Recent hurricanes, Sandy and Isaac, passed through several Caribbean countries, including Haiti, increased the risk of acute diarrheal diseases being transmitted by food and water and may require heightening the responsiveness of health systems in the affected areas. As such, the Pan American Health Organization / World Health Organization (PAHO / WHO) recommends that Member States take action to update their preparedness and response plans and strengthen their surveillance systems for early detection of outbreaks. Member States are called on to continue their efforts and implement actions to improve water quality and sanitation conditions.

In Haiti, since the beginning of the cholera outbreak, starting epidemiological week (EW) 42 in 2010, until May 10th, 2011, the MSPP registered a total of 302,401 cholera cases of which 53.8% (162,651) required hospitalization and 1.7% (5,234) died (global case-fatality rate). Since EW 19 an increase in the number of new hospitalizations is observed in comparison with previous weeks, especially in the South-East and North-West departments and in the capital city, Port-au-Prince. Additionally, Artibonite and Centre continue to report new cases.

Since epidemiological week (EW) 16, the Dominican Republic's surveillance system is registering an increase in the number of suspected cases of cholera, principally in the peripheral area of Santo Domingo, near the river Ozama and Isabela. The increase of cases in Santo Domingo concurs with a raise in the temperature and frequency of rains, which originated flooding in different areas of Santo Domingo.

Since epidemiological week (EW) 1 of 2016 until EW 27, a total of 22,556 cholera cases have been recorded from three countries in the Americas: Ecuador (1), Haiti (21,661), and the Dominican Republic (894). Haiti alone registered 96% of the total cases in 2016 in the Region of the Americas. Table 1 shows the number of reported cholera cases in the Americas during 2015 and table 2 shows the cholera cases reported in selected countries from 2010 to 2016.

On 7 April 2009, the Ministry of Public Health and Social Welfare of Paraguay received laboratory confirmation of a case of cholera arising from Vibrio cholerae O:1 Ogawa, biotype El Tor, toxin producing. The date on onset of symptoms was 6 March, originating in an indigenous community in the Paraguayan Chaco region. Since then, three outbreaks of acute diarrheal disease were detected, with 15 reported cases (though the total number is undetermined) and 3 deaths. Regional health authorities have taken successful measures to assure safe drinking water in the affected areas (chlorination, boiling water, purchase of mineral water) and the situation has been contained, which leads us to believe that transmission was water borne.

In Haiti, the Ministry of Public Health and Population (MSPP) case surveillance system reported that as of EW 19 there was an increase in the number of new cholera cases and new hospitalizations in Port-au-Prince and in the Centre and Sud Est departments. For EW 22 and 23, five other departments (Arbonite, Grand Anse, Nippes, Nord and Ouest) experienced an increase in the number of new cases and new hospitalizations. This increase coincides with the start of the rainy season in Haiti.

In Dominican Republic, the Ministry of Public Health reported that since the beginning of the outbreak up to EW 23 of 2011 there were 1,727 confirmed cases (191 in 2010 and 1,536 in 2011), including 46 deaths. The municipalities of Santa Domingo Este and Oeste, Distrito Nacional, San Pedro de Macoris, Santiago and San Cristóbal registered the highest rates of cholera transmission in the past two weeks.

Currently, in Haiti all ten department of Haiti have reported cases and deaths due to cholera. During the previous three epidemiological weeks, the highest cumulative incidence was observed in the departments of Artibonite (305 cases per 10,000 inhabitants) followed by Nord Ouest, Nord and Centre (with 190 and 185 and 167 cases per 10,000 inhabitants, respectively).
In Dominican Republic, from EW 465 to EW 50, the Ministry of Public Health of the Dominican Republic recorded 73 laboratory confirmed cholera cases, of which 75% (55) were hospitalized. No deaths were ecorded. Also, 4 cases have been considered imported and 69 autochthonous.

Since the beginning of 2015 up to epidemiological week (EW) 48 of 2015, a total of 30,654 cholera cases have been recorded in three countries in the Americas: Cuba (65), Haiti (30,080) and the Dominican Republic (509). Haiti alone registered 98% of the total cases in the Region of the Americas.

