Last Thursday, we were advised by the Pan American Health Organisation (PAHO) of laboratory confirmation of cases of cholera in the Artibonite province in Haiti. As of last Saturday, the Ministry of Health in Haiti reported 3,015 cases of cholera resulting in 253 deaths. Cases have been reported in other areas such as Port au Prince, the Ouest and Central Departments. PAHO has been assisting the Ministry of Health in Haiti to assess the situation and take appropriate action to cauterize the outbreak and save lives.
Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The main symptoms are the sudden onset of profuse watery diarrhea of up to 1 litre per hour, vomiting, abdominal pain, rapid increase in heart rate, dry skin and, sometimes, fever. Symptoms can vary from mild to severe. Transmission is primarily through contaminated drinking water or food. The severity of the diarrhea and vomiting can lead to rapid dehydration and electrolyte imbalance and can result in death within hours if left untreated.
Effective control measures rely on prevention, preparedness and response. The provision of safe water and proper sanitation is critical in reducing the risk and impact of cholera and other water borne diseases. Cholera can be treated successfully through prompt administration of oral rehydration salts. Very severely dehydrated patients require administration of intravenous fluids and appropriate antibiotics to diminish the duration of diarrhea, reduce the volume of rehydration fluids needed and shorten the duration of V. Cholera excretion. Mass administration of antibiotics is not recommended as it has no effect on the spread of cholera and contributes to increasing antimicrobial resistance.
Jamaica has not experienced cholera in more than 150 years. The last outbreak of Cholera in Jamaica was in 1852. 32,000 people or 10% of the population died from the disease. In 1991 and 1992, Jamaica was placed on high alert due to an outbreak of Cholera in Peru. At that time, the Ministry of Health prepared the Cholera Prevention Plan (1991), trained health workers, and placed emphasis on surveillance mechanisms and public education.
Given our proximity to Haiti and the interaction of people from both countries, the Government has activated its National Emergency Response mechanism with the Ministry of Health as the lead agency. Last Friday, the Ministry of Health activated its National Emergency Operations Centre, reviewed the Cholera Prevention Plan of 1991 and devised an Action Plan. Island wide surveillance and monitoring activities have been scaled up as a prevention and preparedness measure in keeping with the Prevention Plan. There are currently no reported cases of Cholera in Jamaica.
Over the last few days, the Ministry of Health has been collaborating with other critical agencies to coordinate the country's response and preparedness measures. Yesterday, I convened a meeting with all relevant public sector entities to review ongoing precautionary measures and coordinate the next steps. The emphasis at this time is on Heightened Surveillance and Public Education.
All health facilities have been placed on alert. At the national level, training of senior staff is underway on the clinical identification, treatment and management of Cholera and printed materials have already been dispatched to health facilities. Similar training of community health workers will be conducted by the end of this week. Oral rehydration fluids are available at health facilities and adequate levels of stock are being maintained. Additional stock is on order for intravenous fluids to supply our health facilities. Laboratory testing will be done locally and support is in place through the Caribbean Epidemiology Centre (CAREC) which is also supplying additional reagents for testing.
Approximately 80% of cholera cases can be successfully treated by the use of oral rehydration salts/fluids. The public must be alerted to the heightened need at this time to observe good hygiene practices:
Regular washing of hands especially before preparing and ingesting food and after toilet functions;
Applying a few drops of bleach to water used for domestic purposes;
Boiling water for drinking or drinking purified bottled water;
Ensuring that food is cooked thoroughly before eating;
Avoiding contact with water that may be contaminated.
At the first sign of symptoms such as diarrhea or vomiting, it is important to drink lots of clean, safe water (coconut water is highly recommended) to prevent dehydration. Persons experiencing any such symptom should seek medical attention immediately. Public hospitals and clinics are on alert to treat all such cases with urgency. The chances of recovery are significantly higher if cases are detected at an early stage.
Precautionary screening measures and inspections are being implemented at all our borders using public health officials in collaboration with immigration officials and in keeping with international standards. Airport surveillance for arriving passengers has been intensified and adequate medical personnel will be stationed at our airports to detect and respond to potential or apparent cases of infection. Vessels arriving in Jamaica which may have called at ports in Haiti will be boarded by quarantine officers and thoroughly checked before being allowed to berth. Additional quarantine staff is being deployed to ensure speedy processing. The Port Authority of Jamaica is holding discussions with cruise lines whose ships include Haiti in their itinerary on the appropriate measures being employed to prevent any transmission of this dreaded disease. Coast Guard patrols have been increased to ramp up surveillance of small craft which ply between Jamaica and Haiti. Close monitoring by the Police and Military is also being undertaken at specific beaches used by small craft travelling from Haiti. Heightened surveillance is also being undertaken by JDF personnel stationed at the Pedro Cays where fisher folk interact from time to time with persons from Haiti.
A public education campaign has commenced in earnest with public service announcements to sensitize the public on the preventive and precautionary measures that must be taken at this time. Cholera specific public education messages and features will be aired tomorrow and targeted public education activities will start early next week.
The Government is naturally concerned to ensure that this necessary state of alert does not negatively impact tourist arrivals. I therefore wish to restate that there are no reported cases of cholera in Jamaica and the measures we are taking are designed to ensure that Jamaica continues to be free of cholera. The Jamaica Civil Aviation Authority is taking steps to secure the assistance of International Civil Aviation Organization (ICAO) to conduct inspections of our airports to reassure our tourism partners of our pro-activeness and surveillance practices. The Jamaica Tourist Board is in constant touch with our marketing personnel, tour operators, travel agents and other key operatives to keep them informed of the steps we are taking to ensure that Jamaica remains a safe and healthy destination.
The steps that must be taken to keep Jamaica cholera-free involve concerted action not just by the Government but, also, by every citizen of Jamaica. We must all ensure that we practice good hygiene, wash our hands with soap regularly, drink only boiled water or bottled water, cook our food thoroughly and avoid, as far as possible, contact with water that may be contaminated. We should take special care to ensure that our children do not play in dirty or stagnant water or swim in rivers since cholera is essentially a water-borne disease. Importantly, we should seek medical attention at the first sign of diarrhea or vomiting.
While we must do everything possible to keep Jamaica free of cholera, we cannot ignore the plight of the Haitian people who now face a new crisis even as they struggle to recover from the effects of the January earthquake. I have instructed the Ministry of Health to assemble a team of medical personnel to be available, if the Haitian Government so requires, to go to Haiti to assist in the control and treatment of this disease.