Online Program

Facility-based cholera surveillance in central Haiti

Tuesday, November 5, 2013 : 3:35 p.m. - 3:55 p.m.

Louise C Ivers, MD MPH, Partners In Health, Boston, MA
Lisa Hirschhorn, MD MPH, Department of Global Health and Social Medicine, Harvard Medical School, Partners In Health, Boston, MA
Matthew Peckarsky, MS, Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Brittany Eddy, MPH, Health Information Systems, University Hospital, Mirebalais, Haiti, Boston, MA
Daniel Chiu, BS, Monitoring, Evaluation & Quality, Partners In Health, Boston, MA
Ralph Ternier, MD, MGSS, Zanmi Lasante, Haiti, Boston, MA
Catherine Oswald, MPH, Zanmi Lasante, Cange, Haiti
Kenia Vissieres, MD, Zanmi Lasante, Haiti, Boston, MA
Peterson Abnis Faure, Zanmi Lasante, Haiti, Boston, MA
Waleska Wesh, Zanmi Lasante, Haiti, Boston, MA
Jean-Gregory Jerome, MD MPH, Monitoring, Evaluation & Quality, Zanmi Lasante, Haiti, Boston, MA
Background: Zanmi Lasante (ZL)/Partners In Health (PIH), has delivered community-based primary healthcare in central Haiti since 1986. Building on that model, ZL responded swiftly to the 2010 cholera epidemic, establishing Cholera Treatment Centers (CTCs) and community-based education and prevention efforts in support of the Haitian Ministry of Health (MOH). We report trends of the epidemic in the Centre and Artibonite Departments of Haiti through May 2013. Methods: Cases of cholera were diagnosed using clinical case definition in patients presenting with acute watery diarrhea. Data were collected using CTC case and death registers across 10 supported CTCs in central Haiti. ZL staff used data dashboards to monitor site case volume, case-fatality rate (CFR) and attack rates. Results: Between October 2010 and May 2013, 102,255 cholera cases were treated at ZL/MOH sites, representing almost 1/6 of all cases reported nationally. 1,129 cholera-related deaths were registered (cumulative CFR of 1.1%). Data from surveillance activities were fed back to implementation teams to facilitate targeted community-level interventions. In the past 12 months, a drop in CFR (0.6%) and new cases (11,196 from 6/2012-5/2013) was seen. Significant geographic variation in remaining burden exists, with half of the recent cholera cases seen at 2 of the 10 CTCs. Discussion: Cholera cases continue to cause morbidity and mortality in Haiti. However, at PIH/ZL sites, CFR has decreased over the duration of the cholera epidemic. Our data demonstrate that very low CFRs are achievable in rural Haiti.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related public policy

Learning Objectives:
Describe the trends in Haiti’s cholera epidemic since the onset of the disease in 2010 Demonstrate that disease control and low case-fatality rates are possible in rural Haiti Explain the operational structure of an effective cholera treatment and prevention program that relies on community health workers in resource limited settings

Keyword(s): Data/Surveillance, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of Community Care and Support for Zanmi Lasante/Partners in Health, Haiti. I am a medical doctor and lead strategy and decision-making for implementation of the cholera program and other community-based clinical services in Central Haiti.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.