asian strain' . BBC News. November 1, 2010. Retrieved November 9, 2010.
  15. ↑ CDC Announces Laboratory Test Results of Cholera Outbreak Strain in Haiti , Infection Control Today. Retrieved November 17, 2010. 
  16. ^ Haiti's cholera epidemic caused by weather, say scientists . The Guardian. November 22, 2010. Retrieved November 22, 2010.
  17. ^ UN troops blamed for Haiti cholera . Al Jazeera English. October 30, 2010. Retrieved November 9, 2010.
  18. ↑ Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti, pp. 3 and 29 (PDF; 1.4 MB)
  19. ↑ Martin Enserink: Haiti's Cholera Outbreak Cholera Linked to UN Forces, But Questions Remain . Science, May 13, 2011. Vol. 332, No. 6031, pp. 776-777.
  20. ^ Daily Press Briefing by the Office of the Spokesperson for the Secretary-General. United Nations, August 18, 2016, accessed on August 18, 2016 (English, the decisive text passage: ... but over the past year, the UN has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera ... ).
  21. ↑ UN south in US court over Haiti's cholera epidemic. Reuters, October 9, 2013, accessed August 18, 2016 .
  22. ↑ Joseph A. Lewnard, Marina Antillón, Gregg Gonsalves, Alice M. Miller, Albert I Ko, Virginia E. Pitzer: Strategies to Prevent Cholera Introduction during International Personnel deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak . In: PLOS Medicine . tape 13 , no. 1 , January 26, 2016, p. e1001947 , doi : 10.1371 / journal.pmed.1001947 ( plos.org [accessed August 11, 2016]).

Coordinates: 19 °  N , 72 °  W