IndexOverviewResultsDiscussionEpidemiologyClinical presentationThe origins of the epidemic in HaitiThe progression of the epidemicAn admission of guilt?OverviewCholera is an acute diarrheal disease caused by the bacterium Vibrio Cholerae, transmitted through the ingestion of water or contaminated food. It is estimated that worldwide it causes between 1.3 and 4 million cases and between 21,000 and 143,000 deaths each year. In 2016, 54% of cases were reported from Africa, 13% from Asia, and 32% from Hispaniola (Dominican Republic and Haiti). The majority of those infected will have mild or even asymptomatic disease. These cases can be easily treated with an oral rehydration solution. Severe cases occur in those who become severely dehydrated, becoming at risk for shock. In these cases, prompt fluid resuscitation is necessary and antibiotics should be administered to reduce the duration of diarrhea, to reduce the volume of rehydration required, and to decrease the amount of V. cholerae excreted in the feces. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay The cholera epidemic in Haiti emerged in October 2010, following the January 2010 earthquake. The effects of these natural disasters on the country's already strained health and healthcare infrastructure, combined with the influx of foreign humanitarian workers from regions with endemic cholera epidemics are important factors in its emergence in Haiti. Results Data shows that since the emergence of Cholera in Haiti in October 2010, there have been a total of 819,000 suspected cases and 9,769 total deaths as of May 2018. This makes it the largest modern cholera epidemic, until was surpassed by the 2016–2017 Yemen epidemic, although it is still the deadliest modern epidemic. Incidence in Haiti has steadily declined in recent years, but although national and WHO measures are in place, eradication has not yet been completed. Studies examining DNA detection and genotyping of V. Cholera isolated in Haiti, combined with the correlation between the arrival of a UN Nepalese battalion and the time and location of the outbreak, make it possible to conclude that the strain was likely imported and released into the country. environmental by the aforementioned UN contingent. This was denied by the United Nations for several years, until they issued an apology in 2016. DiscussionEpidemiological studies, local observations and genetic studies of cholera strains all indicate that the most likely cause of the epidemic is the introduction of the pathogen into the environment by the United Nations Nepalese Battalion. Interestingly, the UN denied this fact for over 5 years and produced its own report on the epidemic and its origins. Having not gone so far as to gather information on the credentials, independence or objectivity of the researchers behind this report, any statement regarding the basis of their approach is impossible. However, it appears that his conclusions may not be valid, as virtually all other research on the subject has come to a different conclusion. The organization's denial and response have been criticized, and perhaps rightly so, given that the UN has a history of denial in a similar situation during the Kosovo conflict. Vibrio cholera is a comma-shaped gram-negative rod. They are highly mobile organisms that exist naturally in aquatic environments. It is a diverse species that includes pathogenic and non-pathogenic variants, only strains that produce cholera toxin are capable of causing cholera. Thereclassification is carried out based on the structure of the O antigen of its lipopolysaccharide. More than 200 serogroups have been reported, but only serogroups O1 and O139 have been associated with large-scale epidemics. V. cholerae O1 is the cause of the current global pandemic and can be divided into two biotypes, El Tor and classic. In order for infection to occur, V. cholerae must survive the acidic environment of the stomach, colonize the small intestine and produce cholera toxin which causes massive fluid secretion in the small intestine. Epidemiology Cholera is presumed to be largely under-reported, but there are an estimated 1.3-4 million cases and between 21,000 and 143,000 deaths attributed annually to V. Cholerae. It mainly affects regions with limited resources and inadequate access to clean water sources. In 2016, 54% of cases were reported from Africa, 13% from Asia, and 32% from Hispaniola (Dominican Republic and Haiti). Cholera is endemic to ca. 50 countries, mostly in Africa and Asia. Epidemics have occurred throughout Africa, Asia, the Middle East and the Americas and can be particularly large. For example, the strain seen in the Haiti outbreak was later associated with outbreaks in neighboring countries, the Dominican Republic, Cuba and Mexico. Infection and transmission patterns generally differ between historically endemic or epidemic areas. Areas of high endemicity typically have a seasonal distribution with peaks before and after the rainy season and the highest incidence occurs in children under the age of five, reflecting a lack of immunity in children. In high epidemic areas immunity is more limited in the population as a whole, which is reflected in a more similar incidence in adults and children. However, overlapping epidemics may occur in endemic regions. An example is the devastated infrastructure in Yemen after years of war, which led to two consecutive epidemics in 2016 and 2017. The second of these epidemics led to the worst cholera epidemic to date, with approx. 