Table of contentsOverviewResultsDiscussionEpidemiologyClinical presentationOrigins of the Haiti epidemicThe progression of the epidemicAn admission of guilt?OverviewCholera is an acute diarrheal disease caused by the bacterium Vibrio Cholerae, transmitted by ingestion of contaminated water or food. It is estimated that globally, it causes between 1.3 and 4 million cases and between 21,000 and 143,000 deaths each year. In 2016, 54% of cases were reported in Africa, 13% in Asia, and 32% in Hispaniola (Dominican Republic and Haiti). Most infected people will have mild or even asymptomatic illness. These cases are easily treated with an oral rehydration solution. Serious cases occur in those who become severely dehydrated and are at risk of shock. In such cases, rapid volumetric resuscitation is necessary and antibiotics should be administered to reduce the duration of diarrhea, reduce the volume of rehydration needed, and decrease the amount of V. cholerae excreted in the stool. Say no to plagiarism. Get a tailor-made essay on “Why violent video games should not be banned”? Get the original essay The cholera epidemic in Haiti emerged in October 2010, following the January 2010 earthquake. The effect Natural disasters on the country's already strained health and sanitation infrastructure, added to the influx of foreign aid workers from regions where cholera outbreaks are endemic, are seen as significant factors in its emergence in Haiti .Results Data shows that since the emergence of cholera, Cholera in Haiti in October 2010, there have been a total of 819,000 suspected cases and 9,769 total deaths as of May 2018. This makes it the largest modern outbreak of cholera , until it was overtaken by the Yemen epidemic in 2016-2017. , although it is still the deadliest modern epidemic. The incidence in Haiti has declined steadily in recent years, but although national and WHO measures are in place, eradication has not yet been achieved. Studies examining the genetic fingerprinting and genotyping of V. Cholera isolated in Haiti, combined with the correlation between the arrival of a Nepalese UN battalion with the time and location of the outbreak, conclude that the strain was probably imported and disseminated in the country. environment by the mentioned UN contingent. This was denied by the UN for several years, until it issued an apology in 2016. DiscussionEpidemiological studies, local observations, and genetic studies of cholera strains all point to the most likely cause of the The outbreak is the introduction of the pathogen into the environment by the Nepalese UN battalion. Interestingly, the UN denied this fact for over five years and produced its own report on the epidemic and its origins. Having not gone so far as to gather information on the credentials, independence or objectivity of the researchers behind this report, any statement regarding the basis of their approach is impossible. However, it appears that his conclusions lack validity, given that virtually all other research on the subject has reached a different conclusion. The denial and the organization's response have been criticized, and perhaps rightly so given that the UN has a history of denial in a similar situation, during the Kosovo conflict. Vibrio cholera is a comma-shaped Gram-negative rod. They are highly mobile organisms that exist naturally in aquatic environments. It is a diverse species that includes pathogenic and non-pathogenic variants, onlyStrains producing cholera toxin are capable of causing cholera. The classification is done according to the structure of the O antigen of its lipopolysaccharide. More than 200 serogroups have been reported, but only serogroups O1 and O139 have been associated with large-scale outbreaks. V. cholera O1 is the cause of the current global pandemic and can be divided into two biotypes, El Tor and classic. For infection to occur, V. cholerae must survive the acidic environment of the stomach, colonize the small intestine, and produce cholera toxin which causes massive fluid secretion in the small intestine. EpidemiologyCholera is believed to be largely underestimated, but there are estimated to be between 1.3 and 4 million cases and between 21,000 and 143,000 deaths. assigned to V. Cholerae each year. It mainly affects regions with limited resources and inadequate access to drinking water sources. In 2016, 54% of cases were reported in Africa, 13% in Asia, and 32% in Hispaniola (Dominican Republic and Haiti). Cholera has been endemic for approx. 