It is now officially hurricane season. Rains have picked up over the previous weeks and this is already causing a surge in the number of new cholera cases. The most recent data from the MSPP (Ministere de la Sante Publique et da la Population) show that there have been over 320,000 cases, 170,000 hospitalizations and that 5,337 people have died as a result of the disease. In a statement on June 1, the Pan American Health Organization (PAHO) noted that:

During the last days the MSPP and PAHO/WHO have observed an increase in the number of alerts of cholera cases, mainly in the Departments of South-East, Grand-Anse, South, Center and West. New cholera cases have been reported in IDP camps.
Also pointing out that, "due [to] lack of resources numerous NGOs have been withdrawing from these areas and interrupting their water-trucking programs. This situation makes more vulnerable the health of the IDP populations." The Health Cluster vulnerability analysis shows that the West department, because of the high concentration of IDPs, is the most at-risk part of the country. Yesterday, Oxfam reported an increase in cholera cases in the area of Carrefour where, according to the IOM, over 60,000 IDPs are spread between 124 sites. Oxfam public health promoter Mimy Muisa Kambere said:

The current cholera outbreak in the Carrefour area is far worse than the one registered in November. At that time, there were a maximum of 900 reported cases of cholera per week. Now, over 300 new cases are registered every single day. However, the number of casualties is far lower than we saw in November as people are able to get help faster.

Doctors Without Borders released a statement of their own today, also noting a marked increase in cases in the capital:

MSF had to reopen emergency CTCs to prevent existing treatment centres in Carrefour, Delmas, Martissant, Cité Soleil and Drouillard from being overwhelmed.

"Since May 29, in one week, MSF has treated almost 2,000 patients in the capital, and we have also been asked to intervene in other areas in the interior of the country, " said MSF head of mission Romain Gitenet.

The other department most at-risk is the Sud Est, where the "overall trend of cholera cases is increasing sharply". The fatality rate in the department continues to be over eight percent compared to a countrywide rate of below two percent.

The most recent Health Cluster bulletin also shows the declining coverage of cholera treatment facilities. From March 16 to May 16 the number of Oral Rehydration Centers has increased from 692 to 810, however the number of Cholera Treatment Centers (CTC), which typically have 40-300 beds, have decreased from 98 to 46. The number of Cholera Treatment Units (CTU), typically with 2-20 beds, has decreased from 214 to 210. The UN funding appeal for cholera remains just 49 percent funded as of May 20, only 4 percentage points higher than it was on February 4.

As the Haitian government and other partners try to ramp up their efforts in combating the epidemic, a group of 44 experts, including Dr. Paul Farmer of Partners in Health, have published a paper in the journal PLoS Neglected Tropical Diseases outlining "a comprehensive, integrated cholera response in Haiti." The authors write that the Haitian government must be in the lead and that efforts to respond to the epidemic "should be used as a wedge to bolster primary health care services and strengthen the Haitian health system." Specifically, the document outlines three main points:

First, we must continue aggressive case finding and scale up treatment efforts, including oral rehydration therapy, intravenous rehydration, antibiotic therapy (for moderate and severe cases), and complementary supplementation with zinc and vitamin A. Second, we must shore up Haiti's water infrastructure by building systems for consistent chlorination and filtration at public water sources and by distributing point-of-use water purification technologies. We must also strengthen sanitation infrastructure by improving and expanding waste management facilities (such as sewage systems and latrines) and waste monitoring. Third, we must link prevention to care by bolstering surveillance, education campaigns (about hand-washing, for example), and water, sanitation, and hygiene (WASH) efforts. Prevention must also include advocacy for scaled-up production of cholera vaccine and the development of a vaccine strategy for Haiti.
Implementation of their strategy, the authors note, "will require political will and substantial, long-term financial commitments from global health authorities, donors, and health providers." In other words, more support than the $7 million the UN cholera appeal has received in the last three and a half months. For a point of reference, the expected cost of opening just a single CTC with 200 beds for three months is $1 million.