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. 2011 Apr 9;377(9773):1248-55.
doi: 10.1016/S0140-6736(11)60273-0. Epub 2011 Mar 15.

Transmission dynamics and control of cholera in Haiti: an epidemic model

Jason R Andrews  1 , Sanjay Basu
Affiliations

Transmission dynamics and control of cholera in Haiti: an epidemic model

Jason R Andrews et al. Lancet. .

Abstract

Background: Official projections of the cholera epidemic in Haiti have not incorporated existing disease trends or patterns of transmission, and proposed interventions have been debated without comparative estimates of their effect. We used a mathematical model of the epidemic to provide projections of future morbidity and mortality, and to produce comparative estimates of the effects of proposed interventions.

Methods: We designed mathematical models of cholera transmission based on existing models and fitted them to incidence data reported in Haiti for each province from Oct 31, 2010, to Jan 24, 2011. We then simulated future epidemic trajectories from March 1 to Nov 30, 2011, to estimate the effect of clean water, vaccination, and enhanced antibiotic distribution programmes.

Findings: We project 779,000 cases of cholera in Haiti (95% CI 599,000-914,000) and 11,100 deaths (7300-17,400) between March 1 and Nov 30, 2011. We expect that a 1% per week reduction in consumption of contaminated water would avert 105,000 cases (88,000-116,000) and 1500 deaths (1100-2300). We predict that the vaccination of 10% of the population, from March 1, will avert 63,000 cases (48,000-78,000) and 900 deaths (600-1500). The proposed extension of the use of antibiotics to all patients with severe dehydration and half of patients with moderate dehydration is expected to avert 9000 cases (8000-10,000) and 1300 deaths (900-2000).

Interpretation: A decline in cholera prevalence in early 2011 is part of the natural course of the epidemic, and should not be interpreted as indicative of successful intervention. Substantially more cases of cholera are expected than official estimates used for resource allocation. Combined, clean water provision, vaccination, and expanded access to antibiotics might avert thousands of deaths.

Funding: National Institutes of Health.

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Conflict of interest statement

Conflict of interest statement

We declare that we have no conflict of interest.

Figures

Figure 1
Figure 1
Model of cholera transmission.
Figure 2
Figure 2
Model projections of cumulative cases of cholera from the start of the epidemic by Department (scale: thousands of cholera cases). Cases from Port-au-Prince were combined with those from the remainder of Oueste Department here.
Figure 3
Figure 3
Impact of interventions on cholera prevalence in the four most heavily-burdened Departments in Haiti. Interventions begin March 1, 2011 (dashed vertical line). Note the different scale on the vertical axis for each Department.
See this image and copyright information in PMC

Comment in

References

    1. Ministere de la Sante Publique et de la Population. [Accessed January 15, 2011];Rapport de cas journalier et cumulatif. 2011 Available at: www.mspp.gouv.ht/site/index.php.
    1. WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. Progress on sanitation and drinking water: 2010 update. 2010 Available at: http://whqlibdoc.who.int/publications/2010/9789241563956_eng_full_text.pdf.
    1. Sullivan C, Meigh J, Giacomello A. The Water Poverty Index: Development and application at the community scale. Natural Resources Forum. 2003;27(3):189–199.
    1. Walton DA, Ivers LC. Responding to cholera in post-earthquake Haiti. N. Engl. J. Med. 2011;364(1):3–5. - PubMed
    1. United Nations Office for the Coordination of Humanitarian Affairs. Cholera Inter-Sector Response Strategy for Haiti. Nov 2010 – Dec 2010. 2010

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