In Cuba, authorities maintain active and strict clinical-epidemiological surveillance of acute diarrheal diseases, studying every suspected case.
In early 2013, the National IHR Focal Point of Cuba reported that by 14 Jan 2013, there were 51 confirmed cases of cholera in an outbreak in Havana related to food handling. Previously, a total of 47 cholera cases had been reported following Hurricane Sandy in the provinces of Camaguey, Guantanamo and Santiago de Cuba. All cases were characterized as Vibrio cholerae toxigenic serogroup O1, serotype Ogawa, biotype El Tor.
Between late July and early August 2013, 5 cases of cholera associated with a history of travel to Cuba were confirmed, as follows:
Italy ex Cuba
On 24 Jul 2013, the National IHR Focal Point for Italy reported to WHO a confirmed case of cholera (V. cholerae serogroup O1 Ogawa) in a 47 year old male patient with travel history to Havana from 23 Jun to 13 Jul 2013. Relevant details of the case, including detailed travel history while in Cuba and further laboratory investigations were shared with competent local authorities in Cuba and WHO.
Venezuela ex Cuba
On 9 Aug 2013, the National IHR Focal Point for Venezuela confirmed 2 cases of cholera (V. cholerae serogroup O1 Ogawa) in a 51 year old male and a 55 year old female with history of travel to Havana, Cuba.
Chile ex Cuba
On the same date, 9 Aug 2013, the National IHR Focal Point for Chile reported 2 cases of cholera, one laboratory confirmed (V. cholerae serogroup O1 Ogawa) and the other by epidemiological link, in persons returning from travel to Cuba.I'm only partially chastened. The PAHO report is very carefully worded and sticks only to the official Cuban reports of cholera plus the foreign cases. Those cases have a "history of travel" to Cuba, but how and where they contracted it is left unsaid.
The Italian case is news to me, and I don't find mention of it in four major Italian newspapers. I note that the details of the case "were shared with competent local authorities in Cuba and WHO," but they do not seem to have been published by WHO or the authorities.
So PAHO is admitting what it can't ignore, such as the many cases of domestic cholera reported by Cuban dissidents.
And of course it's not admitting anything about the causes of the original cholera outbreak in Haiti and its prompt migration to the Dominican Republic.