Warden Message No. 120
Cholera Outbreak in the Artibonite Alert on October 22, 2010
U.S. Embassy Port-au-Prince issued the following Warden Message on October 22, 2010:
The U.S. Embassy in Port-au-Prince is issuing this Warden Message to alert U.S. citizens that The Ministry of Health in Haiti has issued a statement that the diarrhea outbreak in the Artibonite region is due to cholera. Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholera. The infection is generally mild or without symptoms, but can sometimes be severe. Common symptoms may include watery diarrhea, vomiting, and leg cramps. The most important treatment is rehydration, which can almost always be accomplished with oral rehydration.
Dehydration can be corrected with any fluid, and a patient should drink any available appropriate fluid while oral rehydration fluid is sought. In cases where vomiting is also prominent, oral rehydration solutions (ORS) were designed to be rapidly absorbed from the intestine. If ORS is thought to be indicated, many stores and pharmacies carry ORS. Travelers to remote areas should carry their own ORS packets, which can be added to boiled or treated water.
Standard World Health Organization (WHO) ORS tastes salty and is often unpalatable to travelers. Flavored rice-based ORS (Ceralyte) is also available and may be more palatable. Solution held at room temperature should be consumed or thrown away within 12 hours. If it has been kept refrigerated, it must be discarded after 24 hours. If commercial ORS is not readily available, the replacement solution can be made by drinking alternating glasses of fluid. Glass #1: drink 8 oz. fruit juice plus ½ tsp corn syrup or honey or sugar plus a pinch of salt. Glass #2: drink 8 oz. boiled water plus ¼ tsp baking soda.
There is no cholera vaccine currently available in the USA, and vaccination is not generally recommended. Antibiotics are generally not indicated. Although diarrhea can be dramatic, leading to dehydration and shock, the U.S. Government has not experienced any significant cholera illnesses despite our people being stationed in endemic areas, e.g., Bangladesh.
A person can become infected with cholera by drinking contaminated water or eating contaminated food. Since the source of contamination is usually feces of an infected person, the disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.
PREVENTION: FOOD AND BEVERAGE PRECAUTIONS
Cholera is caused by spread by contaminated food and water. Risk can be minimized by following the guidelines below.
· Eat at establishments that are known to cater to foreigners or that are specifically known by other foreigners to be safe.
· Eat foods that are well-cooked and served steaming hot.
· Eat breads, tortillas, crackers, biscuits, and other baked goods.
· Eat fruits, nuts, and vegetables with thick skins, peels, or shells that you remove yourself.
· Eat canned foods.
· Always wash your hands with soap before eating and after using the toilet.
· Eat any food from street vendors or market stalls.
· Eat leafy or uncooked vegetables and salads.
· Eat undercooked, raw, or cold meat, seafood, and fish.
· Eat or drink unpasteurized dairy products such as cheese, yogurt, and milk. Be particularly wary of ice cream and other frozen confections that may have been made or stored in contaminated containers.
· Eat cold sauces such as mayonnaise, salad dressing, chutneys, or salsas, which are usually raw and made by hand.
· Eat buffet foods such as lasagna, casseroles, and quiches—unless you know they are fresh (not reheated) and have been kept steaming hot. Avoid buffets where there are no food covers or fly controls.
· Eat creamy desserts, custards, or sauces that may not have been adequately refrigerated.
No tap water should be considered safe to drink.
· Use sealed bottled water or chemically treated, filtered, or boiled water for drinking and for brushing teeth.
· Drink beverages made only with boiled water whenever possible (such as hot tea and coffee). Water boiled for any length of time (even 1 minute), at any altitude, is safe to drink.
· Drink canned, boxed, or commercially bottled carbonated water and drinks. International brands are safest. Beware of unsealed containers that may have been re-filled.
· Safely drink beer and wine; however, alcohol added to beverages does not render them safe.
· Carry safe water with you if you are going out for the day and where availability of safe water is not assured.
· Breast-feeding is the safest food source for infants who are still nursing. If formula is used, it must be prepared with boiled water and sterilized containers.
· Drink tap water.
· Rinse toothbrush in tap water.
· Use ice unless it is made from boiled, bottled, or purified water. Freezing does not reliably kill organisms that cause diarrhea.
· Drink from wet cans or bottles—the water on them may be contaminated. Dry wet cans/bottles before opening and clean all surfaces that will have contact with the mouth.
· Drink fruit juice unless it comes directly from a sealed container; otherwise it may have been diluted with tap water.
Additional information on news of the diarrhea outbreak, confirmation of Cholera, the Haitian Government’s response, the on-going outbreak investigation, the areas affected in the Artibonite and Central Plateau departments, and the U.S. Government’s response to control the outbreak and prevent further infection, and recommended treatment can be found at the U.S. Embassy’s website: http://haiti.usembassy.gov/
American citizens are advised to avoid this area and should monitor media coverage to stay abreast of the situation as it develops. U.S. citizens are advised to maintain an increased level of vigilance when traveling in and around Port-au-Prince. They should be aware of their surroundings at all times and are encouraged to register with the U.S. Embassy.