The Chart

How cholera in Haiti began

Two years after an earthquake shook Haiti, the small country grappled with the death, the destruction and the debris.

After the earthquake on January 12, another health crisis struck about 10 months later: cholera.

The bacterial disease brings about a painful death, as quickly as within two to three hours, because of the amount of fluid and electrolytes that are lost.  Symptoms are watery diarrhea, dehydration, nausea and vomiting.  

Cholera spreads through contaminated water.  While it has largely been eradicated in the West, it has been known to come back during war or natural disasters when people are forced to live in crowded places without proper sanitation and clean water.

So far, cholera has killed 7,000 people and infected 520,000 people, according to the Pan American Health Organization.

Medical workers continue to encounter about 200 new cases everyday, said Dr. Jon Andrus, deputy director of PAHO, which is part of the World Health Organization.

In an article published in the American Journal of Tropical Medicine Monday, the authors identified who they believe to be the first to get cholera in Haiti after the earthquake.  An 28-year-old man with mental illness from the town of Mirebalais was suffering from hallucinations, disorganized thoughts and paranoia, according to the article written by Dr. Louise Ivers and Dr. David Walton from Harvard Medical School and Partners in Health.

The man was known to wander through town naked, and drank from and bathed in the in the Latem River. He fell ill with watery diarrhea and within a day of showing symptoms, the man died.  The two people who prepared the body for his funeral also developed watery diarrhea.

There is no lab method to confirm that this was the first patient to start the epidemic, wrote the authors. “This patient’s case is the first in the community’s collective memory to have had symptoms that are recognizable, in retrospect, to be those of cholera,” according to the study released Monday.

The patient had an underlying mental health condition that led him to drink from the river and this contributed to his illness, the authors concluded.

The cholera epidemic has continued to spread even until today. The infection spread to the neighboring Dominican Republic, and individual cases were exported to the United States, such as Boston and Miami.

By sequencing the genome of the cholera strain, researchers found that it was nearly identical to strains circulating in South Asia, according to a study published online in the New England Journal of Medicine last year.

An independent report later linked the outbreak to peacekeepers from Nepal.  According to the report, fecal matter from the U.N. camp where the Nepalese were based was improperly routed by a contractor and "this contamination initiated an explosive cholera outbreak downstream in the Artibonite River Delta and eventually throughout Haiti.”

The best way to prevent cholera is to get clean water and better sanitation.  Treatment for the disease is immediately necessary through rehydration, intravenous fluids, antibiotics and zinc supplements.

The authors wrote, “Such discussion is not intended as an attempt to attribute blame.  Rather, the case should cause reflection for global health practitioners on the importance of the increasing interconnectedness of globalization for public health.”