Dr. Alejando Cravioto (Chair) International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
Dr. Claudio F. Lanata Instituto de Investigación Nutricional, and The US Navy Medical Research Unit 6, Lima, Peru
Engr. Daniele S. Lantagne Harvard University, Cambridge, Massachusetts, United States
Dr. G. Balakrish Nair National Institute of Cholera and Enteric Diseases, Kolkata, Indi
Ten months after the devastating earthquake of January 12, 2010, cholera appeared in Haiti for the first time in nearly a century. The outbreak subsequently claimed over 4,500 lives, sickened almost 300,000 people, and continues to cause infections and deaths in Haiti. The source of the cholera has been controversial, with hypotheses that the pathogen that causes cholera (Vibrio cholerae) arrived into Haiti from the Gulf of Mexico due to tectonic shifts resulting from the earthquake, evolved into disease-causing strains from non-pathogenic strains naturally present in Haiti, or originated from a human host who inadvertently introduced the strain into the Haitian environment. A specific form of the third hypothesis, that soldiers deployed from a choleraendemic country to the Mirebalais MINUSTAH camp were the source of the cholera, is a commonly held belief in Haiti.
In order to determine the source of the outbreak definitively, the Secretary-General of the United Nations
formed an Independent Panel of four international experts (the “Independent Panel”), with a mandate to
“investigate and seek to determine the source of the 2010 cholera outbreak in Haiti”. To fulfill this mandate,
concurrent epidemiological, water and sanitation, and molecular analysis investigations were carried out.
On October 22nd, 2010, the first cholera case in Haiti in nearly a century was confirmed at the Haiti National Public Health Laboratory. A review of hospital admission records along the Artibonite River from the mountains of Mirebalais to St. Marc on the coast clearly showed that a normal background rate of non-fatal diarrheal disease in adults and children was abruptly interrupted by the onset of a cholera outbreak. The first hospitalized cholera case in Mirebalais, in the upstream region of the Artibonite River, was on the evening of October 17th, 2010. The first hospitalized cholera cases on the coast, in the Artibonite River Delta in St. Marc and Deschapelle, were on October 20th, 2010. The outbreak was widely established in the coastal areas by October 22nd, 2010. The timeline suggests that the outbreak spread along the Artibonite River.
After establishing that the cases began in the upper reaches of the Artibonite River, potential sources of contamination that could have initiated the outbreak were investigated. MINUSTAH contracts with an outside contractor to handle human fecal waste. The sanitation conditions at the Mirebalais MINUSTAH camp were not sufficient to prevent fecal contamination of the Meye Tributary System of the Artibonite River. Water in the Meye Tributary System reaches the Artibonite River junction in less than 8 hours, and flows downstream in another 1-2 days to a dam and canal system widely used for irrigation throughout the Artibonite River Delta.
Several independent researchers studying genetic material from the bacteria responsible for the outbreak of cholera in Haiti graciously provided their results to us. They used a variety of molecular analysis techniques to examine multiple samples of the bacteria. Their results uniformly indicate that: 1) the outbreak strains in Haiti are genetically identical, indicating a single source for the Haiti outbreak; and, 2) the bacteria is very similar, but not identical, to the South Asian strains of cholera currently circulating in Asia, confirming that the Haitian cholera bacteria did not originate from the native environs of Haiti.