1.C - Cholera in Haiti

Question 1

how does “people moving after a disaster” lead to epidemics after natural disasters?

Answer 1

• the risk factors for outbreaks after disasters are associated primarily with population displacement

Question 2

how do the the 4 key factors lead to epidemics after natural disasters?

Answer 2

1. the availability of safe water and sanitation facilities
2. the degree of crowding
3. the underlying health status of the population
4. the availability of healthcare services

all interact with the context of the local disease to influence the risk for communicable diseases and death.

Question 3

how are poor countries worse off in epidemics after natural disasters?

Answer 3

• developing countries are disproportionatly affected because they may lack resources, infrastructure and disaster-preparedness systems

Question 4

how do “worries over corpses” lead to epidemics after natural disasters?

Answer 4

• the sudden presence of large numbers of dead bodies in the disaster affected area may heighten concerns of disease outbreaks
• when death is directly due to the natural disaster, human remains do not pose a risk for outbreaks
• dead bodies only pose health risks in a few situations that require specific precautions, such as deaths from cholera.

Question 5

how do “nearby toilets” lead to epidemics after natural disasters?

Answer 5

• the risk for communicable disease transmission after disasters is associated primarily with the size and characteristics of the population displaced
• specifically the proximity of safe water and functioning latrines.

Question 6

how does “malnutrition” lead to epidemics after natural disasters?

Answer 6

• malnutrition increases the risk for death from communicable diseases and is more common in conflict-affected populations, particularly if their displacement is related to long-term conflict

Question 7

how does “lack of good tap water” lead to epidemics after natural disasters?

Answer 7

• diarrheal disease outbreaks can occur after drinking water has been contaminated and have been reported after flooding and related displacement

Question 8

how do rats lead to epidemics after natural disasters?

Answer 8

• leptospirosis is an epidemic-prone zoonotic bacterial disease
• rodents shed large amounts of leptospires in their urine, and transmission occurs through contact of the skin and mucous membranes with water, damp soil or vegetation (such as sugarcane), or mud contaminated with rodent urine

Question 9

how does “overpopulation in one area” lead to epidemics after natural disasters?

Answer 9

• crowding is common in populations displaced by natural disasters and can facilitate the transmissoin of communicable diseases
• crowded living conditions facilitate measles transmission and neccessitate even higher immunization coverage levels to prevent outbreaks

Question 10

how does “Malaria getting better at first” lead to epidemics after natural disasters?

Answer 10

• while initial flooding may wash away existing mosquito breeding sites, standing water caused by heavy rainfall or overflow of rivers can create new breeding sites.
• this situation can result (with typically some weeks delay) in an increase of the vector population and potential for disease transmission

Question 11

how does “mosquito based vector diseases doing well” lead to epidemics after natural disasters?

Answer 11

• the crowding of infected and susceptible hosts
• a weakened public health infrastructure
• and interruptions of ongoing control programs
• are all risk factors for vectorborne disease transmission

Question 12

how does “conditions which make it worse for migrants” lead to epidemics after natural disasters?

Answer 12

• communicable diseases are common in displaced populations that have poor access to basic needs such as safe water and sanitation, adequate shelter and primary healthcare services
• these conditions are favourable for disease transmission

Question 13

what do populations at risk to epidemics after natural disasters need?

Answer 13

• assuring access to safe water and primary healthcare services is crucial
• as well as surveillance and early warning to detect epidemic prone diseases known to occur in the disaster affected area

Question 14

what are the key reasons why infectious diseases usually break out following a disaster?

Answer 14

• dead bodies and disease
• displacement. infrastructure gets destroyed. mass movement of people into slum conditions (internal migration)
• water related communicable diseases (after flooding and related displacement)
• destruction of homes/infrastructure
  > people move into temporary camps/slums = ↑ neighbourhood effect
  > close proximity = ↑ disease spread
• toilets
• healthcare and education

Question 15

what happened in Haiti in 2010?

