This is the first documented cholera epidemic in the Caribbean in many years, since the last pandemic of the early 1990s. WHO's recent declaration that travel restrictions from Haiti will not be required raises serious questions of whether spread in the region is truly unlikely. Despite the WHO official's comment:
"There is no need to close the borders or restrict travel or trade because a neighbouring country has cholera. This is what we say for all cholera outbreaks worldwide."
This would imply this is an ordinary outbreak / epidemic of cholera. It is not, and it represents a key epidemiological change for the Carribean region that should be monitored closely.
The Dominican Republic has closed its borders, however it is generally believed the border is highly porous. Should the epidemic continue, we expect to see cases there eventually. Jamaica is on high alert, as are other countries in the region. While we do not want to cause further damage to Haiti's economy, the question of international travel restrictions should be re-examined at frequent intervals given the volume of multi-national responders flying in to assist.
Several days ago, the HEAS posted an advisory to several key medical communities in the United States to prompt diagnostic awareness and to ask a travel history. Most physicians in the United States have never seen a case of cholera, and prompt recognition is key to effective treatment. The disease is easily treated, with very low mortality if the patient is managed appropriately. Translocation of this disease to developed countries will not result in a large outbreak.
Translocation of cholera to developing or undeveloped areas of the Caribbean, Mexico, Central or South America would likely present in a similar manner as seen in Haiti.
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