50 countries, mainly in Africa and Asia. Outbreaks have occurred throughout Africa, Asia, the Middle East, and the Americas, and may be particularly widespread. As an example, the strain seen in the Haiti outbreak was later associated with outbreaks in the neighboring countries of the Dominican Republic, Cuba, and Mexico. Infection and transmission patterns typically differ between historically endemic or epidemic areas. Areas of high endemicity generally have a seasonal distribution with peaks before and after rainy seasons, and a higher incidence in children under five years of age, reflecting a lack of immunity in children. In areas of high epidemics, immunity is more limited in the general population, which is reflected in a more similar incidence in adults and children. However, in endemic regions, epidemics can overlap. One example is Yemen's devastated infrastructure after years of war, which led to two successive outbreaks in 2016 and 2017. The second of these outbreaks led to the worst cholera outbreak to date, with around 100,000 people affected. 500,000 cases and 2,000 associated deaths in just four months. Transmission of V. cholera occurs primarily through ingestion of contaminated food or water. Water is an important reservoir in endemic regions and, as bacteria can live on plankton, water filtration is important to reduce incidence. It is believed that in epidemics, person-to-person transmission of hyperinfectious V. cholera is essential for its rapid spread. Clinical presentation Cholera is a disease that can be extremely virulent. In most cases, the presentation is mild or asymptomatic. Its incubation period is generally one to two days. The classic presentation consists of bulky, watery (rice water) stools. It may have a typical fishy smell. The diarrhea is usually painless without tenesmus and can reach a rate of up to 1 liter per hour in severe cases. Vomiting and abdominal pain may also occur, but fever is rare. May be indistinguishable from other types of gastroenteritis. In cases of severe illness, rapid hypovolemia and loss of electrolytes is a feared outcome, and in cases of death, a median time of approximately 12 hours from the onset of symptoms to death has been reported. Approximately 5% of patients develop a serious course of the disease. In mild to moderate cases, oral rehydration solution (ORS) is the gold standard and can successfully treat approximately 80% of cholera cases. In case of mild illness, the volumeadministered must be equal to the estimated volume loss. For moderate illness, adults should receive between 2,200 and 4,000 ml in the first 4 hours. In the event of serious illness, rehydration takes place in two phases: IV rehydration and ORS. IV rehydration is carried out using Ringer lactate at a rate of 50 ml per kg for the first hour, then reduced. ORS should be started as soon as the patient is able to drink. Antibiotics are indicated in severe cases, to decrease the duration of vomiting, the amount of rehydration needed, and to reduce the amount of V. cholera excreted in the stool. Origins of the Haiti epidemic On January 12, 2010, the earthquake and humanitarian disaster occurred causing between 100,000 and 316,000 casualties and devastating public infrastructure such as sewers and drinking water, which were already in short supply before the natural disaster. On October 19, reports of an unusually high incidence of patients with diarrhea and dehydration were addressed by the Haitian Ministry of Public Health and Population (MSPP). Vibrio cholera of serogroup O1, serotype Ogawa and biotype El Tor is isolated from samples. The cases were first reported in Arbonite and central departments, but cases were occurring in 7 out of 10 departments and the capital Port-au-Prince as of mid-November. At that time, 16,111 people were hospitalized with acute watery diarrhea and 992 deaths from cholera were reported. An effort to identify the origins of the outbreak was quickly launched, as there had been no cholera outbreak in Haiti in the previous century, although isolated outbreaks in other countries in the Americas. Initially, the earthquake was thought to be the cause of the outbreak, but rumors eventually surfaced that a Nepalese UN contingent had imported the outbreak. This contingent arrived from October 8 and underwent a medical examination before its departure. However, stool samples were only taken when clinically indicated and it is noted in the UN report that there were no cases of diarrhea before or during the contingent's tenure in Haiti. The UN camp in question was located near the village of Meille, along a stream which flows into the Artibonite. Cases of illness began to appear downstream in the Arbonite River delta, probably fascinated by the fact that this river is known to be used for bathing and as drinking water for the villages along its course, in addition agricultural irrigation. The UN accused an independent contractor of improperly disposing of sewage, but it is