Seroepidemiologic Survey of Epidemic Cholera in Haiti to Assess Spectrum of Illness and Risk Factors for Severe Disease

Abstract

To assess the spectrum of illness from toxigenic Vibrio cholerae O1 and risk factors for severe cholera in Haiti, we conducted a cross-sectional survey in a rural commune with more than 21,000 residents. During March 22–April 6, 2011, we interviewed 2,622 residents ≥ 2 years of age and tested serum specimens from 2,527 (96%) participants for vibriocidal and antibodies against cholera toxin; 18% of participants reported a cholera diagnosis, 39% had vibriocidal titers ≥ 320, and 64% had vibriocidal titers ≥ 80, suggesting widespread infection. Among seropositive participants (vibriocidal titers ≥ 320), 74.5% reported no diarrhea and 9.0% had severe cholera (reported receiving intravenous fluids and overnight hospitalization). This high burden of severe cholera is likely explained by the lack of pre-existing immunity in this population, although the virulence of the atypical El Tor strain causing the epidemic and other factors might also play a role.

Predictors of Disease Severity in Patients Admitted to a Cholera Treatment Center in Urban Haiti

“…However, HIV disease did not prove to be a risk factor for a trend toward more severe dehydration. One study suggested that HIV-infected patients were more susceptible to disease based on lower vibriocidal responses to cholera vaccine when compared with non-HIV infected recipients 23. In our cohort, HIV-status did not influence the severity of disease, but the HIV seroprevalence was high.…”

Cholera Elimination in Hispaniola

“…The outbreak strain in Hispaniola exhibits characteristics of both the El Tor and classical biotypes,13 and it was difficult to anticipate overall attack rates or the overall proportion of Vibrio cholerae infections that might lead to severe disease in the immunologically naive population of Haiti. A seroepidemiologic survey confirmed very high rates of infection—often subclinical 14. This survey and evaluations of case series helped identify risk factors for disease.…”

El análisis molecular de la secuencia del genoma completo de aislados clínicos de Vibrio cholerae en México en 2013 revela la presencia de la cepa causante de la epidemia de Haití en 2010

“…Un paciente falleció. El espectro de la enfermedad en este brote difiere del observado en los brotes notificados en el Caribe 12 . Justo después de esta identificación, la epidemia se extendió a los Estados de México, Hidalgo, San Luis Potosí y Veracruz.…”