Most of what I’ve learned about cholera comes from public service announcements on Haitian TV and radio. One entertaining TV announcement features popular comedian, Ton Ton Bicha, and hunky music star, Ti Jo from Kreyol La. On the screen we see an ailing Ti Jo explaining in graphic detail his textbook cholera symptoms to goofy Ton Ton Bicha who tells him what to do to get better. Sometimes I hear people on the street singing the jingle from it…. ‘Ti Jo pap mouri, Ti Jo pap mouri!’ (Ti Jo isn’t going to die!)
I’ve also seen many pamphlets like the one that the Diocesan development arm (CEDDISEC) circulates which explains how to keep from contracting cholera and what to do if you or someone you know becomes infected.
Thanks to these efforts by the Haitian Ministry of Health and the NGO’s, just about anyone on the street in Port au Prince seems to be able to recite the recipe for the oral rehydration serum.
The announcements however have not answered all of my questions about this scary bacterium and until yesterday, I’d been filling in the gaps with piecemeal word of mouth info. In an effort to clear up the muddy waters (in my head) I sought out legit answers.
Below are my findings. They are not a complete resource, but just some answers to questions that might be of interest especially to foreigners traveling to Haiti.
Can one contract/spread cholera through casual contact with infected people?
Cholera is rarely spread person to person. It is spread when the feces of an infected person gets into the water people drink or the food that they are eating. The bacterium must be ingested. A scenario of person to person transmission would be a parent cleaning their infected child’s bottom and then the parent putting a soiled finger in their mouth or transferring the poo particles onto food and eating it.
(CDC. Cholera Prevention and Control. <http://www.cdc.gov/cholera/prevention.html>)
Is a prudent traveler safe from contracting cholera?
Visitors are unlikely to catch it, but are not completely safe. Visitors in Haiti generally drink clean water and use hand sanitizer religiously. That puts them at low risk. Still there are a few preventative measures that might not be completely obvious even to very prudent travelers.
1. Wash hands thoroughly with treated water or use hand sanitizer after using the restroom and before eating then shake to dry
Some facts about using hand sanitizer:
*Hand sanitizer must contain more than 60% alcohol to kill the bacterium.
*Apply enough hand sanitizer that the entire surface area of your hands still isn’t dry 10 seconds afterwards
*Hand sanitizer doesn’t do a good job of soaking through grime, so rinse visibly dirty hands with water before applying
2. Use treated water for everything – drinking, ice, washing hands, preparing food, washing dishes, brushing teeth, even bathing. Treat a bucket of water with chlorine or other treatment for bathing.
3. Only eat fully cooked food that is still hot and fresh fruits and veggies that you have washed and peeled yourself. The bacteria can flourish in food that has been contaminated after cooking and then allowed to sit at room temperature.
(Deborah Franklin. “Hand Sanitizers, Good or Bad?”. The New York Times. March 21, 2006. <http://www.nytimes.com/2006/03/21/health/21cons.html>), (CDC. Cholera Prevention and Control. <http://www.cdc.gov/cholera/prevention.html>), (The Mayo Clinic. Cholera Prevention. <http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=symptoms>)
What should a visitor to Haiti have on hand?
The CDC recommends: An antibiotic to treat diarrhea, access to means of purifying water, oral rehydration salts or serum packets, hand sanitizer with 60% or more alcohol content
(CDC. Travel Health Precaution. <http://wwwnc.cdc.gov/travel/content/travel-health-precaution/haiti-cholera.aspx>)
Is there a vaccine?
Yes, there are two: Dukoral, which is WHO approved, and ShanChol, which is not at this time. Neither are available in the United States. Dukoral is a two or three dose vaccine which reduces an individual’s risk of contracting cholera for about 2 years. The CDC doesn’t recommend the vaccine for most travelers because, “the available vaccines offer incomplete protection for a relatively short period of time.” (CDC. Cholera General Information. < http://www.cdc.gov/cholera/general/>)
Vaccinating might not be used as a means to slow the outbreak because there is a limited amount of the vaccine stockpiled in the world and it is difficult to administer since it is a double or triple dose over a period of weeks. Also, the vaccines, when administered properly, provide up to 90% immunity to cholera – in other words, vaccinated individuals can still spread the germ.
(Donald G. McNeil Jr. “Haiti, Cholera Vaccine Pilot Program Recommended”. The New York Times December 17, 2010 <http://www.nytimes.com/2010/12/18/world/americas/18briefs-Haiti.html>) , (Richard Knox. “Cholera Vaccine Isn’t The Answer for Haiti”. NPR October 28, 2010 <http://www.npr.org/blogs/health/2010/10/28/130884642/why-the-cholera-vaccine-isn-t-the-answer-for-haiti>)
Can one have cholera and not even know it?
Yes. About 80% of people with cholera show mild or no symptoms. Infected people without symptoms can still spread the germs just like other infected people via their stool for two weeks.
(The Permaculture Guild. How to Prevent and Treat Cholera. <http://www.permacultureguild.us/how-to-prevent-and-treat-cholera/>). (The Mayo Clinic. Cholera Symptoms. <http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=symptoms>)
Isn’t cholera just a horrible case of diarrhea and vomiting; why are so many people gravely affected by it?
Cholera continues to spread in Haiti. Some epidemiologists estimate that the outbreak could persist for three to five years. Lack of sewage treatment and access to clean water allow the germs to spread. Access to health care is limited and the onset of symptoms is rapid. People die of cholera due to extreme dehydration. People with healthy immune systems can generally fight off the bacteria if they stay hydrated.
What can be done to help?
Donate to organizations that are working hard with the Ministry of Health to stop the spread of cholera. Visitors can bring extra rehydration packets and hand sanitizer with more than 60% alcohol with to share.