Current status of cholera in the Region

In Cuba, no new cases have been reported since 23 August 2013. Between epidemiological week (EW) 27 of 2012 to EW 34 of 2013, there have been 678 confirmed cholera cases in total, including three deaths. The cases have been registered in the provinces of Camaguey, Granma, Guantanamo, Havana and Santiago de Cuba, as well as in other towns associated with these provinces.

In the Dominican Republic, since the beginning of the epidemic (November 2010) through EW 40 of 2013, the total number of suspected cholera cases reported was 31,070 of which 458 died. In 2013, an increase of cases has been recorded in two periods, first between EW 1 to EW 9 and subsequently between EW 32 and EW 40 (see Figure 1). The provinces of Puerto Plata, San Juan, Santiago and Santo Domingo account for 64% of the suspected cases registered in the last four epidemiological weeks. The case-fatality rate in 2013, of 2.1%, remains higher than that of 2011, reaching 1.7%, and of 2012, with 0.8%. The health authorities are investigating and implementing corresponding response measures.

In Haiti, since the beginning of the epidemic (October 2010) to 10 October 2013, the total number of cholera cases reached 682,573, of which 379,870 were hospitalized (55.6%) and 8,330 died. The global case-fatality rate has been 1.2% since November 2011, however, with variations between 4.3%, in the department of Sud Est to 0.6%, in Port-au-Prince. Since the 12 October 2013 Epidemiological Update on cholera there have been 2,936 new cases and 83 deaths registered; all ten departments of Haiti have registered new cases.

In Mexico, from 9 September to 18 October 2013, the Mexico International Health Regulations (IHR) National Focal Point (NFP) has reported 171 confirmed cases, including one death, of infection with Vibrio cholerae O:1 Ogawa toxigenic. Since the 12 October 2013 Epidemiological Update on cholera, there have been 12 new cases, all in the state of Hidalgo.

Of the confirmed cases, two (1.2%) are residents of the Federal District, 157 (91.8%) are from the state of Hidalgo, 9 (5.3%) are from the state of Mexico, 1 (0.6%) is from the state of San Luis Potosi and 2 (1.2%) are from the state of Veracruz.

In total, 86 (50.2%) are female and 85 (49.8%) are male with ages ranging from 3 months old to 88 years old. Thirty-nine (23%) of the cases were hospitalized.

In the state of Hidalgo the investigation indicated that the river water is the source of contamination.

The health authorities of Mexico continue to: strengthen epidemiological activities at the national level; ensure the availability of inputs and quality of care in medical units; implement actions to ensure access to drinking water and basic sanitation at the community level; and monitor and check the chlorine levels of drinking water.

Health professionals at different levels of the health care system are being trained in cholera prevention, treatment and control. Public awareness campaigns on water and food safety are being carried out in Spanish and indigenous languages (Nahuatl and Otomi), including national radio messages on the prevention of diarrheal disease. Authorities in the state of Mexico are distributing flyers for public awareness.

This is the first local transmission of cholera recorded since the 1991-2001 cholera epidemic in Mexico. The genetic profile of the strain isolated from patients in Mexico presents high similarity (>95%) with the strain that is currently circulating in three Caribbean countries (Haiti, Dominican Republic and Cuba), and is different from the strain that had been circulating in Mexico during more than a decade ago.