A survey conducted from May 2010 to October 2013 in five from ten departments of Haiti among 5,342 persons aged from 1 to 107 years showed a gametocytic rate = 3.2%. However, it varies greatly from one Department to another, ranging from 0.5% in Grande Anse Department to 5.9% in Southeast Department. Malaria is present in Haiti in heterogeneous coastal foci. Gametocytes occur at all ages, but two times most often in male under 20 years. Entomological studies in Haiti are needed to better characterize the relationships between man and the vector Anopheles albimanus, adapting the fight more effectively.

Malaria is considered to be a major problem of public health in Haiti. However the impact of Plasmodium falciparum on health is poorly known in this country. The objective of this study is to verify the incidence of malaria as the cause of hospital consultation and to evaluate the rate of P. falciparum gametocytes carriage among the population living in a municipality within the Department of Grand'Anse where the prevalence of malaria is considered one of the strongest in Haiti. Analysis of hospital statistics of Corail (Grand'Anse) showed that only 17.4% of consultations of patients presenting with fever are due to microscopically confirmed malaria. The fraction of the population most affected is that of adults aged 15-39 years (55% of cases). Children under five represent only 11% of the cases. A community survey showed the rarity of the carriage of gametocytes in asymptomatic persons (0.9%). In Haiti, the epidemiological characteristics of malaria must have specified and documented field studies in order to adapt a strategy for fighting against this parasitic disease with greater efficiency.

Abstract. An epidemiologic (cross-sectional study) survey on 462 inhabitants in Corail, Haiti showed that 16.5% were infected with Mansonella ozzardi. This finding was determined from a single 20-μL sample of finger prick blood from each person. Among children, 2% had a detectable microfilaremia. In persons 15 years of age, the prevalence of infection for males and females was 23% and 21%, respectively. In general, the microfilaremias were low and 70% of positive persons had 10 microfilariae per 20 μL of blood; only 5% had 50 microfilariae. This study shows that persons living near mangrove marshes that are breeding sites for Culicoides furens and C. barbosai biting midges, which are recognized vectors of M. ozzardi in Haiti, are consequently more frequently infected than those living in downtown area of Corail or inland.Mansonella ozzardi, which is found strictly in the Western Hemisphere, is present in the subtropical, tropical, and temperate regions of Central and South America, and in the Caribbean. Adults live in the subcutaneous tissue, and juvenile stages require development in a dipteran host, namely biting midges of the genus Culicoides or black flies of the genus Simulium.In Haiti, M. ozzardi is found in limited coastal foci. 1 Epidemiologic surveys conducted in the 1970s in Bayeux in northern Haiti reported that 16% of inhabitants had M. ozzardi microfilariae in peripheral blood. 2 In this area, Culicoides furens serves as an efficient intermediate host. 3 Experimental studies showed that the biting midge Leptoconops bequaerti is also capable of supporting the complete development of M. ozzardi but only on a very limited scale. 4 Studies in the southern peninsula of Haiti in the 1980s showed that another biting midge, C. barbosai, a species breeding exclusively in the mangrove marshes, may also support the development of M. ozzardi to the infective stage. 5 More than thirty years after these first studies on this neglected tropical disease, this report presents the results of an epidemiologic survey performed in Corail, Haiti.The commune of Corail is located on the northern coastal area of the Grande Anse region between the communes of Roseaux, and Pestel (Figure 1). This commune, which has an area of 108 km 2 , consists of three municipal sections: Champy, Fond d'Icaque, and Duquillon. The main city in this district is also named Corail. The total estimated population in 2009 was 17,793 inhabitants. This population is engaged in fishing, agriculture, coffee and charcoal production, and production of small livestock. This area is mountainous and isolated because of poor access by roads. Corail is located near a bay colonized by mangrove marshes. An epidemiologic study was performed in June-July 2013 in Corail and its surroundings, Campê che (coastal marshes), and Fond d'Icaque (inland location, altitude = 164 meters above sea level) to characterize the endemic profile of M. ozzardi in these areas.Blood films were collected as part of ongoing epidemiologic surveillance by the National Laboratory of Pub...

