Implementation of an Alert and Response System in Haiti during the Early Stage of the Response to the Cholera Epidemic

Abstract

The start of the cholera epidemic in Haiti quickly highlighted the necessity of the implementation of an Alert and Response (A&R) System to complement the existing national surveillance system. The national system had been able to detect and confirm the outbreak etiology but required external support to monitor the spread of cholera and coordinate response, because much of the information produced was insufficiently timely for real-time monitoring and directing of a rapid, targeted response. The A&R System was designed by the Pan American Health Organization/World Health Organization in collaboration with the Haiti Ministry of Health, and it was based on a network of partners, including any institution, structure, or individual that could identify, verify, and respond to alerts. The defined objectives were to (1) save lives through early detection and treatment of cases and (2) control the spread through early intervention at the community level. The operational structure could be broken down into three principle categories: (1) alert (early warning), (2) verification and assessment of the information, and (3) efficient and timely response in coordination with partners to avoid duplication. Information generated by the A&R System was analyzed and interpreted, and the qualitative information was critical in qualifying the epidemic and defining vulnerable areas, particularly because the national surveillance system reported incomplete data for more than one department. The A&R System detected a number of alerts unrelated to cholera and facilitated rapid access to that information. The sensitivity of the system and its ability to react quickly was shown in May of 2011, when an abnormal increase in alerts coming from several communes in the Sud-Est Department in epidemiological weeks (EWs) 17 and 18 were noted and disseminated network-wide and response activities were implemented. The national cholera surveillance system did not register the increase until EWs 21 and 22, and the information did not become available until EWs 23 and 24, when the peak of cases had already been reached. Although many of the partners reporting alerts during the peak of the cholera epidemic have since left Haiti, the A&R System has continued to function as an Early Warning (EWARN) System, and it continues to be developed with recent activities, such as the distribution of cell phones to enhance alert communication.

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review

“…Healthcare provision measures included: health infrastructure improvements, such as the construction of new clinics, treatment centres, or hospitals [20, 24, 28, 30, 34, 38, 39, 45, 48] ( n =  9, 29%); improved case management [21, 27, 30, 33, 34, 36, 41] ( n =  7, 23%); appointment of public health officers and reorientation of specialists [19, 22, 24, 28, 36, 48] ( n =  6, 19%); training of doctors, community health workers, and other professionals [22, 28, 38, 39] ( n =  4, 13%); provision of pre- or post-exposure prophylaxis [21, 30, 37] ( n =  3, 10%); reactive vaccination campaigns [29, 41, 47] ( n =  3, 10%); introduction of treatment beds [24, 46] ( n =  2, 6%); use of new technology for diagnosis and treatment [24, 27] ( n =  2, 6%); timely hospital admission and effective triage of patients [40] ( n =  1, 3%), and safe transfer of identified cases [40] ( n =  1, 3%). Psychosocial support was also provided in one study [25] ( n =  1, 3%).…”

“…Epidemiological investigation and/or surveillance measures consisted of: the setting up or improvement of surveillance systems [19, 24, 26, 27, 30, 33, 36, 37, 40, 49] ( n =  10, 32%); active case-finding and contact tracing [25–28, 34, 37, 49] ( n =  7, 23%); collection of serological samples and documentation of cases [22, 28, 37] ( n =  3, 10%); entomological surveys and mapping [22–24] ( n =  3, 10%); screening of all arrivals and departures in and out of the country by land, air, and sea [29, 49] ( n =  2, 6%); operational studies for testing case definitions [22] ( n =  1, 3%); and establishment of a phone-based alert management system [37] ( n =  1, 3%). Intervention materials were real-time polymerase chain reaction (PCR), dashboards, and mobile phones [29, 44] ( n =  2, 6%).…”

New technologies in predicting, preventing and controlling emerging infectious diseases

“…The Alert and Response system was able to detect a rise in cholera cases in hard-to-reach communities with poor access to health centers, few weeks before the national surveillance system, which relied on data only from healthcare facilities. 31 Web-based tools for real-time surveillance Web queries are increasingly being used as a source for syndromic surveillance. Analysis of health-related search engine queries can assist in tracking regional infectious disease activity.…”

Geographical Perspectives on Epidemic Transmission of Cholera in Haiti, October 2010 Through March 2013

“…When the disease did finally arrive in October of the same year, it found a set of pre-and post-disaster circumstances that were highly conducive to its rapid transmission. Earthquake damage to the country's already poor sewage and water systems was compounded by overcrowded and insanitary living conditions and deficiencies in public health infrastructure to treat and prevent the disease (Gelting et al 2013;Santa-Olalla, et al 2013). cases, an incubation period of 2-5 days is usually followed by the sudden onset of diarrhoea and vomiting, giving rise to massive fluid loss and dehydration.…”