also worth mentioning that Haitian epidemiologists observed several sanitary deficiencies in the UN camp, including a pipe discharging sewage into the river . The first case of the Haitian cholera outbreak is believed to have been a 28-year-old man from the commune of Mirebalais. He reportedly suffered from an untreated psychiatric illness for years and, although he had access to clean water at home, he was reportedly frequently seen walking naked around the city during the day, bathing and drinking in the Latem River. This river is fed by the Meye River, considered the source of the cholera epidemic. On October 12, 2010, this man developed profuse watery diarrhea and attempted to be treated conservatively with oral bloodletting by his family at his home. They did not seek medical attention and the man died less than 24 hours after symptoms appeared. Two people preparing this man for his vigil also reportedly developed watery diarrhea. The first hospitalized case of cholera occurred inMirebalais on October 17, 2010. Compared to the capital Port-au-Prince, with 3 million inhabitants out of a total population of 10 million inhabitants, Mirebalais is a small city with 90% unemployment. At the start of the outbreak, there were only unpaved roads and the city was largely isolated from the rest of the country. This may explain why it took time to mount a response to the outbreak that originated in this area, as it was not exactly a targeted area. The progression of the epidemic On October 18, a Cuban medical brigade reported a sharp increase in acute watery diarrhea to Haitian health authorities, with a total of 61 cases treated the previous week in Mirebalais. That same day, the situation worsened with 28 new admissions and 2 deaths. At the same time, the water systems in the town of Mirebalais were being repaired and residents were using the river as a water source. Also note that the detainees drank water from the river downstream of Meille. 34 cases and 4 deaths have been recorded at this prison with no other probable cause discovered. On October 31, the health deficiencies in the UN camp were resolved and the incidence in Mirebalais began to decrease. Prior to October 19, no cases had been recorded in the lower Artibonite camp. That same day, 3 children died from acute watery diarrhea and as of October 31, there were 3,020 cases and 129 deaths recorded. Although not directly linked to the Artibonite River, the epidemic has also spread to the capital Port-au-Prince. Here, the epidemic went through two phases. As cases arrived from the Artibonite Delta to Port-au-Prince from October 22 to November 5, the incidence was quite moderate with only 76 daily cases on average. Then, there was an explosion of cases occurring mainly in Cité-Soleil, a slum in the city. Despite this, the incidence was considerably lower than in other regions of Haiti [(0.51% until November 30, compared to 2.67% in Artibonite, 1.86% in the Center, 1 .4% in the North-West and 0.89% in the North) and also the mortality rate linked to cholera (0.8 deaths/10,000 people in Port-au-Prince, compared to 5.6/10,000 in the 'Artibonite, 2/10,000 in the Artibonite). Center, 3.2/10,000 in the North and 2.8/10,000 in the North-West). Initially, the epidemic was spreading rapidly with more than 285,000 cases and 4,865 deaths as of March 2011. As of March 2012 there have been a total of 531,000 cases and 7,050 deaths since the outbreak began, leaving more than 5 % of population affected. There were 112,076 cases and 894 deaths in 2012. There was a gradual decline over the following years. In 2013, there were 58,809 cases and 593 deaths. In 2014, from January 1 to November 30, there were 21,916 cases and 244 deaths, a 66% reduction compared to the same period the previous year. From January to December 2015, there were 36,045 cases (24% increase) and 322 deaths (5% increase). In 2016, there were a total of 41,421 cases and 446 deaths, an increase from the previous year linked to rain? There was a sharp decline in 2017, to 13,681 cases and 159 deaths. Since the start of the epidemic until May 2018, the total number of cumulative cases rose to 819,000 and the cumulative number of deaths to 9,769. An admission of guilt? Although facing increasing pressure and growing evidence to the contrary, the UN has publicly downplayed its role in the still unresolved Haiti cholera crisis. Initially, the organization denied any wrongdoing. He published his own report on the epidemic, which concluded that "the introduction of this strain of cholera following contamination of the environment by fecal matter could not be the source" and that "the The cholera epidemic in Haiti was caused by the confluence of the circumstances described: and it was not the.”.