Preventing maritime transfer of toxigenic Vibrio cholerae.

Organisms, including Vibrio cholerae, can be transferred between harbors in the ballast water of ships. Zones in the Caribbean region where distance from shore and water depth meet International Maritime Organization guidelines for ballast water exchange are extremely limited. Use of ballast water treatment systems could mitigate the risk for organism transfer.

Lessons learned during public health response to cholera epidemic in Haiti and the Dominican Republic.

After epidemic cholera emerged in Haiti in October 2010, the disease spread rapidly in a country devastated by an earthquake earlier that year, in a population with a high proportion of infant deaths, poor nutrition, and frequent infectious diseases such as HIV infection, tuberculosis, and malaria. Many nations, multinational agencies, and nongovernmental organizations rapidly mobilized to assist Haiti. The US government provided emergency response through the Office of Foreign Disaster Assistance of the US Agency for International Development and the Centers for Disease Control and Prevention. This report summarizes the participation by the Centers and its partners. The efforts needed to reduce the spread of the epidemic and prevent deaths highlight the need for safe drinking water and basic medical care in such difficult circumstances and the need for rebuilding water, sanitation, and public health systems to prevent future epidemics.

Rapid development and use of a nationwide training program for cholera management, Haiti, 2010.

When epidemic cholera appeared in Haiti in October 2010, the medical community there had virtually no experience with the disease and needed rapid training as the epidemic spread throughout the country. We developed a set of training materials specific to Haiti and launched a cascading training effort. Through a training-of-trainers course in November 14-15, 2010, and department-level training conducted in French and Creole over the following 3 weeks, 521 persons were trained and equipped to further train staff at the institutions where they worked. After the training, the hospitalized cholera patients' case-fatality rate dropped from 4% to <2% by mid-December and was <1% by January 2011. Continuing in-service training, monitoring and evaluation, and integration of cholera management into regular clinical training will help sustain this success.

Toxigenic Vibrio cholerae O1 in water and seafood, Haiti.

During the 2010 cholera outbreak in Haiti, water and seafood samples were collected to detect Vibrio cholerae. The outbreak strain of toxigenic V. cholerae O1 serotype Ogawa was isolated from freshwater and seafood samples. The cholera toxin gene was detected in harbor water samples.

El cólera epidémico en América Latina de 1991 a 1993: implicaciones de las definiciones de casos usadas en la vigilancia sanitaria / Epidemic cholera in Latin America, 1991­1993: implications of case definitions used for public health surveillance

This report presents the various cholera case definitions used by the affected countries of Latin America, shows the numbers of cholera cases and deaths attributable to cholera (as reported by Latin American countries to PAHO through 1993), and describes some regional trends in cholera incidence. The information about how cholera cases were defined was obtained from an October 1993 PAHO questionnaire. In all, 948 429 cholera cases were reported to PAHO by affected Latin American countries from January 1991 through December 1993, the highest annual incidences being registered in Peru (1991 and 1992) and Guatemala (1993). The case-fatality rate over the three-year period, and also in 1993, was 0.8%. A general downward trend in the incidence of cholera was observed in most South American countries, while the incidence increased in most Central American countries. A good deal of variation was noted in the definitions used for reporting cholera cases, hospitalized cholera cases, and cholera-attributable deaths. Because of these variations, broad intercountry comparisons (including disease burden calculations and care quality assessments based on case-fatality rates) are difficult to make, and even reported trends within a single country need to be evaluated with care. The situation is likely to be complicated in the future by the arrival of V. cholerae 0139 in Latin America, creating a need to distinguish between it and the prevailing 01 strain. For purposes of simplicity, wide acceptance, and broad dissemination of case data, the following definitions are recommended: Confirmed case of 01 cholera: laboratory-confirmed infection with toxigenic V. cholerae 01 in any person who has diarrhea. Confirmed case of 0139 cholera: laboratory-confirmed infection with toxigenic V. cholerae 0139 in any person who has diarrhea. Clinical case of cholera: acute watery diarrhea in a person over 5 years old who is seeking treatment. Death attributable to cholera: death within one week of the onset of diarrhea in a person with confirmed or clinically defined cholera. Hospitalized patient with cholera: a person who has confirmed or clinically defined cholera and who remains at least 12 hours in a health care facility for treatment of the disease