BackgroundMalaria is considered a public health priority in Haiti, with a goal to eliminate by year 2020. Chloroquine is the first-line treatment recommended by the Ministry of Public Health and Population. In order to verify the suitability of chloroquine for uncomplicated malaria treatment, an in vivo study of susceptibility of Plasmodium falciparum to chloroquine was conducted from January 2013 to March 2015 in six localities in the south of Haiti.ResultsSixty-one patients who presented with confirmed P. falciparum malaria were included in the study and followed until day 28 after having taken 25 mg/kg of chloroquine orally over 3 days. The sample included 28 children under the age of 10, 9 adolescents aged 10–19 years, and 24 adults aged 20 years and over. Among them, 30 were monitored on day 3 (49%) and 33 on day 28 (59%). Clinical and parasitological monitoring was carried out on day 7 on 28 subjects, on day 14 on 13 subjects and on day 21 on 18 subjects. Residual parasitaemia with presence of trophozoites was found in 7 of 30 subjects on day 3 (23%), and in 6 of 28 subjects on day 7 (21%) who had a temperature less than 37.5 °C. These patients can be considered as late parasitological failures. All monitoring performed on day 28 was negative. Gametocytes were found in 3 patients (9%) despite the use of primaquine. The continuing low parasitaemia on day 3 and 7 in more than one fifth of cases raises the question of the efficacy of chloroquine in southern Haiti.ConclusionsResults suggest a decrease of chloroquine susceptibility for treatment of P. falciparum malaria cases in southern Haiti. Consequently, there is a need to strengthen malaria treatment surveillance and to study the effectiveness of chloroquine in Haiti by monitoring patients after treatment.

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Asymptomatic Plasmodium falciparum infection is responsible for maintaining malarial disease within human populations in low transmission countries such as Haiti. Investigating differential host immune responses to the parasite as a potential underlying mechanism could help provide insight into this highly complex phenomenon and possibly identify asymptomatic individuals. We performed a cross-sectional analysis of individuals who were diagnosed with malaria in Sud-Est, Haiti by comparing the cellular and humoral responses of both symptomatic and asymptomatic subjects. Plasma samples were analyzed with a P. falciparum protein microarray, which demonstrated serologic reactivity to 3,877 P. falciparum proteins of known serologic reactivity; however, no antigen-antibody reactions delineating asymptomatics from symptomatics were identified. In contrast, differences in cellular responses were observed. Flow cytometric analysis of patient peripheral blood mononuclear cells co-cultured with P. falciparum infected erythrocytes demonstrated a statistically significant increase in the proportion of T regulatory cells (CD4+ CD25+ CD127-), and increases in unique populations of both NKT-like cells (CD3+ CD8+ CD56+) and CD8mid T cells in asymptomatics compared to symptomatics. Also, CD38+/HLA-DR+ expression on γδ T cells, CD8mid (CD56-) T cells, and CD8mid CD56+ NKT-like cells decreased upon exposure to infected erythrocytes in both groups. Cytometric bead analysis of the co-culture supernatants demonstrated an upregulation of monocyte-activating chemokines/cytokines in asymptomatics, while immunomodulatory soluble factors were elevated in symptomatics. Principal component analysis of these expression values revealed a distinct clustering of individual responses within their respective phenotypic groups. This is the first comprehensive investigation of immune responses to P. falciparum in Haiti, and describes unique cell-mediated immune repertoires that delineate individuals into asymptomatic and symptomatic phenotypes. Future investigations using large scale biological data sets analyzing multiple components of adaptive immunity, could collectively define which cellular responses and molecular correlates of disease outcome are malaria region specific, and which are truly generalizable features of asymptomatic Plasmodium immunity, a research goal of critical priority.

Background An effective laboratory system is an essential component of a public health system caring for patients with communicable and non-communicable diseases. Unfortunately, in developing countries this system is often sub-optimal, which negatively impacts health care. This paper describes the current situation of the clinical laboratory sector in Haiti and highlights challenges that exist in Haiti and other developing countries as they try to establish a clinical laboratory system. Method A cross-sectional survey was conducted in 30 laboratories across Haiti from January 19 to February 4, 2016. The laboratories surveyed were public or mixed public-private sector facilities belonging to different levels of the healthcare hierarchy. Labs were visited and directors of the health care institutions, lab managers, and members of their teams were interviewed and National Public Health Laboratory documents and information about the legal framework of the laboratory system was reviewed. Results The National Laboratory of Public Health is the reference lab for the national lab network and plays a key role in epidemiologic surveillance. Investigators felt that that the general conditions in the nation’s labs (83%) are good, but numerous deficiencies are identified. Electricity is often limited and 86% of facilities have mixed energy system. Bacterial cultures and susceptibilities are not performed. Most of the lab technologists (88.2%) have received only 2 two-year training certificates, while only the remainder (11.8%) had completed three-year programs training. Few continuing education opportunities are available. Equipment repair is available in more facilities (83%) than routine maintenance (63%) and is complicated by the diversity of brands employed. A total of 93% of the labs participate in the quality control program run by the National Lab. Conclusion The establishment of an effective national laboratory system requires coordination and input from many areas, including regulation of the sector, training of the technicians, sound infrastructure (including a stable supply of electricity) and dependable communications. Achieving this in developing countries will only be possible if different actors, national and international, coordinate their efforts.