Acute Watery Diarrhea and Cholera: Haiti Pre-decision Brief for Public Health Action

This website is archived for historical purposes and is no longer being maintained or updated.

Key Recommendations

The most effective measures to prevent transmission of acute watery diarrhea are provision of safe (chlorinated) water; safe water storage; appropriate disposal of feces; and handwashing with soap after caring for patients, toileting, cleaning other persons after toileting, or before preparing, serving, or eating food. Because onset of the rainy season is likely to enhance transmission of acute watery diarrhea, these measures should be strengthened immediately, particularly in settlements for displaced persons.
Outbreaks of acute watery diarrhea are likely to occur. Surveillance systems should be able to rapidly detect an increase in reported cases of acute watery diarrhea. Such an increase should trigger efforts to determine the source of transmission, ensure implementation of control measures in the affected area, and determine the microbial etiology.
Dehydration is the critical clinical issue. Adequate supplies for oral and intravenous rehydration and training in clinical management of dehydration need to be in place throughout the affected regions before an outbreak occurs.
Cholera is extremely unlikely to occur. However, if adults present with acute watery diarrhea and severe dehydration, cholera testing should be performed.

National surveillance data for acute watery diarrhea in Haiti were not previously available. Studies in Haiti have suggested that diarrhea is a common illness (approximately 4–6 episodes of diarrhea per child per year) and cause of death (5–16% of deaths) among children ^1-4. Estimated diarrhea incidence in Haiti is several times higher than the expected annual incidence among young children in industrialized countries.
Epidemic cholera has not been reported from Haiti before.
The National Public Health Laboratory (LNSP) was not routinely performing diagnostic tests for watery diarrhea before the earthquake.

Bowen A, Jain S. Epi-Aid #2005-009 Trip Report: Assessment of Post-Hurricane Jeanne Disease Surveillance and Emergency PuR Distribution-Gonaives, Haiti, 2004.
Cayemittes M, Placide MF, Mariko S, Barrère B, Sévère B, Alexandre C. Enquête Mortalité, Morbidité et Utilisation des Services, Haïti, 2005-2006. Calverton, Maryland, USA, Ministère de la Santé Publique et de la Population, Institut Haïtien de l’Enfance et Macro International Inc. 2007.
WHO. Haiti: Mortality Country Fact Sheet 2006.
AHO. Haiti: Health situation analysis and trends summary. 2010.
Ligon BL. Infectious diseases that pose specific challenges after natural disasters: a review. Semin Pediatr Infect Dis. 2006;17(1):36-45.
Mach O, Lu L, Creek T, Bowen A, Arvelo W, Smit M, Masunge J, Brennan M, Handzel T. Population-based study of a widespread outbreak of diarrhea associated with increased mortality and malnutrition in Botswana, January-March, 2006. Am J Trop Med Hyg. 2009;80(5):812-8.
Watson JT, Gayer M, Connolly MA. Epidemics after natural disasters . Emerg Infect Dis. 2007;13(1): 1-5.
Yee EL, Palacio H, Atmar RL, Shah U, Kilborn C, Faul M, Gavagan TE, Feigin RD, Versalovic J, Neill FH, Panlilio AL, Miller M, Spahr J, Glass RI. Widespread outbreak of norovirus gastroenteritis among evacuees of Hurricane Katrina living in a "megashelter" in Houston, Texas: lessons learned for prevention. Clin Infect Dis. 2007;44(8):1032-9.