Independent, UN panel confirms Haiti cholera outbreak caused by South Asian strain
UNITED NATIONS — The cholera outbreak that has killed nearly 5,000 people in Haiti was caused by a South Asian strain that contaminated a river where tens of thousands of people wash, bath, drink and play, a U.N. independent panel of experts said Wednesday.
Although many have blamed the epidemic on U.N. peacekeepers from South Asia working in Haiti, the report issued by the panel declined to point the finger at any single group for the outbreak, saying it was the result of a “confluence of circumstances.”
“The evidence overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meye Tributary of the Artibonite River with a pathogenic strain of current South Asian type Vibrio cholerae as a result of human activity,” the report said.
It said the panel concluded the epidemic “was not the fault of, or deliberate action of, a group or individual.”
U.N. Secretary-General Ban Ki-moon requested the independent probe amid reports of poor sanitation at a U.N. base housing Nepalese peacekeepers near Mirebalais, the central town where the outbreak was first reported.
Besides killing almost 5,000 people in a country still recovering from a devastating earthquake more than a year ago, the outbreak has sickened another 250,000.
The belief that the Nepalese peacekeepers are to blame for the epidemic is widespread in Haiti, straining relations between the population and U.N. personnel. Angry protests berating the peacekeepers erupted late last year, and just last week about 100 demonstrators blamed the United Nations for the spread of cholera.
Ban will carefully consider the panel’s findings and recommendations, U.N. spokesman Martin Nesirky said.
The spokesman said the U.N. chief will convene a task force to study the findings and recommendations to ensure they are dealt with promptly.
Haitian officials in the health ministry declined to comment Wednesday afternoon, saying they had not yet read the report. The U.N. envoy to Haiti Edmond Mulet was to deliver the report to the government Wednesday.
Doctors Without Borders, a medical charity that has treated about 130,000 cholera patients since the outbreak, welcomed the report’s release. "We’re happy that there’s a process to ensure the origins of the epidemic can be investigated, and that the report has been made public for full transparency,” said Sylvain Groulx, the group’s chief of mission in Haiti.
The report came amid concerns from the U.S.-based medical aid group Partners in Health that an increase in new cholera patients in rural Haiti may signal a new surge of the epidemic with the onset of the spring rainy season.
Panel members said Haiti’s outbreak underscored the need for U.N. personnel and other first responders coming from countries where cholera is endemic to be screened for the disease, receive a prophylactic dose of appropriate antibiotics before departure, or both. They also recommended that U.N. installations worldwide treat fecal waste using on-site systems “that inactivate pathogens before disposal.”
In their report’s conclusions, panel members said the Artibonite River’s canal system and delta “provide optimal conditions for rapid proliferation” of cholera, that Haitians lacked immunity to the disease, and that many areas of the country suffer from poor water and sanitation conditions.
It also said the South Asia strain that caused the outbreak “causes a more severe diarrhea due to an increase in the production of a classical type of cholera toxin and has the propensity of protracting outbreaks of cholera.”
“The conditions in which cholera patients were initially treated in medical facilities did not help in the prevention of the spread of the disease to other patients or to the health workers,” it added.
“The introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care system deficiencies,” panel members said.
The Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti can be read here:
Cholera: UN Cholera Panel Builds Case Against UN Blue Helmets, Then Clears Them
By Colum Lynch, Foreign Policy, May 5, 2011
On Wednesday evening, Ban Ki-moon's office abruptly released a long-awaited report by an independent medical panel the U.N. chief had commissioned to "investigate and seek to determine the source of the 2010 cholera outbreak in Haiti." The four-member team, headed by Dr. Alejandro Cravioto, head of the International Center for Diarrhoeal Disease Research in Dhaka, Bangladesh, never really fulfills that mandate.
Instead it concluded that the forces contributing to the spread of a disease-poor sanitation and a dysfunctional health care system -- were so varied as to make it impossible to identify a specific culprit. "The independent panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances as described above, and was not the fault of, or deliberate action of, a group or individual," according to the panel's report.
But the report's underlying findings appear unlikely to do much to allay Haitian suspicions that the deadly epidemic that killed 4,500 Haitians and sickened more than 300,000 was delivered to Haiti's doorstep by a contingent of U.N. blue helmets from Nepal. On the contrary, the report adds to the existing evidence suggesting that U.N. peacekeepers are among the most likely sources.
Cholera made its first appearance in nearly a century in Haiti last October, and even today, it continues to kill and sicken Haitians. The panel concluded that the disease was introduced into the Haitian population by human activity in the Meye Tributary, a branch of the Artibonite River, and quickly spread throughout the river delta, infecting thousands of Haitians along the way. At the time, Nepalese peacekeepers were stationed at a camp in Mierbalais, along the banks of the Meye, fueling suspicion that the waste of an infected peacekeeper had flowed into the river.
The panel dismissed an earlier study by a French epidemiologist, Renaud Piarroux, who concluded that the cholera outbreak was introduced into Haiti by an infected U.N. soldier, saying he had not provided sufficient evidence to support his case. The panel also noted that U.N. medical records show no evidence that Nepalese peacekeepers had shown signs of illness before or during the outbreak.