Answer 15

• hit by a powerful magnitude 7 earthquake
• 220,000 people were killed, 300,000 injured and 1.3 mill were made homeless

Question 16

give a piece of evidence that shows Haiti is poor

Answer 16

60% of the population survives on less than $2.5/day

Question 17

where did people move after the earthquake in Haiti?

Answer 17

• hundreds of thousands of homeless people were housed in makeshift camps

Question 18

what were the living conditions for the majority of the population prior to the event?

Answer 18

• in the captial, Port-Au-Prince, prior to the EQ 86% of the population lived in slums, 50% the population had no access to toilets
• given the insanitary conditions, drinking water contaminated by sewage and overcrowding, an outbreak of cholera was inevitable

Question 19

statistics for the cholera outbreak

Answer 19

• between the initial outbreak and Nov 2014, nearly 720,000 cases of cholera were recorded, with 8700 deaths

Question 20

summarise the main reasons why cholera easily spread in Haiti

Answer 20

• situated alongside the Meille River, the UN camp hosting peacekeepers from Nepal discharged its waste directly into the river
• at the time, Nepal was suffering a cholera outbreak and the peacekeepers are suspected to have transmitted the disease through their waste.
• the river was a primary source of water for thousands of people, and lacking sanitation options, the water may have been consumed without proper treatment

Question 21

how did human factors increase disease risk?

Answer 21

• urban centres lacking water and sanitation infrastructure are especially susceptible.
• the rapid diffusion of the disease is tied to squalid conditions and insufficient health and sanitary infrastructure in earthquake ravaged Haiti.
• in areas with poor sanitation, explosive diarrhea and vomiting can accelerate the diffusion of disease.

Question 22

what strategies can be used to mitigate the disease?

Answer 22

• cholera can be prevented through careful sanitation and hygiene.
• if bottled water is unavailable, boil the water for at least one minute or treat it with chlorine/bleach
• any food, especially shellfish/seafood, should be thoroughly cooked.
• safe handwashing practices are crucial
• latrines should be located away from homes and defecation should take place at least 30 m away from a body of water.

Question 23

what environmental factors helped this disease spread?

Answer 23

• rainfall and flooding spread contaminated water
• however, this wasn’t a sig factor in Haiti’s initial outbreak since rainfall was low when earthquake hit in October 2010
• it was later on Nov 5th 2012 that Hurricane Tomas caused rapid flooding
  = overflowing latrines, further spreading infected water.

Question 24

why is hurricane Tomas significant?

Answer 24

• mass flooding = disease spreads considerably
• ↑ destruction of infrastructure/houses
• camps/slums flooded
  (- tropical storm, synoptic link)

Question 25

what social/economic factors helped this disease spread?

Answer 25

• importance of Artibonite River within people’s day to day lives was a major factor in why initial outbreak was so severe. common practice of growing rice in paddy fields and reliance on river for fishing/transportation. ↑ exposure to contaminated water
• poverty - stricken nature of Haiti = significant lack of access to safe drinking water + basic sanitation prior to EQ. only 17% of Haitians had access to proper latrines = problem ↑ by damage to infrastructure from EQ.
• large numbers of people forced to use rivers for all their water needs, including drinking, cooking, washing and alternative latrines
• lack of general awareness + importance of sanitation techniques e.g. hand washing/disposal of human waste
• most medical facilities = poorly funded and ill equipped to sufficently treat epidemic of this scale. also lacked space/facilities to contain spread of diseas among their patients.

Question 26

how did the Artibonite River impact the cholera outbreak negatively?

Answer 26

• importance of Artibonite River within people’s day to day lives was a major factor in why initial outbreak was so severe.
• common practice of growing rice in paddy fields and reliance on river for fishing/transportation.
• ↑ exposure to contaminated water

Question 27

how did poverty impact the cholera outbreak negatively?

