2. Maurice Sanders, MD Walden University February 5, 2012 Aspect of Environmental Health: Local to Global PUBH 6165-5 Instructor: Dr. Eve Clute Winter Quarter 12/05/11-02/26/12 Educating U.S. Public Health Professionals about Cholera in Haiti

3. Introduction  Death toll in three months was 3,800 in October 2010  More than 190,00 were infected in Haiti  Training and compliance critical in treating and preventing the spread of cholera in Haiti Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

4.  Cholera is an intestinal infection caused by Vibrio cholerae  Vibrio cholerae has different strains and more than 70 serogroups  Strains that cause cholera have the strains that are both O1 and toxigenic. Etiology of Cholera.

5. Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.. Mode of Transmission of Cholera  Vibrio cholerae is transmitted through water and food.  The source is usually the feces of cholera patients  V. cholerae has an environmental reservoir in warm coastal waters  Person-to-person spread by shaking hands, or by touching or taking care of a patient has not been shown to occur

6. Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.. Clinical Presentation of Cholera  The incubation period is 1-3 days  V. cholerae produces cholera toxin in the intestine  V. cholerae causes secretory diarrhea, dehydration, and vomitus  Can cause shock, muscle cramps, arrhythmias, and a change in mental status due to a profound loss of fluid and electrolytes.  75% affected are asymptomatic  Most of the 25% that are symptomatic have a mild illness  5% will require hospitalization and 2% will have a severe illness

7. Assessment of Fluid Status  Adequate Hydration  Moderate Dehydration  Severe Dehydration Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

8. UNICEF (2004). New Formulation of Oral Rehydration Solution with Reduced Osmolality. Updated April 2004. Accessed January 19, 2012.. Treatment of Cholera with Rehydration Therapy  Oral rehydration solution or sachet (UNICEF, 2004)  Bottled water without an unbroken seal, boiled water, or water that has been treated with chlorine  Intravenous rehydration with Ringer’s Lactate Solution or Normal Saline

9. Oral Antimicrobial Therapy for Cholera  Doxycycline  Azithromycin  Tetracycline  Erythromycin Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

10. . Complications from Rehydration Therapy for Cholera  Hypoglycemia  Acute pulmonary edema  Renal failure  Hypokalemia Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

11. Laboratory Diagnosis of Cholera  Specimen collection  Organism isolation by microbiology laboratory Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

12. Surveillance of Cholera in Haiti  Detect outbreaks early  Estimate how many people become sick and die  Know when and where the disease occurs  See if the disease is spreading and where  Estimate where supplies and staff are needed  Evaluate whether control measures are successful Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

13. Guidelines for an Area Affected by Cholera  The Ministry of Health and Population in Haiti must be notified of any patient with acute watery diarrhea and severe dehydration or death from acute watery diarrhea  For hospitals equipped with rapid diagnostic test (RDT), RDT is performed on 10 specimens  If 3 out of 10 samples are positive for cholera, the samples are sent to the National Public Health Laboratory for information and identification for each sample  If V. cholera O1 is isolated from one or more patients, the location is considered affected by cholera Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

14. Data Collection and Reporting  Suspected cholera cases and deaths are recorded  Categories of cases were divided in hospital cases, hospital deaths, and community deaths  Cases are divided in persons under 5 years and persons 5 years and older  Cases were documented with patient’s demographics, symptoms, date of admission, treatment, and outcome  This information is sent to the departmental epidemiologist Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

15. Prevention of Cholera in the Household  Drink and use safe water  Wash hands with soap and safe water  Use latrines or bury feces  Do not defecate in any body of water  Cook food thoroughly  Peel fruits and vegetables  Clean up safely  If diarrhea develops, drink ORS and go to a clinic Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

16. Oral Vaccines for Health Professionals and Others Traveling to Haiti  Two doses need to be administered 7-14 days apart  Three doses are needed in children 2-5 years old  67-85% immunity is achieved one week after the second dose  Duration of protection is approximately 2 years  Does NOT decrease the severity of cholera if contracted  Vaccination is NOT recommended in family members in Haiti since the cholera vaccine takes 2-3 weeks to take effect Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf.

17. Haiti’s Future after the Earthquake Improving Haiti’s water and sanitation infrastructure is critical to achieving large health gains and reducing the opportunity for cholera to spread. To date, the United States Government has spent over $75 million on improved water, sanitation, and hygiene facilities, establishing and running cholera treatment centers, training Haitian health care workers in preventing, diagnosing and treating cholera, and providing treatment and prevention materials. We must continue to invest in cholera prevention infrastructure and activities, while also maintaining relationships with other agencies and partners to reestablish and strengthen public health systems in Haiti. Centers for Disease Control and Prevention (CDC). (2011). Cholera in Haiti: One Year Later. Last updated October 25, 2011. Accessed January 22, 2012. http://www.cdc.gov/haiticholera/haiti_cholera.htm.

18. References Centers for Disease Control and Prevention (CDC). (2011). Cholera in Haiti: One Year Later. Last updated October 25, 2011. Accessed January 22, 2012. http://www.cdc.gov/haiticholera/haiti_cholera.htm. Centers for Disease Control and Prevention (CDC). (2011). Haiti Cholera Training Manual: A Full Course for Healthcare Providers. Last updated January 24, 2011. Assessed January 22, 2012. http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf UNICEF (2004). New Formulation of Oral Rehydration Solution with Reduced Osmolality. Updated April 2004. Accessed January 19, 2012.

19. Contact Info: Maurice Sanders, MD maurice.sanders@waldenu.edu Educating U.S. Public Health Professionals about Cholera in Haiti