UF researchers go to Haiti to mitigate cholera threat, explore possible sources

November 9, 2010

GAINESVILLE, Fla. — University of Florida public health researchers are back in Haiti this week, tracking the cholera outbreak and distributing oral rehydration packets assembled by College of Pharmacy faculty and students.

While taking samples to determine the source of the cholera bacterium, two UF faculty affiliated with the Emerging Pathogens Institute will distribute 1,000 oral rehydration packets to people in the Gressier/Leogane area about 12 miles west of Port-au-Prince.

In the last month, Haitians have suffered with an outbreak of cholera, a bacterial infection spread by unsanitary conditions and lack of clean water. The disease, which is easily treatable, has already killed almost 600 Haitians. This is the first outbreak in the country in nearly 60 years. January’s earthquake displaced millions of people, forcing them into squalid living conditions.

“When people migrated, it compounded the problem,” said cholera expert Afsar Ali, a research associate professor of environmental and global health in the College of Public Health and Health Professions, who went to Haiti this week to assist with distribution of the oral rehydration packets.

Cholera epidemics can be exacerbated when contaminated human fecal matter reintroduces the bacteria into the environment and water supply. Although the epidemic has not spread to the Gressier/Leogane area, UF public health researchers worry that if it does, life-saving supplies may not get to the rural area quickly enough.

“When cholera strikes, it strikes very quickly, with large numbers of cases presenting all at once,” said Glenn Morris, Emerging Pathogens Institute director and a professor of infectious disease in the UF College of Medicine.

Having a stockpile of sugar/salt packets to make oral rehydration solution is essential to saving lives, he said.

Bernard Okech, a research assistant professor of environmental and global health who accompanied Ali, has traveled to Gressier several times in the past year and, in coordination with other UF faculty and NGOs, is constructing an infectious disease field laboratory to study enteric, or intestinal, diseases such as cholera. UF professors already work with three health clinics outside of Port-au-Prince, including one in Leogane, whose staff requested UF assistance to minimize the cholera threat.

In a report earlier this year to the Centers for Disease Control and Prevention, Ali suggested that cholera was likely present in Haiti’s natural environment, and he predicted it would re-emerge under the right circumstances.

October provided the right weather conditions to foster the growth of the bacterium, which may have originated from marine waters. Ali suggests that when it entered brackish river water, which was already high in plankton blooms, the bacteria found a boundless source of food to help it spread.

Ali and Okech will spend a week collecting samples of both water and stool at locations near Port-au-Prince where the outbreaks occurred. They will ship samples to EPI for testing to try to determine the origin of the cholera bacteria.

Earlier this month, federal health officials reported that DNA tests of the cholera identify it as an Asian strain, which prompted questions for researchers about the bacteria’s pathway to Haiti.

The salts and sugar in the oral rehydration packets help prevent cholera victims from becoming dehydrated, the disease’s most dangerous symptom. Paul Doering, a distinguished service pharmacy professor who supervised the volunteers who assembled the packets, said the material costs pennies compared to other medicines.

Cary Mobley, a clinical associate professor and registered pharmacist, worked quickly to order and mix the chemical ingredients, which his pharmacy students helped measure and package into individual doses.

Cholera causes its victims to suffer from severe diarrhea and vomiting, which results in extreme dehydration within hours of infection, and early treatment with fluids is key to survival. Up to 40 percent of severely affected victims under the age of 5 may die without rehydration, but less than 1 percent die when treated.

Included with the oral rehydration packets are documents in Haitian Creole to educate people in the region about preventive measures against the illness. Edsel Redden, a former county extension agent with the UF Institute of Food and Agricultural Sciences who has worked in Haiti for 23 years, will help Ali teach residents to prepare the drinkable saline solution, “so [Haitians] won’t always have to depend on us,” Ali said.