During the epidemiological week 5 of 2011, at national level, Haiti registered an increase in the weekly incidence rate, which went from 8.1 cholera cases per 10,000 inhabitants in EW 4 to 11.4 cases per 10,000 inhabitants in EW 5. This was linked which is an increase of 5.2 % in the new case registered when compared to the previous week. At subnational level, three departments registered an increase in their weekly incidence rate (Nord, Nord Est and Ouest).

While in Dominican Republic, the Ministry of Health reported a total of 380 laboratory-confirmed cases of cholera and three deaths from the beginning of the outbreak to EW 5.

The present report contains information about the cholerea cases in Haiti and the Dominican Republic. In Haiti the number of deaths at the national level, of the 1,415 deaths recorded by the MSPP, 67% occurred at the health services level, and 33% at the community level. The in-hospital case fatality rate at the national level is 2.3%. In the DOminican Repúblic, the IHR National Focal Point reported a confirmed imported cholera case in a 32-year-old male who was hospitalized after presenting an acute diarrheal syndrome. Later, other two cases were confirmed, all of them in Santo Domingo.

Between epidemiological week (EW) 1 and 5 of 2017, a total of 1,897 cholera cases were reported in Haiti, including 28 deaths. In the Dominican Republic, from the beginning of the year to EW 2 of 2017, there were 7 suspected cholera cases and 2 confirmed cases reported, including one death.

Since the beginning of 2015 up to epidemiological week (EW) 22 of 2015, a total of 16,961 cases have been reported in three countries in the Region of the Americas: Haiti (16,687 cases), the Dominican Republic (273 cases) and Cuba (1 case).

The last confirmed case of cholera in Cuba was reported in January 2015, and was reported by the Canada International Health Regulations (IHR) National Focal Point. The case was an individual with history of travel to Cuba.

Ante la actual situación de cólera en Haití y dado el riesgo de reintroducción del cólera a otros países de la Región, la Organización Panamericana de la Salud recomienda a los Estados Miembros redoblar los esfuerzos de vigilancia, actualizar los planes de preparación y respuesta e implementar las medidas de prevención y promoción de la salud apropiadas.

In Haiti, during the second EW of 2011 and for the third consecutive week, Haiti has registered a decrease in the weekly incidence rate at the national level. It decreased from 24.1 to 12.7 and to currently 10.1 cholera cases per 10,000 inhabitants. Three departments located in the north of the country, increased their weekly incidence rate (Nord, Nord Est, and Artibonite). At the national level, the in-hospital case fatality rate for week 2 of 2011 stayed at 1.3%. Very similar to the previous week which was 1.2%.

While in the Dominican Republic, the Ministry of Public Health reported the first death caused by cholera in the province of Altagracia. Since the beginning of the outbreak in SE 45 of 2010 and as of to SE 2 of 2011 there were 244 laboratory confirmed cases.

In Haiti, the national number of cases and hospitalizations has decreased in the past three weeks, following the increase which occurred between EW 20 and 25. At the local level two departments, Nord and Nord Ouest, recorded an increase in the number of new cholera cases and new hospitalizations since EW 22. Meanwhile, Port-au-Prince and the Centre, Grand Anse and Nippes departments which had recorded an increase in cases between EW 22 and 23, have recorded a decline for the past three weeks.

While in Dominican Republic, the Ministry of Public Health reported that since the beginning of the outbreak up to EW 29 of 2011 they recorded a total of 13,200 suspected cholera cases and confirmed 87 deaths due to cholera. The Distrito Nacional and the provinces of Elías Piña, San Cristóbal, San Juan, San Pedro de Macoris, Santiago and Santo Domingo Este and Oueste registered the highest rates of cholera transmission.

In light of current cholera outbreaks in the Region, the Pan American Health Organization (PAHO) / World Health Organization (WHO) recommends Member States implement their preparedness and response plans and strengthen cholera surveillance systems. PAHO/WHO also calls on countries to further efforts to improve quality and conditions of water and sanitation. 

Since epidemiological week (EW) 1 of 2016 until EW 17, a total of 14,574 cholera cases have been recorded from three countries in the Americas: Ecuador (1), Haiti (13,859), and the Dominican Republic (714). Haiti alone registered 95% of the total cases in 2016 in the Region of the Americas.