Answer 27

• poverty - stricken nature of Haiti = significant lack of access to safe drinking water + basic sanitation prior to EQ.
• only 17% of Haitians had access to proper latrines = problem ↑ by damage to infrastructure from EQ.

Question 28

how did large numbers of people impact the cholera outbreak negatively?

Answer 28

• large numbers of people forced to use rivers for all their water needs, including drinking, cooking, washing and alternative latrines

Question 29

how did lack of general awareness impact the cholera outbreak negatively?

Answer 29

• lack of general awareness + importance of sanitation techniques e.g. hand washing/disposal of human waste

Question 30

how did medical facilities impact the cholera outbreak negatively?

Answer 30

• most medical facilities = poorly funded and ill equipped to sufficently treat epidemic of this scale.
• also lacked space/facilities to contain spread of diseas among their patients.

Question 31

what were the IMPACTS of cholera following the natural disaster?

Answer 31

• EQ earlier in the year led to high levels of internal migration = helped to spread the disease across the country
• migrants often lived in temporary accomodation e.g. emergency camps/staying with extended family. = overcrowding in poor quality accomodation ↑ likelihood of transmission. accomodation rarely had access to clean water/latrines.
• between Oct 2010-2014 there were more than 720,000 cases of cholera in Haiti, with a total of 8,700 deaths (actual number may be higher due to difficulties in obtaining data in remote areas).

Question 32

how did the EQ enhance the impacts of cholera?

Answer 32

EQ earlier in the year led to high levels of internal migration = helped to spread the disease across the country

Question 33

how did temporary accomodation enhance the impacts of cholera?

Answer 33

• migrants often lived in temporary accomodation e.g. emergency camps/staying with extended family.
• = overcrowding in poor quality accomodation ↑ likelihood of transmission.
• accomodation rarely had access to clean water/latrines.

Question 34

in numbers, what was the impact of cholera on Haiti?

Answer 34

• between Oct 2010-2014 there were more than 720,000 cases of cholera in Haiti, with a total of 8700 deaths
• (actual number may be higher due to difficulties in obtaining data in remote areas).

Question 35

what strategies were used to mitigate this disease? who was involved in doing this and why?

Answer 35

• large scale response from the UN, aid organisations and medical relief groups
• direct need to save lives
• while at the same time it was of utmost importance to halt the spread of disease
• direct treatment implemented via specialised cholera treatment centres to relieve the overburdened hospitals
• these programmes found themselves overwhelmed with patients
• local hospitals and clinics recieved additional training
• reducing the spread of infection was even larger task. widespread health awareness campaign launched.
• aid groups also launched campaigns focused on the importance of boiling/chlorinating water, and supplied chlorine tablets to rural communities
• HUGE SUCCESS!!!
• infection rates plummeted in 2011
• mortality among cholera victims ↓ from 10% in october 2010 to less than 1% from jan 2011 onwards

Question 36

who was involved in the strategies mitigating against cholera?

Answer 36

• large scale response from the UN, aid organisations and medical relief groups
• direct need to save lives
• while at the same time it was of utmost importance to halt the spread of disease

Question 37

how were overburdened hospitals relieved during the cholera outbreak?

Answer 37

• direct treatment implemented via specialised cholera treatment centres to relieve the overburdened hospitals
• these programmes found themselves overwhelmed with patients
• local hospitals and clinics recieved additional training

Question 38

how did organisations tackle reducing the spread of infection?

Answer 38

• reducing the spread of infection was even larger task. widespread health awareness campaign launched.
• aid groups also launched campaigns focused on the importance of boiling/chlorinating water, and supplied chlorine tablets to rural communities

Question 39

were the strategies used to mitigate against cholera successful?

Answer 39

• HUGE SUCCESS!!!
• infection rates plummeted in 2011
• mortality among cholera victims ↓ from 10% in COt 2010 to less than 1% from jan 2011 onwards