En este informe se presentan las diversas definiciones de casos de cólera usadas en los países de América Latina que se han visto afectados por la epidemia; se da el número de casos de cólera y de las defunciones por la enfermedad (según datos notificados a la OPS por los países latinoamericanos en 1993), y se describen algunas tendencias regionales de la incidencia de cólera. La información relacionada con la forma en que se definieron los casos de la enfermedad se obtuvo por medio de un cuestionario administrado por la OPS en octubre de 1993. En total, 948 429 casos de cólera fueron notificados a la OPS entre enero de 1991 y diciembre de 1993 por los países latinoamericanos afectados por la epidemia y las incidencias anuales más altas se registraron en el Perú (1991 y 1992) y Guatemala (1993). La tasa de letalidad para todo el trienio, y también para 1993, fue de 0,8%. La incidencia de cólera mostró una tendencia descendente general en la mayor parte de los países sudamericanos pero aumentó en casi todos los países de Centroamérica. Se observó gran variabilidad en las definiciones aplicadas para notificar casos de cólera, casos de cólera hospitalizados y defunciones atribuibles al cólera. Esta variabilidad dificulta cualquier comparación global entre países (y hasta estimar la carga de morbilidad y evaluar la calidad de la atención sobre la base de las tasas de letalidad), y aun las tendencias notificadas dentro de un mismo país deben evaluarse con cuidado. Es muy probable que en un futuro la situación se complique por la llegada de la cepa Vibrio cholerae 0139 a América Latina, situación que genera la necesidad de distinguir entre ella y la cepa 01, que es la predominante. Para efectos de simplificación y para lograr la amplia aceptación y extensa divulgación de la información sobre los casos, se recomiendan las siguientes definiciones: caso confirmado de cólera 01: infección por V. cholerae 01 toxígeno, confirmada por métodos de laboratorio, en cualquier persona con diarrea. Caso confirmado de cólera 0139: infección confirmada por V. cholerae 0139 toxígeno, confirmada por un laboratorio, en cualquier persona con diarrea. Caso clínico de cólera: diarrea acuosa de carácter agudo en una persona mayor de 5 años que busca tratamiento. Defunción atribuible al cólera: defunción durante la semana inmediatamente posterior al comienzo de la diarrea en una persona con cólera confirmado o diagnosticado según la definición clínica. Paciente hospitalizado con cólera: persona con cólera confirmado o diagnosticado según la definición clínica que pasa un mínimo de 12 horas en un centro de atención para el tratamiento de la enfermedad.

Epidemic cholera in Latin America, 1991-1993: implications of case definitions used for public health surveillance

This report presents the various cholera case definitions used by the affected countries of Latin America, shows the numbers of cholera cases and deaths attributable to cholera (as reported by Latin American countries to PAHO through 1993), describes some regional trends in cholera incidence. The information about how cholera cases were defined was obtained from an Octuber 1993 PAHO questionnarie. In all, 948 429 cholera cases were reported to PAHO by affected Latin America countries from January 1991 through December 1993, the highest annual incidences being registered in Peru (1991 and 1992) and Guatemala (1993). The case-fatality rate over the three-year period, and also in 1993, was 0.8 per cent. A general downward trend in the incidence of cholera was observed in most South American countries, while the incidence increased in most Central American countries. A good deal of variation was noted in the definitions used for reporting cholera cases, hospitalized cholera cases, and cholera-attributable deaths. Because of these variations broad intercountry comparisons (including disease burden calculations and care quality assessments base on case-fatality rates) are difficult to make, and even reported trends within a single country need to be evaluated with care. The situation is likely to be complicated in the future by the arrival of V. cholerae O139 in Latin America, creating a need to distinguish between it and the prevailing O1 strain. For purposes of simplicity, wide acceptance, and broad dissemination of case data, the following definitions are recommended: Confirmed case of O1 cholera: laboratory-confirmed infection with toxigenic V. cholerae O1 in any person who has diarrhea. Confirmed case of O139 cholera: laboratory-confirmed infection with toxigenic V. cholerae 0139 in any person who has diarrhea. Clinical case of cholera: acute watery diarrhea in a person over 5 years old who is seeking treatment. Death attributable to cholera: death within one week of the onset of diarrhea in a person with confirmed or clinically defined cholera. Hospitalized patient with colera: a person who has confirmed or clinically defined cholera and who remains at last 12 hours in a health care facility for treatment of the disease

This report will also be published in Spanish in the Bol. Oficina Sanit. Panam. Vol. 121, 1996

Prevención de la transmisión del cólera: evaluación rápida de la calidad del agua municipal en Trujillo, Perú / Prevention of cholera transmission: rapid evaluation of municipal water quality in Trujillo, Peru

Se sabe que el agua potable sin clorar ni hervir estuvo asociada con la transmisión de la epidemia de cólera en Trujillo, Perú, en febrero de 1991. En septiembre de ese mismo, se comenzó a clorar el sistema municipal de conducción de agua. La calidad del agua de Trujillo se supervisa a nivel central en las represas y los principales puntos de distribución, pero se desconocen los efectos de dicha vigilancia en la calidad del agua distribuida, En febrero de 1993, con objeto de evaluar la calidad del agua potable de los sectores residenciales de Trujillo, se tomaron muestras de agua de 30 viviendas seleccionadas sistemáticamente, se midieron sus concentraciones de cloro y se hicieron cultivos para bacterias coliformes. La concentración de cloro libre varió de 0 a 1,5 mg/L (mediana=0,4 mg/L). En 5 muestras (17 por ciento) no se detectó cloro libre y en 14 (47 por ciento) las concentraciones fueron menores de 0,4 mg/L. Se aislaron coliformes totales en 16 (53 por ciento) muestras, pero ningún coliforme fecal. Estos resultados demuestran la amplia variabilidad de las concentraciones de cloro en el agua municipal que se distribuye a las viviendas. Esa variabilidad, junto con la necesidad de guardar el agua potable en las casas a causa de su escasez, respalda la recomendación del Ministerio de Salud en virtud de la cual los residentes han de tratar el agua potable en el hogar. El sencillo marco de muestreo empleado en este estudio proporcionó una evaluación rápida de la calidad del agua municipal suministrada al consumidor. Es posible realizar encuestas similares con facilidad en otras áreas metropolitanas donde la calidad del agua sea dudosa, para obtener rápidamente información precisa sobre la calidad del agua suministrada al consumidor