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HAVANA - A year after the first cholera cases in decades were reported in Cuba, the country is still struggling with outbreaks in various provinces, health workers and residents told Reuters on Thursday.



On Tuesday the United States issued a health advisory urging U.S. citizens living in or traveling to Cuba to take appropriate precautions such as the frequent washing of hands and avoiding untreated water, street food, undercooked shellfish and uncooked foods.

Last week the Pan American Health Organization reported five confirmed cholera cases among travelers to the Caribbean island this summer, an Italian, two Venezuelans and two Chileans.

They were the first tourists known to have contracted the illness since cholera's appearance on the island in July 2012.

The Cuban government has yet to publicly respond to the reports and officials were not immediately available for comment.

Cholera is generally not fatal but can kill in just a few hours when diarrhea and vomiting cause dehydration, especially among the elderly.

The illness runs its course within a week, making it relatively easy to track.

"There is cholera in various places and you can imagine we are having a very busy summer," an employee of the public health ministry told Reuters, who declined to be identified because he was not authorized to comment to the media.

"Many of us think the government should stop keeping it a secret. Cholera is very unpleasant, but rarely lethal, at least here in Cuba," he said.

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Tourism is an important source of revenue and employment in Cuba, attracting more than 2.5 million visitors in 2012.

The United States slapped travel restrictions on Cuba soon after the 1959 revolution prohibiting most Americans from visiting the communist-run country, however a loosening of rules by the Obama administration has allowed Cuban-Americans to return home at will, as well as licensed groups of other U.S. citizens to travel there for specific academic, cultural and other reasons, resulting in more than 70,000 visiting in 2012.

LOTS OF CASES

Public health workers in Camaguey province in central Cuba said they had to postpone vacations when they were mobilized due to an outbreak in July.

"There were lots of cases, but it was not a very virulent strain of cholera so to be sure it was very unpleasant but no deaths that I know of," a local nurse said.

Another July outbreak was reported by residents in western Matanzas province.

There was an outbreak in Havana in January, the only one reported to date by the government after cholera first made its presence felt in eastern Granma province in July 2012, sickening close to 500 people and killing three, according to the government, and earlier this month another outbreak when locals and tourists became ill after eating at a Havana restaurant.

The restaurant was closed for a week, its employees tested, and eateries within a few blocks also closed and inspected.

Cuban health workers have ample experience dealing with cholera in Haiti and elsewhere, and are well organized and drilled to respond to outbreaks of disease on the island.

The cholera protocol includes isolating suspected cases and tracing their activity and contacts, issuing water purification tablets, and other measures such as decontaminating the shoes of train and bus passengers.

There had been no cholera outbreaks reported in Cuba since well before the 1959 revolution and the creation of a national health system by the communist government.

Current cases of the disease in Cuba may stem from Haiti, where there has been a cholera epidemic since 2010 which sickened 635,980 people and killed 7,912 through 2012.

Thousands of Cuban health workers have been stationed in Haiti since it was devastated by an earthquake in 2010.

Cuba lies closer to Haiti than any other Caribbean country, with the exception of the Dominican Republic, which shares the island of Hispaniola with the crisis-stricken country and reported 29,433 cholera cases and 422 deaths from 2010 through 2012.

(Reporting by Marc Frank; Editing by David Adams and Eric Beech)