Current migration pathways for the refugees of the Port-au-Prince devastation are shown below:
Credit: USSOUTHCOM, JTF-Haiti
USSOUTHCOM and JTF-Haiti estimate emigration volumes from Port-au-Prince as follows:
- Artibonite: 62,573
- Nord-Oest: 31,250
- Grand Anse: 30,000
- Nippes: 30,000
- Oest: 22,800
- Sud: 22,425
- Centre: 14,680
- Nord: 13,500
- Nord-Est: 7,700
When considering areas of Haiti that have reported anthrax epizootics and human cases, population displacement to the Artibonite Valley represents a point of concern. Peck and Fitzgerald reported in 2007 a dramatic increase in incidence of human cutaneous anthrax cases, from 1 case reported in 1992 to 25 cases reported in 2002. [1] This represented a 17-fold increase in incidence. Fortunately, the volume of cases was low:
Below is a map of the involved area.
Of note, there is currently a population displacement vector heading to this area of Haiti numbering over 60,000 individuals.
The most common site of infection was the face (61% of cases), with massive edema as the most common clinical finding. Other findings included fever, local lymphadenopathy, and abdominal pain. Pain localized to the lesion was infrequent (14% of cases). Below is a picture of a patient who survived infection following IV penicillin:
Anthrax appeared seasonally in the Artibonite Valley, peaking in May and June. This provides us time to engage veterinary and epidemiological support to further investigate the risk to the growing population of IDPs in Artibonite Valley. The call to action here is an updating of the Peck and Fitzgerald assessment, as it covered anthrax reporting up to 2002.
Other areas of Haiti have reported anthrax, particularly in the southern peninsula, however dramatic increases in incidence have not been reported in recent years. Both cattle and goats have been associated with epizootics in Haiti. The intersection of risk is demand by IDPs for protein sources in the ensuing weeks. The last outbreak involving human cases of anthrax in Haiti was documented on August 14, 2009, an unspecified number of human anthrax cases including one fatal case in Calumette, Bell-Anse commune. The source of the infection was suspected to be contaminated meat. Calumette is an area east of Port-au-Prince that reported “moderate” perceived shaking. This is an area in proximity to a population displacement vector to Jimani, DR:
We would remind the readers that anthrax is considered hyperendemic in Haiti. Reports of this disease would not be unexpected. The purpose of this post is to highlight potential issues for ground responders to enable rapid recognition of the disease and effective treatment.
References
1. Peck RN, Fitzgerald DW. Cutaneous anthrax in the Artibonite Valley of Haiti: 1992-2002. Am J Trop Med Hyg. 2007 Nov;77(5):806-11.
2. GIDEON. http://www.cyinfo.com
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