Facility-based cholera surveillance in central Haiti

Background: Zanmi Lasante (ZL)/Partners In Health (PIH), has delivered community-based primary healthcare in central Haiti since 1986. Building on that model, ZL responded swiftly to the 2010 cholera epidemic, establishing Cholera Treatment Centers (CTCs) and community-based education and prevention efforts in support of the Haitian Ministry of Health (MOH). We report trends of the epidemic in the Centre and Artibonite Departments of Haiti through May 2013. Methods: Cases of cholera were diagnosed using clinical case definition in patients presenting with acute watery diarrhea. Data were collected using CTC case and death registers across 10 supported CTCs in central Haiti. ZL staff used data dashboards to monitor site case volume, case-fatality rate (CFR) and attack rates. Results: Between October 2010 and May 2013, 102,255 cholera cases were treated at ZL/MOH sites, representing almost 1/6 of all cases reported nationally. 1,129 cholera-related deaths were registered (cumulative CFR of 1.1%). Data from surveillance activities were fed back to implementation teams to facilitate targeted community-level interventions. In the past 12 months, a drop in CFR (0.6%) and new cases (11,196 from 6/2012-5/2013) was seen. Significant geographic variation in remaining burden exists, with half of the recent cholera cases seen at 2 of the 10 CTCs. Discussion: Cholera cases continue to cause morbidity and mortality in Haiti. However, at PIH/ZL sites, CFR has decreased over the duration of the cholera epidemic. Our data demonstrate that very low CFRs are achievable in rural Haiti.