Toward Cholera Elimination in Haiti

Since cholera was inadvertently imported into Haiti in 2010, the country has reported a total of 813,972 suspected cases and 9,614 deaths (1). To control cholera in the country, a nationwide rapid response strategy was implemented in July 2013, which aimed to detect local outbreaks and send rapid response teams door-to-door to visit cases and their nearby neighbors to carry out case-area targeted interventions (CATIs) (2).

From July 2013 to December 2019, UNICEF recorded 48,710 CATIs implemented across 139 communes, of which approximately 71% of interventions involved a complete package: house decontamination by chlorine spraying, health education about cholera, distribution of soap and chlorine tablets, and distribution of antibiotic prophylaxis to close contacts of cholera cases (3).

Since 2016, suspected cholera case numbers in Haiti have dropped every year (1). The last cholera case observed in the country was reported in February 2019, in L’Estère, Artibonite Department (3). Since this time, each of the 5,223 stool samples have tested negative for Vibrio cholerae O1 (3).

Based on the analysis of cholera control interventions carried out in Haiti since 2013, CATIs conducted by rapid response teams played a key role in stopping disease transmission. The critical issue is now whether Vibrio cholerae O1 has settled in the environment in Haiti and could lead to the reemergence of cholera outbreaks. However, strains have only sporadically been isolated in surface waters in Haiti and usually concomitant to local cholera cases, likely due to fecal contamination. Furthermore, the last epidemic strain of Vibrio cholerae O1 found in surface waters was isolated in November 2015. Cholera recurrence after lull periods may likely originate from low-grade and underreported interhuman transmission rather than from environmental reservoirs (3).

If the current trend continues, Haiti will officially achieve cholera elimination in 2022. This success should foster further investments in water, sanitation, and hygiene infrastructure, which will protect Haiti against possible future cholera epidemics as well as other waterborne diseases.