The Challenges of Cholera Surveillance in Haiti Post Epidemic
Why is cholera back in Haiti? by Dr. Keddy Moise
By: Dr. Keddy Moise
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The lesson is that a public health system is never independent of the general functioning of a country. Especially a surveillance system.
Photo credit: Etant Dupain
On a warm February morning earlier this year, I was thrilled to learn some fantastic news about Haiti. After years of struggle, the country had come to eliminate cholera. This diarrheic disease acquired principally by ingesting food or water contaminated with the vibrio cholerae bacteria has had a tragic impact on the island. In 2010, a few months after a deadly earthquake killed hundreds of thousands, UN peacekeeping troops stationed along the Artibonite river in central Haiti started the local epidemic. The epidemic had regional consequences as the El Tor strain the UN soldiers imported into the country from South Asia was linked to outbreaks in other countries, including the Dominican Republic, Cuba, and even Mexico.
What followed was a decade of astounding physical and psychological trauma. Nevertheless, with incredible willpower and critical partnerships with international agencies, 12 years later, the Haitian Ministry of Health closed this chapter with relative satisfaction. Hence the announcement and celebrations in February. Unfortunately, the joy of this accomplishment was short-lived. A mixture of misfortune in conjunction with an unstable political situation, major economic setbacks, and the deadly COVID-19 pandemic are likely responsible for the reversal of this significant achievement.
In October 2022, a resurgence of the cholera outbreak was reported in Haiti. There are conflicting reports about the exact number of people affected by this resurgence, but by October 19th, the Ministry of Health had confirmed 23 deaths. The most alarming outbreak is happening now in the largest prison in the country. Questions remain unanswered about why this dreaded specter has reappeared. The National Cholera Surveillance System, established by Haiti’s Ministry of Public Health with support from the CDC, is the focus of most of these interrogations. The surveillance system was and is still instrumental in the fight to eliminate cholera. Despite its efficiency at the start of the epidemic, it is hard to say whether such a system was consistently implemented in Haiti after cases went down.