Declan Butler is one of the best science and health reporters in the world. In Nature News, he writes: Cholera tightens grip on Haiti. Excerpt:
Until the 1970s, when oral rehydration therapy was widely introduced, death rates during outbreaks often exceeded 50%. But cholera is eminently treatable if patients are promptly rehydrated, and public-health responses to cholera epidemics typically reduce mortality rates to below 1%.
Experts think that conditions in Haiti are resulting in far higher death rates than this. At the beginning of the outbreak, mortality was estimated at around 9%, falling to an estimated 4–6% over the past few weeks as patients began to be treated.
That gain, however, has been wiped out by riots that were fanned by rumours that Nepalese UN peacekeepers were the source of the outbreak. The row over the source has been self-defeating, says Jon Andrus, deputy director of the Pan American Health Organization (PAHO), the regional office of the World Health Organization. With many of the sick unable to get past roadblocks to reach treatment centres, and deliveries of supplies held up, death rates have again soared past 9%, he says.
The precise death toll is uncertain, like everything else about the outbreak. PAHO relies partly on a vast network of humanitarian groups and non-governmental organizations, such as Doctors Without Borders and the UN Children's Fund, to collect and report data from the field. Many of these groups aren't coordinated well with each other, and Andrus says that it's a huge challenge to ensure data quality, adherence to a standardized cholera case definition, and timely reporting.
"Coordinating these groups on a normal day in Haiti would be difficult enough, but in post-earthquake Haiti in the middle of a cholera outbreak, it becomes a huge challenge," he says.