500,000 cases and 2,000 associated deaths in just four months. Transmission of V. cholera occurs primarily through ingestion of contaminated food or water. Water is an important reservoir in endemic regions and since bacteria can live on plankton, water filtration is important to reduce their incidence. In epidemics, person-to-person transmission of hyperinfectious V. cholera is believed to be essential for rapid propagation. Clinical presentation Cholera is a disease that can be extremely virulent. In most cases, presentation is mild or asymptomatic. It typically has an incubation period of one to two days. The classic presentation is a bulky, watery stool (rice water). It may have a typical fishy odor. Diarrhea is usually painless without tenesmus and in severe cases can reach an output of up to 1 liter per hour. Vomiting and abdominal discomfort may also occur, but fever is rare. It may be indistinguishable from other types of gastroenteritis. In severe disease, rapid hypovolemia and electrolyte loss is a feared outcome, and in deaths, an average time between symptom onset and death of approximately 12 hours has been reported. Approximately 5% of patients develop the severe course of the disease. In mild to moderate disease, oral rehydration solution (ORS) is the gold standard and can successfully treat approximately 80% of cholera cases. In mild disease, the volume administered should equal the assessed volume loss. In moderate disease, adults should be given between 2,200 and 4,000 ml in the first 4 hours. In severe disease, rehydration occurs in two phases: IV rehydration and ORS. ThereIV rehydration is carried out using Ringer's lactate at a dose of 50 ml per kg the first hour, then reduced. ORS should be started as soon as the patient is able to drink. Antibiotics are indicated in more severe cases, to decrease the duration of vomiting, the amount of rehydration needed, and to reduce the amount of V. cholera eliminated in the feces. Origins of the Haitian Epidemic On January 12, 2010, an earthquake and humanitarian disaster occurred resulting in between 100,000 and 316,000 casualties and devastating public infrastructure such as sewerage and drinking water, already lacking before the natural disaster. On October 19, an unusually high incidence of patients with acute lacrimose syndrome, diarrhea and dehydration was reported by the Haitian Ministry of Public Health and Population (MSPP). Vibrio cholera serogroup O1, serotype Ogawa and biotype El Tor is isolated from the samples. Cases were first reported in the Arborite and central departments, but by mid-November there were cases in 7 out of 10 departments and in the capital Port Au Prince. At this point there were 16,111 people hospitalized with acute watery diarrhea and 992 cholera deaths reported. An effort to identify the origins of the epidemic was quickly initiated, as there had not been a cholera epidemic in Haiti in the previous century, although isolated outbreaks in other countries in the Americas had been observed. The earthquake was initially theorized to be the cause of the epidemic, but rumors eventually emerged that a UN Nepalese contingent had imported the epidemic. This contingent arrived on 8 October and underwent a medical examination before departure. However, stool samples were only acquired when clinically indicated, and the UN report notes that no cases of diarrhea occurred before or during this contingent's tenure in Haiti. The UN camp in question was located near the village of Meille, along a stream that flows into the Artibonite River. Cases of the disease began to appear downstream in the Arbonite River delta, presumably captivated by the fact that this river was known to be used for bathing and as drinking water for villages along its route, as well as irrigation in agriculture. The UN accused an independent contractor of inadequately removing wastewater, but it should also be mentioned that Haitian epidemiologists observed several sanitation deficiencies at the UN camp, including a pipe that discharged wastewater into the river. It is believed that the first case of Haitian cholera The epidemic was a 