But the panel compiled circumstantial evidence pointing at the Nepalese peacekeepers as a possible cause. Genetic analysis reviewed by the panel indicated that the Haitian cholera strain all but certainly originated in South Asia, and possibly came from Nepal. One set of genetic tests examining mutations in cholera gene samples indicated that "the strains isolated in Haiti and Nepal during 2009 were a perfect match."
The panel also found that the "sanitation conditions" at the U.N. camp in Mirebalais "were not sufficient to prevent contamination of the Meye Tributary System with human fecal waste." The timeline of the cholera's spread, which struck communities throughout the delta in a matter of days, "is consistent with the epidemiological evidence indicating that the outbreak began in Mirebalais and within two to three days cases were being seen throughout the Artibonite River Delta." In sum, "the evidence overwhelming supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meye Tributary of the Artibonite River with a pathogenic strain of current South Asian type Vibrio cholarae as a result of human activity."
Suspicion first fell on the Nepalese contingent, which arrived at Mirebalais between Oct. 8 and Oct. 24, the same period the first cholera deaths were recorded in the region. The troops had just completed three months of training in Kathmandu, Nepal, and a medical exam, though the panel does not say whether they were screened for cholera. The soldiers were then allowed to return to their homes for 10 days before traveling to Haiti. Peacekeepers from other countries, including a contingent of 60 Bangladeshi policemen posted at Mierbalais, were also deployed in the area. "The precise country from where the Haiti isolate of Vibrio cholerae arrived is debatable," the panel stated. But the "initial genetic analysis" indicates similarities with strains found in South Asia, including Nepal.
The panel acknowledges that the outbreak highlights the inherent risk of spreading cholera through the deployment of foreign aid workers and peacekeepers in a crisis zone. And it prescribes a series of measures the U.N. should undertake -- including improve sewage treatment in UN camps, cholera screening and the distribution of antibiotics -- to prevent the introduction of cholera into a vulnerable trouble spot. But the report provides no discussion of whether the U.N. or the team sought to conduct their own tests of the Nepalese peacekeepers after the outbreak to determine whether any had been infected.
The panel nonetheless decided to give the United Nations, and the Nepalese, the benefit of the doubt. "The introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care deficiencies. These deficiencies, coupled with conducive environmental and epidemiological conditions, allowed the spread of the Vibrio cholerae organism in the environment, from which a large number of people became infected."
In the end, the panel echoed the U.N.'s talking points throughout the cholera crisis: that the battle to end the scourge should take priority over determining how it got there. "The source of cholera in Haiti is no longer relevant to controlling the outbreak," he said. "What are needed at this time are measures to prevent the disease from becoming endemic," the report concluded.
Surely, no one would quibble with that sentiment. But wasn't the panel's primary mission to do just that?
Verdict: Haiti's Cholera Outbreak Originated in UN Camp
By Richard Knox, NPR News, May 6, 2011
Suspicions that U.N. peacekeepers brought cholera to Haiti last fall are so incendiary in that beleagured nation that most health experts fighting the outbreak have refused to discuss it. But an expert panel appointed by U.N. Secretary-General Ban Ki-Moon has concluded those suspicions are correct. In a 32-page report released quietly on Wednesday, the four-person panel leaves no doubt that cholera spread quickly from a U.N. camp in the upper Artibonite River valley to waters used by tens of thousands of Haitians for bathing, washing and drinking.
So far, Haiti's cholera epidemic has sickened nearly 300,000 people and killed 4,500 of them.
While the U.N. panel stops short of saying Nepalese peacekeepers carried cholera to Haiti, their report says preliminary genetic tests indicate "the strains isolated in Haiti and Nepal ... were a perfect match." Reflecting the sensitive nature of their findings, the panel takes pains to say the explosive outbreak was due to a "confluence" of factors "and was not the fault of, or deliberate action of, a group or individual."
Some of those factors are:
- Widespread use of the Artibonite River and its tributaries for washing, bathing and drinking;
- Lack of immunity to cholera in Haiti, where the disease hasn't been seen for nearly a century;
- Poor water and sanitation conditions in Haiti; and
- An especially virulent type of cholera, with a toxin that causes more severe diarrhea.
While all of those things contributed, the experts don't mince words in saying cholera was introduced into Haiti and spread from the U.N. camp where peacekeepers were quartered. "The sanitation conditions at the [U.N. camp] were not sufficient to prevent contamination of the Meye Tributary System with human fecal waste," the report says. The Meye River feeds into the Artibonite, Haiti's longest river.
Sewage from the UN camp could have gotten into the river system in two ways — from a drainage canal running through the camp or from an open septic pit near the Meye River where a private contractor dumped sewage from the camp.
The experts say Hurricane Thomas last November and a flood in the region last summer played no role in spreading cholera. The report says the U.N. should clean up its facilities around the world to make sure fecal wastes don't contaminate the environment.
Beyond that, the group says all U.N. personnel mobilized for emergencies should be vaccinated against cholera, receive prophylactic antibiotics, or both. Personnel from areas where cholera is endemic should be screened for cholera before they go to countries where it isn't a problem. And the panel says authorities should look into using cholera vaccines to reduce spread of the disease once an outbreak has occurred – an idea that's controversial among health experts.
Secretary-General Ban says he will appoint a task force to study the panel's findings and "ensure prompt and appropriate follow-up."