Cholera in Haiti

Abstract

The cholera epidemic that hit Haiti from October 2010 to February 2019 was the world's deadliest of the last 25 years. Officially, the successive waves caused 9789 deaths, although numerous additional casualties could not be recorded. The origin of this epidemic has been the subject of a controversy involving two opposing theories. The first hypothesis, put forward by renowned American academics, was that the cholera epidemic originated from the environment, due to the proliferation and transmission of aquatic Vibrio cholerae bacteria driven by a confluence of circumstances, i.e., the earthquake followed by a hot summer and, ultimately, heavy rainfall and flooding. The alternative hypothesis, which was subsequently confirmed by epidemiological and genomic studies, attributed the epidemic to the recent importation of cholera by UN peacekeepers recently arrived from Nepal, and to a river polluted with sewage. In late 2016, the Secretary General of the United Nations finally begged the Haitian people for forgiveness. This implicit recognition of the role of the UN in the cholera epidemic helped to fund the ongoing fight against it. Case-area targeted interventions aimed at interrupting cholera transmission were reinforced, which resulted in the extinction of the epidemic within two years. In the meantime, several phylogenetic studies on Vibrio cholerae during the seventh cholera pandemic demonstrated that local environmental and global epidemic Vibrio populations were distinct. These studies also showed that epidemics arose when the bacterium had diversified and that it had spread during transmission events associated with human travel.