Health Cluster Bulletin, Nov 7, 2011, #29.
Highlights:
* There are currently 29 CTCs, 163 CTUs, and 766 ORPs functioning in-country.
* Over the past weeks, heavy rains and subsequent flooding have caused considerable increases of cases in several departments, but mainly in the South. Due to these floods, several treatment centers and localities became inaccessible by road. However, thanks to concerted efforts of the departmental health authorities (DSS) and its partners (CRS, IMC, IOM, MINUSTAH, PAHO/WHO, Solidarité Internationale, TdH, UNICEF, UNOPS, WFP), medical and other supplies were either airlifted or transported through the high waters by local population, in order to provide the affected areas with sufficient supplies.
* Other cholera outbreaks have been reported in the North notably in Cap Haitien, in Ouanaminthe in North East and in the Nippes Department. The rainy season provides favorable conditions for the spread of cholera and other diseases among vulnerable populations.
* Short-term cholera funding is coming to an end while some long-term funding is not yet available. More and more NGOs are withdrawing from their intervention area for lack of funding. This will pose further threats and limitations to the cholera response.
Situation Overview:
* Currently we observe an average of 500 cholera cases per day with significant variations between departments. These can be actual differences, but are sometimes the result of under reporting in certain communes or treatment of other diarrhea-like illnesses at health structures.
* At present there are still some 550,000 persons living in a total of 802 camps. According to the latest survey conducted in 626 sites hosting about 500,000 IDPs by the National Directorate for Water and Sanitation (DINEPA) and the WASH Cluster, access to water, sanitation and hygiene (WASH) services is deteriorating. Withdrawal of humanitarian actors and lack of funds has resulted in a lack of drainage services, poor maintenance and repair of infrastructures and latrines, once again providing an opportune environment for the spread of cholera.
* The epidemiological tendency of cholera has seen outbreaks in highly populated urban areas that have spread to rural zones. This epidemic tendency is likely to continue for the next 2-3 years, though with smaller outbreaks, until it reaches a stabilized endemic phase.
* Ongoing monitoring and assessment of the development of cholera is required in order to adequately adapt the response. However the current cholera response is facing a withdrawal of partners owing to lack of funding and consequential closure of cholera treatment structures, this also poses serious difficulties for the long-term institutional response.
* The withdrawal of the British Red Cross (BRC) from the South Department is set for 31 October; during the first week of November a handover will take place with the Haitian Red Cross. IMC's funding in the South for the cholera response will end on 31 December 2011.
* The funding of MdM-Belgium for cholera activities in Nippes Department, which was to terminate this month, was extended until 31 December.
* In North-East Department, Merlin has extended their cholera activities until the end of the year.
* MSF-CH concluded their emergency cholera activities in October in the North Department, but continues to work in Leogane (West).
* Intermon Oxfam has announced the end of its cholera activities for 30 November in Port-au-Prince, Gressier, Grand Goave and Petit Goave. The organization has been working with local partners providing a response to the cholera outbreak since November 2010. It will continue activities in the country but no longer has the resources, human or material, to respond to future cholera outbreaks.
EPIDEMIOLOGICAL SURVEILLANCE
* As of 14 October 2011, the cumulative number of reported cholera cases was 473,649, of which 251,885 (53%) were hospitalized and 6.631 persons had died.
* The global attack rate is 4.6%, with 7.8% in Port-au-Prince and 1.1% in South East.
* Overall mortality rate for Haiti since the start of the epidemic is 63.7 per 100,000 inhabitants, with important variations between departments as shown below (figure 2).
* Surveillance information and graphs are available at the Ministry of Health and Population (MSPP) http://mspp.gouv.ht/site/index.php.
Functional Cholera Treatment Structures in Haiti (excerpted)
end Jan 2011 end Oct 2011
Cholera treatment centers: 101 29
Cholera treatment unit: 185 163
Oral rehydration post: 778 766