Current Map of Cholera-Affected Areas

We will adjust this map as more information becomes available. 

Updates: Official stats, estimates of true case loads, updated map.

While the UN OCHA maps and official MSPP reporting tends to focus on Artibonite and points north, there are other areas routinely not included on the OCHA maps that have reported cholera.  We opt on the side of "cholera until proven otherwise" or when political sensitivity is such that full disclosure and transparency allows.

Current official stats are more than 72,017 cases that have sought treatment and 1,648 fatalities.  We note large discrepancies between HEAS partner information and officially reported statistics, reflective of official under-reporting.

• Case fatality rates such as the most recent Health Cluster report of 2.3% is representative of gross national level aggregation of information available to officials, which represents a substantial bias towards CTC/CTUs staffed by experienced teams such as MSF.  What is not reflected is the continually documented "first contact" pattern of daily clinical mortality seen by rural communities and urban environments such as Gonaives several weeks ago reported by officials do not reflect the true impact of cholera at the community level.  The daily mortality we have documented on multiple occasions may range from 10 to 100%.  We often see sudden overwhelming of local capacity to the point of backloading corpses for burial, having run out of body bags.
• Conservative estimates therefore suggest more than a quarter-million cases of cholera in Haiti to-date, the majority of which were subclinical. 
• In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics.  We therefore estimate the upper bound of estimated total (subclinical and clinically apparent) case counts to be nearly one million.  From a practical operations point of view, these estimates are academic.  The bottom line is the epidemic continues to spread completely out of control.
  
• Although PAHO projections use an attack rate of 2% of a total estimated Haiti population of 10 million to estimate 200,000 total clinically apparent infections, the true community load will be closer to 800,000 if subclinical infections are counted. 
  
• We err on the side of over-estimating because this is a "virgin soil" epidemic and expected to aggressively spread throughout the country and across the border into the Dominican Republic to cause massive disruption.
• We are now pursuing answers to the question of uptake by indigenous zooplankton and spread along oceanic currents that pass west of the Gonave Gulf, which is where the Artibonite River discharges, north and west along the northern Cuban coastline and north to the waters east of Florida.   
  
• We assess the elections on the 28th facilitated further spread.  To what degree remains uncertain.
  
• Multiple healthcare worker infections have been reported on the ground in Haiti with one report of a worker returning to the United States infected.
• There will be more cases in the United States; we believe it likely more cases are inside the US unreported.  Implications for the United States are neglible.

The below represents areas of specific concern and active monitoring by the HEAS:

 

• Red- where we continuously receive emergency requests for assistance due to "first contact" high mortality and have facilitated several mobile emergency responses.
• Orange- where we occasionally receive notification of "first contact" high mortality but confirmation is difficult; we suspect there is far greater mortality in these mountains but it goes unreported because of very low NGO presence and difficulty of access.
  
• Yellow- where we have confirmed cholera activity at multiple sites throughout the southern peninsula, however the majority of international response is focused on PaP, Artibonite, and recently the north… the south is left relatively untouched in terms of response.  As with the orange areas, we suspect far more activity that is what reported because of very low NGO presence.  We also note very large time lags in official reporting from this area.  The southern peninsula is the next battle front, where we expect the 'war' to go very badly given the low availability of response assets.

 

 

View Overall Haiti Cholera Epidemic Map in a larger map

Comments

[Garygilmore1]

wow this is crazy and no major news sources are even reporting on it?

[Stephen Nuchia]

Medical implications for the United States (of the returned visitors case) are minimal. The best citation I could find in a quick web search is a widely-quoted figure of six reported Cholera cases in the US in 1999. With first-world sanitation the biggest risk would be a restaurant worker with a "silent" case.

Let us hope the political implications remain equally benign. This could have some negative impact on the climate of support for Haiti here.

My contacts with small groups running CTCs are screaming for supplies. People are trying to arrange private airlifts, asking if there are pharmacies nearby they might be able to buy Ringer's and body bags from. Apparently the official logistic structure is ignoring them, or is close to collapse. If there is an organized helicopter resupply effort the word is not getting out to many of these clinic, and people are dying needlessly because of it.