How We Can Stop Cholera
Farmer, M. D. Paul, Rejouit, Jean-Renold, Newsweek
Two doctors on why there's still hope for Haiti.
After decades of political violence, after being pounded by hurricanes and floods, and after the January 2010 earthquake, Haiti now faces a cholera epidemic that has so far defied all efforts to bring it under control--efforts made even more difficult by last week's rioting over disputed election results. In the outbreak's first 30 days, the disease claimed an estimated 2,000 lives. It started in central Haiti, many miles upstream from the tent cities around Port-au-Prince where more than 1 million displaced Haitians defecate, wash, and eat in overcrowded, unsanitary conditions. But no epidemic of cholera stays local for long: cases have already been reported not only in every district but also in the Dominican Republic and Florida.
There's reason to fear that this outbreak is, in the words of a colleague who's an expert on the disease, "not your grandmother's cholera." The strain described by epidemiologists as "an El Tor biotype of Vibrio cholerae serogroup 01" seems especially virulent and hard to slow down. In fact, if the long history of a similar El Tor strain in Bangladesh is any indication, the disease could become endemic in Haiti. That threat makes it all the more urgent for the world to renew its relief efforts in Haiti--and to resist the temptation to write off the country's 10 million people as beyond hope.
The No. 1 priority is to deliver quality care to the sick. Although cholera's profuse diarrhea can shrivel and kill a healthy adult in hours, early detection and expert care can save virtually anyone who contracts the disease. And in our opinion, proper care includes aggressive use of antibiotics. Some authorities recommend that treatment consist only of oral rehydration or, failing that, intravenous resuscitation. Antibiotic therapy is currently recommended only for the most severe cases, because of cost and for fear of encouraging the growth of drug-resistant microbes. In the case of Haiti's present outbreak, we think this is a mistake. Antibiotics can shorten the course of illness, decrease the volume of diarrhea, and reduce the time that patients shed contagious organisms--all of which helps prevent deaths and limit transmission.
Oral cholera vaccines are another powerful tool against the disease, protecting as many as 90 percent of people who have been fully vaccinated. Some say this can't work in Haiti, since at least two doses are recommended; others argue the vaccine is too expensive or in short supply. But we've already accomplished an even tougher feat by completing a three-course dose of the cervical cancer vaccine in Haiti for 76 percent of the girls we enrolled--about twice the rate for similar programs in the United States--and the earthquake struck between the first and second doses. Vaccines were not recommended during last year's cholera outbreak in Zimbabwe, and 4,000 people died in a single year. …