Health Cluster Bulletin
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HEALTH CLUSTER BULLETIN CHOLERA AND POST-EARTHQUAKE RESPONSE IN HAITI – FRIDAY, MARCH 9, 2011 – #21 Highlights The national strategy for cholera response, jointly developed by MSPP with PAHO/WHO’s support, has been finalized and is pending for final validation from MSPP. According to the MSPP on the transition strategy of phasing out NGOs from the CTCs and CTUs, NGOs should keep the infrastructure (CTC, CTU, ORC) in place with enough supplies to keep them functioning and ensure a hand over to the MSPP or to another NGO capable to run the service. Taking into consideration the stabilizing trend and reduction of cholera cases, the MSPP expressed the need for the health actors operating in Haiti to move towards a strategy to rebuild the health system, where the reconstruction of health infrastructure and training of professionals are the priority There is an urgent need to strengthen WASH coordination and activities at the departmental level Heightened vigilance is required due to the increased risk for spread of cholera related to the carnival celebrations. It is now time to take advantage of the lessons learned during the cholera epidemic and revisit the public health surveillance system in an integrated manner, focusing on institutionalization of the systematic use of all sources of information, for early warning and timely decision making. Officials from Haiti’s MSPP met with counterparts from PAHO/WHO, UNICEF, and other partners to outline the new plan to improve immunization services in Haiti over the next five years. Dear health partners, While there is a marked decrease in the incidence of cholera cases, the proximity of the carnival, elections campaign, and rainy season are risk factors that can have a negative impact in the decreasing trend. Aware of these risks, MSPP as well as some of the NGOs are staying vigilant and delaying the closing of treatment centers. Thank you, Health Cluster Coordination Alerts in Archaie triggered rapid response from MSPP, PAHO/WHO, and the Red Cross The Ministère de la Santé Publique et de la Population (MSPP) and PAHO, the Regional Office of the World Health Organization (WHO) for the Americas, coordinate the Health Cluster. MSPP Cluster Contacts: Dr. Claude Surena; Dr. Jean Hugues Henrys; PAHO/WHO Contacts: Dr. Juan Carlos Gustavo Alonso; Dr. Josep Vargas Health Cluster partners are asked to contribute to this bulletin with information on needs and activities as well as corrections to content, by emailing [email protected] (subject heading: Health Cluster Bulletin). For useful information on meetings, guidelines, and CTC, CTU, and health facility locations, visit: http://haiti.humanitarianresponse.info. HAITI HEALTH CLUSTER BULLETIN #21 – PAGE 2 Situation Overview According to the data sent by the MSPP, the cumulative number of reported cholera cases up to 21st of February is 243,197, including 4,626 deaths. Despite the downward trend during the last periods, the number of hospitalized cholera cases (5,934) reported during the week of 15-21 February, 2011 has been the highest since week of 17 January 2011 (Figure 1). The West Department accounts for 43% of the reported hospitalized cases during week 15-21 February 2011. The case fatality rate observed among hospitalized cases was 2.1%. Figure 1 Cumulative number of cholera cases hospitalised by week of reporting (N=132,232) Haiti, 8 Nov 2010 to 21 Feb 2011 120,000 80,000 40,000 Nb Nb hospitalizations 0 08/11/2010 22/11/2010 06/12/2010 20/12/2010 03/01/2011 17/01/2011 31/01/2011 14/02/2011 Week of reporting Methanol poisoning: On 25 January, 12 people died in Archaie. The symptoms were compatible with methanol poisoning. On 17 February, at the Cabaret Health Centre, Nord-Baie de Haine, 3 people died with the same symptoms. The investigation carried out found that all of them consumed a local alcoholic beverage, Clairin, which is the suspected source of poisoning. On 24 February, 4 additional people died in Baie de Henne. On 2 March, a team of MSPP and PAHO- WHO started an investigation which is still ongoing. The treatment protocol for methanol poisoning has been made available. PAHO/WHO has funded a sensitization campaign in Cabaret. No more cases have been reported in the last period. It is necessary to improve access to drinking water and environmental sanitation in order to maintain the positive trend of the cholera epidemic. There is a constant concern expressed at the departmental level to increase efforts in the WASH sector, ensure better coordination of actors and invest more by national authorities and the international actors. Though the UNHAS air operation is currently only funded until the end of February 2011, WFP has decided to keep the Mi-6 helicopter until the end of May 2011, as the aircraft is still needed to deliver life-saving cholera relief items to remote mountainous areas. WFP is currently approaching donors to request for additional funding