December 22, 2016 -- GAINESVILLE, Fla. — Hurricane Matthew’s sweep through southern Haiti last October killed hundreds; left nearly 200,000 without homes; and flooded rivers, latrines and wells, contaminating drinking water and prompting reports of increasing cholera cases in the hardest hit areas of the nation.
“It hasn’t gone away,” said Dr. J. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute (EPI). “Cholera is still in Haiti, with the UN acknowledging responsibility for helping put it there initially after the devastating 2010 earthquake.”
Morris and Ira Longini, Ph.D., professor of biostatistics in the College of Public Health and Health Professions and the College of Medicine, made up part of an international committee convened to recommend strategies to limit the risk of major new cholera epidemics following the devastation caused by the category four hurricane.
Since the meeting, one million doses of oral cholera vaccine have reached the country, bound for its southern peninsula, which bore the brunt of the storm.
The committee, named the “Special Consulting Group to the Minister of Health and Population of Haiti, Port-au-Prince,” was called together by the National Institutes of Health (NIH), meeting in Washington D.C. on October 13 and 14 to advise Haiti’s Minister of Health on ways to stop the spread of the disease. A report summarizing the meeting was published December 7 in The New England Journal of Medicine.
The publication came less than a week after UN Secretary General Ban Ki-moon admitted that UN personnel in Haiti were the “most likely source” of the nation’s 2010 cholera epidemic.
In addition to the Special Consulting Group’s recommendation of immediate vaccination, it also suggested long-term approaches for eliminating cholera in Haiti. The NEJM “Perspective,” titled “Eliminating Cholera Transmission in Haiti,” said, “[Comprehensive] national Oral Cholera Vaccine coverage combined with targeted water, sanitation, and hygiene interventions could eliminate the transmission of cholera in Haiti over the next 3 to 5 years.”
The Emerging Pathogens Institute remains well-positioned to help address this challenge, according to Morris. Within the last six months, the institute has received nearly $7 million from the NIH to further enhance our understanding of cholera transmission in Haiti.
“We’ll be looking specifically at how cholera is transmitted and what the risk factors are for acquiring it,” Morris said. “We will also be working to better understand environmental reservoirs and other factors that may have played a role in the persistence of the disease in Haiti since the initial 2010 epidemic.”
The funding supports two of EPI’s cholera research projects in Haiti: “Cholera Transmission and Evolution in Port-au-Prince, Haiti” is focusing on cholera transmission dynamics in an urban setting, working in collaboration with GHESKIO in Port-au-Prince. “Cholera persistence, transmission, and clinical illness in Haiti” explores transmission in rural settings. Both projects aim to shed light on the risk factors for transmission and the evolution of the toxigenic Vibrio cholerae O1 strain, which is behind the cholera epidemics in Haiti. which has caused the Haitian cholera epidemics.
Longini believes a measured vaccination program coupled with infrastructure improvements will protect Haitians from the disease.
“It would make sense to roll out cholera vaccination to high-risk areas first in the coming years,” he said, “with evaluation of effectiveness comparing those areas that are vaccinated to those that have not yet received vaccine. This ‘stepped wedge’ strategy would work well for Haiti. At the end of the process, all the high-risk areas would be vaccinated, and we would have some measures of the effectiveness of the campaign.”
Morris emphasized EPI’s commitment to curtailing transmission in Haiti.
“We’re doing the underlying research to see what is working and to make sure we optimize our approach,” Morris said. The researchers, he added are united in the goal of ending cholera transmission in Haiti.
“In one of the great public health tragedies of our time, cholera was introduced into Haiti in the aftermath of the 2010 earthquake,” he said. “With expertise and resources from multiple partners, including the UN, we are hopeful that we will see the day when cholera is no longer being transmitted within Haiti.