Starting in Epidemiological Week (EW) 41, an increase in acute diarrhea cases, with severe cases and deaths, was observed in the departments of Artibonite and Central. In EW 42, isolation of V. cholerae O: 1 serotype Ogawa was confirmed in samples from hospitalized patients.

In the Americas Region, between epidemiological week (EW) 1 and EW 50 of 2017, a total of 13,582 suspected cholera cases were reported on the island of Hispaniola, of which 99% occurred in Haiti (13,468 cases, including 157 deaths). 1 During the same period, 62 suspected cholera cases were reported in the Dominican Republic, including two deaths.

Recent antimicrobial susceptibility testing of V. cholerae isolated in Haiti, conducted by the National Laboratory of Public Health and the Center for Disease Control and Prevention (CDC), shows resistance to trimethroprim-sulfamethoxazole, furazolidone, nalidixic acid, and streptomycin. Therefore, the purpose of this alert is to share the provisional recommendations regarding treatment of patients with cholera, based on the susceptibility pattern of the strains isolated to date in Haiti.

The presence of a cholera outbreak affecting a total of 25 persons was reported on 21 December 2003 in Zamora Chinchipie province, Yantzaza canton, Chicaña parish, San Vicente de Caney district. Information submitted on 22 January 2004 indicates that the outbreak is now under control.

Between epidemiological week (EW) 1 and EW 43 of 2016, a total of 35,755 cholera cases were reported in four countries of the Americas: the Dominican Republic (1,097), Ecuador1 (1), Haiti (34,656), and Mexico (1). Of the total cases, 97% were reported in Haiti.

In Haiti,during the third EW of 2011 Haiti registered an increase in the weekly incidence rate at the national level, which went from 10.1 cholera cases per 10,000 inhabitants in EW 2 to 13.6 cases per 10,000 inhabitants in EW 3, which is an increase of 6.9% in the new case registrered when compared to the previous week. Of all the departments, six, increased their weekly incidence rate (Centre, Ouest, Nippes, Sud Est, Nord-Est, and Nord-Ouest) and four showed a decrease (Artibonite, Grande Anse, Nord and Sud). The hospitalization case fatality rate at the national level in EW 3 of 2011 was 1.5%, two decimals above the previous week.

While in the Dominican Republic, the Ministry of Public Health informed that since the beginning of the outbreak in EW 45 of 2010 to EW 2 of 2011, there were 263 cases confirmed by laboratory and one death that happened in EW 2.

The Pan American Health Organization / World Health Organization (PAHO/WHO) reminds Members States that measures such as restrictions on movement of persons and seizure of goods produced under good manufacturing practices are unnecessary and ineffective to control the spread of cholera. Member States are encouraged to continue surveillance activities and to implement the recommended actions that reduce cholera spreading determinants.

The purpose of this Epidemiological Alert is to recall that the orientations of the Organization related to travel and international trade are still in effect.

Considering the start of the rainy season in Central America and the Caribbean, which increases the risk of transmission for various diseases, including cholera, the Pan American Health Organization/World Health Organization (PAHO/WHO) encourages Member States the continuation of surveillance efforts to detect the occurrence of outbreaks and implementing intervention actions to reduce cholera spread determinants.

Between epidemiological weeks (EW) 1 and 14 of 2017, a total of 4,871 suspected cholera cases were reported in Haiti, including 69 deaths. During the same period, 62 suspected cholera cases were reported in the Dominican Republic, including two deaths.

In 2017, a total of 13,803 suspected cases of cholera were reported on the island of Hispaniola: 13,681 cases (including 159 deaths) in Haiti and 122 cases (including 4 deaths) in the Dominican Republic. Up to epidemiological week (EW) 29 of 2018, 2,883 cholera cases were reported on Hispaniola; 99% occurred in Haiti (2,843 cases, including 34 deaths). 

