No new cholera cases have been reported in Haiti for just over two years. The last confirmed case was identified in Artibonite Department in late-January 2019 (1). With this news, the country is one year away from declaring cholera elimination. To officially proclaim elimination of the disease, a country must remain cholera-free for at least three consecutive years, while maintaining an effective surveillance system able to detect and confirm any cholera cases should they occur (2).
The cholera epidemic in Haiti was devastating, with 813,252 suspected cases and 9,611 deaths from 2010 to early-2019 (3). The epidemic was finally controlled thanks to the implementation of the Haitian National Cholera Elimination Plan 2013–2022. The plan included improvements in water and sanitation infrastructure, enhanced disease surveillance for early detection of cholera cases, and establishment of rapid response activities to quickly control localized outbreaks, including case-area targeted water, sanitation and hygiene interventions (1,4,5). A nationwide alert-response strategy was also established to monitor the epidemic and response efforts on a weekly basis. (5). As case numbers receded, it was critical to not let the guard down and effectively stop disease transmission during this “window of opportunity”. The same lesson could be applied to the ongoing COVID-19 pandemic.
The experience in Haiti clearly demonstrates that cholera elimination may be possible in other countries deemed cholera-endemic, if steps are taken to improve disease surveillance, outbreak response efforts and water and sanitation infrastructure.
1. PAHO/WHO. Haiti reaches one-year free of Cholera [Internet]. 2020. Available here.
2. Global Task Force on Cholera Control. Ending Cholera. A Global Roadmap to 2030. World Health Organization (WHO); 2017 Oct.
3. WHO. Cholera: The Weekly Epidemiological Record [Internet]. Annual cholera cases and deaths per country. Available here.
4. Republic of Haiti, Ministry of Public Health and Population, National Directorate for Water Supply and Sanitation. National Plan for the Elimination of Cholera in Haiti 2013–2022. [Internet]. 2013. Available here.
5. Rebaudet S, Bulit G, Gaudart J, Michel E, Gazin P, Evers C, et al. The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study. PLoS Negl Trop Dis. 2019;13(4):e0007263.