Cholera Haiti - Risk assessment

After more than three years with no cases of cholera reported in Haiti, on 2 October 2022, the national authorities reported two confirmed cases of Vibrio cholerae O1 in the greater Port-au-Prince area. Clusters of suspected cases and deaths are under investigation in various communes of Ouest Department. In epidemiological week (EW) 39 of 2022 (ending 2 October), healthcare facilities reported an increase in cases of severe acute diarrhea among hospitalized patients, including both children and adults. As of 2 October, more than 20 suspected cases of cholera, including seven fatalities, were detected by healthcare personnel.

Haiti has been experiencing a security crisis due to violence from armed gangs in Port-au-Prince and other cities which has exacerbated the humanitarian crisis in the country. The current vulnerabilities include malnutrition, internally displaced persons (IDPs), non-functional structures, limited or lack of access to health services, fuel shortages, limited access to safe water and poor sanitation and hygiene facilities, amongst others. These factors would have an impact on the dynamics of the cholera resurgence and on the severity of the disease in patients with acute diarrhea. Access to the affected areas is difficult and therefore, timely assessment of the epidemiological situation and provision of health care for cases is complex.

The security crisis has also impacted the capacity of the public health system and the international organizations to respond effectively. Haiti experienced the first outbreak of cholera ever confirmed in the country beginning in October 2010, affecting over 820,000 people and killing 9,792 persons until January 2019 (between 2010 and 2016, between 27,000 and 340,000 cases of cholera were reported annually in Haiti, with a case fatality ratio (CFR) between 0.8-2.2%). Based on this, the national risk is assessed as very high. In the Region of the Americas, since 2010, confirmed cases of cholera have predominantly been reported from Haiti, followed by the Dominican Republic, Cuba, and Mexico. Sporadic imported cases have also been reported in other countries in the Region. While there is greater capacity in other countries to detect and control outbreaks of cholera, concurrent emergencies in the region have stretched out and weakened these capacities. Based on this, the regional risk is assessed as moderate.