Abstract. The first oral cholera vaccine (OCV) campaign, since its prequalification by the World Health Organization, in response to an ongoing cholera epidemic (reactive vaccination) was successfully conducted in a poor urban slum of approximately 70,000 inhabitants in Port-au-Prince, Haiti, in 2012. Vaccine coverage was 75% of the target population. This report documents the impact of OCV in reducing the number of culture-confirmed cases of cholera admitted to the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) cholera treatment center from that community in the 37 months postvaccination (April 2012-April 30, 2015. Of 1,788 patients with cultureconfirmed cholera, 1,770 (99%) were either from outside the vaccine area (1,400 cases) or from the vaccinated community who had not received OCV (370 cases). Of the 388 people from the catchment area who developed culture-confirmed cholera, 370 occurred among the 17,643 people who had not been vaccinated (2.1%) and the remaining 18 occurred among the 52,357 people (0.034%) who had been vaccinated (P < 0.001), for an efficacy that approximates 97.5%. Despite not being designed as a randomized control trial, the very high efficacy is a strong evidence for the effectiveness of OCV as part of an integrated package for the control of cholera in outbreak settings.

More than 1 in 10 females (13%) reported being a victim of sexual assault in the 2012 Mortality, Morbidity, and Service Utilization Survey conducted in Haiti. This study aimed to describe the characteristics of sexual assault and its psychological consequences among female victims of sexual assault (patients) who presented to the Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) clinic in Port-au-Prince, Haiti, and determine which characteristics impact seeking medical evaluation or follow-up care. We conducted comparisons of the characteristics of sexual assault and psychological impact among female patients in Haiti by age stratification using chi-square or analysis of variance tests. Logistic regressions were used to assess the determinants of receiving medical evaluation within 72 h or returning for follow-up. A total of 4092 female patients presented from January 2006 to December 2015. Patients aged £10 years had significantly higher rates of assault by known assailants and a single assailant (p < 0.001). A total of 2650 (64.8%) patients reported at least one psychological condition, and 2458 patients (60.1%) returned within 6 months for follow-up. The adjusted odds ratio of returning for follow-up among patients exhibiting a psychological condition at first visit was 0.20 (0.17-0.24; p < 0.001), indicating that patients exhibiting a psychological condition were 80% less likely to return for follow-up. There are significant differences in sexual assault characteristics between child and adult patients. Psychological assessments could help predict the likelihood of return for follow-up. Health care workers should be trained to recognize psychological trauma as a risk factor for loss to follow-up.

Abstract. Human immunodeficiency virus (HIV) infection has been postulated to alter the natural history of cholera, including increased susceptibility to infection, severity of illness, and chronic carriage of Vibrio cholerae. Haiti has a generalized HIV epidemic with an adult HIV prevalence of 1.9% and recently suffered a cholera epidemic. We conducted a prospective study at the cholera treatment center (CTC) of GHESKIO in Haiti to characterize the coinfection. Adults admitted at the CTC for acute diarrhea were invited to participate in the study. Vital signs, frequency, and volume of stools and/or vomiting were monitored, and single-dose doxycycline was administered. After counseling, participants were screened for HIV by enzyme-linked immunosorbent assay and for cholera by culture. Of 729 adults admitted to the CTC, 99 (13.6%) had HIV infection, and 457 (63%) had culture-confirmed cholera. HIV prevalence was three times higher in patients without cholera (23%, 63/272) than in those with culture-confirmed cholera (7.9%, 36/457). HIV prevalence in patients with culture-confirmed cholera (7.9%) was four times higher than the adult prevalence in Port-au-Prince (1.9%). Of the 36 HIV-infected patients with cholera, 25 (69%) had moderate/severe dehydration versus 302/421 (72%) in the HIV negative. Of 30 HIV-infected patients with weekly stool cultures performed after discharge, 29 (97%) were negative at week 1. Of 50 HIV-negative patients with weekly stool cultures, 49 (98%) were negative at week 1. In countries with endemic HIV infection, clinicians should consider screening patients presenting with suspected cholera for HIV coinfection.

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