The Cure for Cholera - Improving Access to Safe Water and Sanitation

From the School of Public Health and Health Services, George Washington University, Washington, DC (R.J.W.)
New England Journal of Medicine (Impact Factor: 55.87). 01/2013; 368(7). DOI: 10.1056/NEJMp1214179
Source: PubMed


Whenever epidemics of cholera occur, the global public health community is energized. Experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted. In the past two decades, these things happened after cholera appeared in Latin America in 1991, in the wake of the Rwandan genocide and the ensuing refugee crisis in Zaire (now Democratic Republic of Congo) in 1994, in Zimbabwe in 2008, and in October 2010, at the onset of the ongoing epidemic in Haiti (see article by Barzilay et al.). But even when it is not covered in the news . . .

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    • "How DINEPA reconciles this complex fabric of post-earthquake water-related infrastructure into a usable network for communities that currently rely on a collection of single-point sources for access to water will determine the impacts that this infrastructure has on public health outcomes in the future. Assuring access to safe water is a challenging problem particularly confounded by the complex post-earthquake context of Haiti, where cholera remains a threat.15 Challenges surrounding surveillance of this water-related infrastructure cannot be addressed until a clearer understanding of what exists on the ground develops and how this infrastructure impacts the quality of water it supplies. "
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    ABSTRACT: We inventoried non-surface water sources in the Leogane and Gressier region of Haiti (approximately 270 km2) in 2012 and 2013 and screened water from 345 sites for fecal coliforms and Vibrio cholerae. An international organization/non-governmental organization responsible for construction could be identified for only 56% of water points evaluated. Sixteen percent of water points were non-functional at any given time; 37% had evidence of fecal contamination, with spatial clustering of contaminated sites. Among improved water sources (76% of sites), 24.6% had fecal coliforms versus 80.9% in unimproved sources. Fecal contamination levels increased significantly from 36% to 51% immediately after the passage of Tropical Storm Sandy in October of 2012, with a return to 34% contamination in March of 2013. Long-term sustainability of potable water delivery at a regional scale requires ongoing assessment of water quality, functionality, and development of community-based management schemes supported by a national plan for the management of potable water.
    The American journal of tropical medicine and hygiene 10/2014; 91(4). DOI:10.4269/ajtmh.14-0165 · 2.70 Impact Factor
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    ABSTRACT: In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using data from Malawi. Over the next two decades, scalable WASH interventions could avert 57,949-78,567 cholera cases, OCV could avert 38,569-77,636 cases, and interventions that combined WASH and OCV could avert 71,586-88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect.
    The American journal of tropical medicine and hygiene 10/2013; 89(4):633-640. DOI:10.4269/ajtmh.13-0201 · 2.70 Impact Factor
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    ABSTRACT: Successful and sustained efforts have been made to curtail the major cholera epidemic that occurred in Haiti in 2010 with the promotion of hygiene and sanitation measures, training of health personnel and establishment of treatment centers nationwide. Oral cholera vaccine (OCV) was introduced by the Haitian Ministry of Health as a pilot project in urban and rural areas. This paper reports the successful OCV pilot project led by GHESKIO Centers in the urban slums of Port-au-Prince where 52,357 persons received dose 1 and 90.8% received dose 2; estimated coverage of the at-risk community was 75%. This pilot study demonstrated the effort, community mobilization, and organizational capacity necessary to achieve these results in a challenging setting. The OCV intervention paved the way for the recent launching of a national cholera vaccination program integrated in a long-term ambitious and comprehensive plan to address Haiti's critical need in water security and sanitation.
    The American journal of tropical medicine and hygiene 10/2013; 89(4):671-681. DOI:10.4269/ajtmh.13-0171 · 2.70 Impact Factor
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