28-year-old man from the city of Mirebalais. He was reported to have suffered from an untreated psychiatric illness for years, and despite having access to clean water at his home, he would commonly be seen walking naked around the city during the day and bathing in and drinking from the Latem River. This river is fed by the Meye River, believed to be the source of the cholera epidemic. On October 12, 2010, this man developed profuse watery diarrhea and his family attempted to be treated conservatively with oral fluids in his home. They did not seek medical attention and the man died less than 24 hours after symptoms appeared. Two people preparing this man for his wake also reportedly developed watery diarrhea. The first hospitalized case of cholera occurred in Mirebalais on 17 October 2010. Compared to the capital Port-au-Prince, which has 3 million inhabitants out of the country's total population of 10 million, Mirebalais is a small city with 90% unemployment. Around the time the epidemic began, there were only unpaved roads and the city was largely isolated from the rest of the country. This may explain why it took some timeto organize a response to the epidemic that came from this area, since it was not exactly an area to focus on. The progression of the epidemic On October 18, a Cuban medical brigade reported a sharp increase in acute watery diarrhea infections to the Haitian health authorities , for a total of 61 cases treated in the previous week in Mirebalais. On the same day the situation worsened with 28 new hospitalizations and 2 deaths. At the same time, the water systems of the city of Mirebalais were being repaired and the inhabitants were using the river as a source of water. It should also be noted that the prisoners drank water from the river downstream from Meille. In this prison, 34 cases and 4 deaths have been recorded without any other probable cause being discovered. On October 31, health deficiencies at the UN camp were resolved and the incidence in Mirebalais began to decline. Before October 19, no cases had been recorded in the lower Artibonite area. On the same day 3 children died of acute watery diarrhea and by 31 October 3020 cases and 129 deaths had been recorded. Although not directly linked to the Artibonite River, the epidemic also spread to the capital Port-au-Prince. Here the epidemic had two phases. As cases arrived from the Artibonite Delta in Port-au-Prince from October 22 to November 5, the incidence was rather moderate with only 76 daily cases on average. Then there were explosions, which occurred mainly in Cité-Soleil, a poor area of ​​the city. Despite this, the incidence was significantly lower than in other areas of Haiti [(0.51% through November 30, compared to 2.67% in Artibonite, 1.86% in Central, 1.4 % in the North-West, and 0.89% in the North) as well as the mortality rate related to cholera (0.8 deaths/10,000 people in Port-au-Prince, compared to 5.6/10,000 in Artibonite, 2/ 10,000 in the Centre, 3. 2/10,000 in the North and 2. 8/10,000 in the North-West)]. Initially the epidemic was spreading rapidly with over 285,000 cases and 4865 deaths by March 2011. By March 2012 a total of 531,000 cases and 7,050 deaths had occurred since the start of the epidemic, affecting over 5% of the population. In 2012, 112,076 cases and 894 deaths were recorded. In the following years there was a progressive decline. In 2013 there were 58,809 cases and 593 deaths. In 2014, from January 1st to November 30th, 21,916 cases and 244 deaths were recorded, a reduction of 66% compared to the same period the previous year. In the period January-December 2015, there were 36,045 cases (24% increase) and 322 deaths (5% increase). In 2016 there were a total of 41,421 cases and 446 deaths, an increase from the previous year related to rain? There was a sharp decline in 2017 to 13,681 cases and 159 deaths. From the beginning of the epidemic until May 2018, the overall cases amounted to 819,000 and the overall death toll to 9769. Cholera crisis still unresolved in Haiti. The organization initially denied any wrongdoing. It published its own report on the epidemic, which concluded that “the introduction of this strain of cholera as a result of environmental contamination with feces could not be the source” and “the cholera epidemic in Haiti was caused by confluence of circumstances described, and was not the fault or deliberate action of a group or individual.” Furthermore, the report states that the actual origin is no longer relevant in the context of epidemic control. However, after more than 5 years of denying any responsibility or involvement, UN Secretary-General Ban Ki-moon publicly apologized in August 2016 for the UN's role in the outbreak. While admitting no legal responsibility for the epidemic, the UN announced a $400 million fund to help Haitians”.