Currently, in Haiti Currently, there are cases and deaths due to cholera in the 10 departments of Haiti. The highest cumulative incidence rate as of EW 48 was observed in the department of Artibonite with 274 cases per 10,000 inhabitants, followed by Nord Ouest and Centre with 149 and 145 cases per 10,000 inhabitants, respectively. These departments also recorded the highest cumulative incidence rates in the previous week.
In Dominican Republic, From EW 46 to EW 48, the Ministry of Public Health of the Dominican Republic recorded 22 laboratory confirmed cholera cases, of which 15 were hospitalized. No deaths were recorded. Also, 2 cases have been considered imported and 20 autochthonous.

The Pan American Health Organization / World Health Organization (PAHO/WHO) updated the Cholera outbreaks situation in the Region.

In Haiti, the Haitian Ministry of Public Health and Population (MSPP) case surveillance system eported that as of EW 19 there was an increase in the number of hospitalized patients in Port-au-Prince and the Centre department. This increase coincides with the beginning of the rainy season in Haiti.

While in Dominican Republic, the Ministry of Public Health informs that since the beginning of the outbreak up to EW 20 of 2011 there were 1,329 laboratory confirmed cases (191 in 2010 and 1,138 in 2011), including 27 deaths. The Distrito Nacional and the provinces of Santiago, San Pedro de Macorís, La Romano and the border provinces of Independencia and Elías Piña also registered an increase in cases with respect to the previous weeks.

As of EW 44, and at the national level, a total of 544 deaths have been recorded, 57% of which have occurred at the health services level, and 43% at the community level. The daily case fatality rates observed in health services at the national level have ranged from 2.2% to 6.0% (3.8% average). Alternatively, in the department of Artibonite, this rate has ranged from 1.2% to 6.8% (3.5% average). The impact of efforts undertaken to improve case management and access to health services on recorded case fatality rates is being analyzed.

During Epidemiological Week 7 of 2011, at the national level, Haiti registered an increase in the weekly incidence rate, which increased from 5.1 cholera cases per 10,000 inhabitants in EW 6 to 10.2 cases per 10,000 inhabitants in EW 7. This was linked to an increase of 4.2% in the new cases registered as compared to the previous week. At the sub-national level, five departments (Centre, Nippes, Ouest, Sud y Nord) registered an increase in their weekly incidence rate.

While in the Dominican Republic, the Ministry of Health reported a total of 470 laboratory-confirmed cases of cholera, including four fatal cases, since the beginning of the outbreak up to EW 7.

In Haiti,during the fourth EW of 2011 Haiti registered a decrease in the weekly incidence rate at the national level, which went from 13.6 cholera cases per 10,000 inhabitants in EW 3 to 8.1 cases per 10,000 inhabitants in EW 4. At department level, three departments (Artibonite, Grande Anse, Nord and Sud) increased their weekly incidence rate. The in-hospital case fatality rate at the national level in EW 4 of 2011 was 1.0%.

While in the Dominican Republic, the Ministry of Public Health informed that since EW 45 of 2010 to EW 4 of 2011, there were 336 cases confirmed by laboratory and one death that happened in EW 2.

The Pan American Health Organization / World Health Organization (PAHO / WHO) reminds Members States that measures such as restrictions on movement of persons and seizure of goods produced under good manufacturing practices are unnecessary and ineffective to control the spread of cholera. Member States are encouraged to continue surveillance activities and to implement the recommended actions that reduce cholera spreading determinants.

In 2015, a total of 36,654 cholera cases have been recorded from three countries in the Americas: Cuba (65), Haiti (36,045) and the Dominican Republic (544). Haiti alone registered 98% of the total cases in the Region of the Americas.

Since the beginning of 2015 up to epidemiological week (EW) 38 of 2015, a total of 22,950 cholera cases have been recorded in three countries in the Region of the Americas: Cuba, Haiti and the Dominican Republic. Haiti alone registered 98% (22,511) of the total cases in the Region of the Americas.

Since the beginning of 2015 up to epidemiological week (EW) 32 of 2015, a total of 21,227 cases have been recorded in three countries in the Region of the Americas: Cuba, the Dominican Republic, and Haiti. Haiti alone registered 98% (20,830) of the total cases in the Region of the Americas.

From Epidemiological Weeks (EWs) 4 to 11, an increase in the number of cases of acute diarrhea has been detected in the municipality of São Bento do Una, state of Pernambuco, Brazil, similar to the peak that occurred during the first trimester of last year.