to keep the service active. The fixed-wing aircraft includes 410 service, however, will be discontinued in April 2011 due to maintenance issues. A decision will be taken to determine whether to bring it back at a later date. Officials from Haiti’s MSPP met with counterparts from PAHO/WHO, UNICEF, and other partners to outline their new plan to improve immunization services in Haiti over the next five years. The new Haiti plan covers routine vaccination, epidemiological surveillance, social mobilization, communication, training and management from 2011 through 2015, with detailed costs and plans for inclusion of pentavalent and other new vaccines. Its aim is to strengthen Haiti’s basic Expanded Program on Immunization and convert it into a National Immunization Program targeting families. More information can be found on: http://new.paho.org/hq/index.php?option=com_content&task=view&id=5111&Itemid=1926&lang =en HAITI HEALTH CLUSTER BULLETIN #21 – PAGE 3 Cholera health structures: 10 January 16 January 23 January 30 January 6 February 13 February 20 February Operational CTC 81 85 101 101 100 98 98 Operational CTU 156 129 165 185 188 215 215 Epidemiological Surveillance Indicator-based component As stated above, between 20 October 2010 and 21 February 2011, the cumulative number of reported cholera cases was 243,197, including 4,626 deaths. The observed cumulative incidence since the beginning of the outbreak was of 23.5 per 1,000 inhabitants, ranging from 4.0 per 1,000 in the Department of South-East to 38.2 per 1,000 in the Department of Artibonite (Figure 2). Figure 2: Cumulative incidence of reported cholera cases (number of cases per 1,000 inhabitants), by Department, 20 October 2010 - 21 February 2011 The observed overall case fatality rate was 1.9%, ranging from 0.9% in Port-au-Prince to 9.4% in the Department of South-East. Since the beginning of the outbreak, 89.4% (217,432) of the reported cases were observed among individuals aged 5 years or more, and the proportion of cases observed in children less than 5 years ranged from 5.5% in the Centre Department to 13.9% in the Artibonite Department. Of the total number of reported cholera cases, 54% (132,232) had been hospitalized since the beginning of the outbreak (Figure 3) HAITI HEALTH CLUSTER BULLETIN #21 – PAGE 4 Figure 3 Cumulative number of cholera cases hospitalised by week of reporting (N=132,232) Haiti, 8 Nov 2010 to 21 Feb 2011 120,000 80,000 The number of hospitalized cholera cases (5,934) reported during the week of 15-21 February 2011, was the highest since week ending40,000 on 17 January 2011 (Figure 4). The Department of West accounts for forty-three percent (43%) Nb hospitalizations of the reported hospitalized cases during week 15-21 February 2011. The case fatality ratio observed among hospitalized0 cases was 2.1%, ranging from 1.4% in the Department of North West to 3.2% in the Department of Grande Anse. 08/11/2010 22/11/2010 06/12/2010 20/12/2010Figure03/01/2011 4 17/01/2011 31/01/2011 14/02/2011 Week of reporting Number of cholera cases hospitalised by week of reporting (n=132,232) Haiti, 8 Nov 2010 to 21 Feb 2011 20,000 15,000 10,000 5,000 Nb Nb hospitalizations 0 08/11/2010 22/11/2010 06/12/2010 20/12/2010 03/01/2011 17/01/2011 31/01/2011 14/02/2011 Week of reporting Event-based component (alerts) The number of daily alerts received from partners in the field is leveling off, and increasingly reflect hazards other than cholera and cholera hot spots in remote areas (Figure 5). However, the rainy season, carnival celebrations, as well as the phasing out of cholera treatment centres and units calls for heightened attention by health authorities and partners involved in surveillance activities, both at health care facility and community level. An accurate and timely monitoring of the evolution of the cholera outbreak that allows for prompt control intervention requires the integration and triangulation of all sources of information: formal and informal, quantitative and qualitative, health care facility based and community based. The contribution of the event based alert component introduced and systemized during the cholera outbreak has proven increasingly valuable in ensuring the early warning function with respect to other public health events. Therefore, efforts should be made by health authorities and HAITI HEALTH CLUSTER BULLETIN #21 – PAGE 5 partners to support the process related to the integration of all information sources that would also allow a more effective information management process. Figure 5 Number of alerts related to public health events received and followed up by date of receipt (N= 392) Haiti, 8 Nov 2010 - 28 Feb 2011 20 18 16 14 12 10 8 6 Nombre d' alertes 4 2 0 1/3/2011 2/7/2011 11/8/2010 12/6/2010 1/10/20111/17/20111/24/20111/31/2011 2/14/20112/21/20112/28/2011 11/15/201011/22/201011/29/2010 12/13/201012/20/201012/27/2010 Date notification Wash (Environmental Health) The excreta situation has not improved or advanced since December.