PORT-AU-PRINCE Quake-hit Haiti and its aid partners fought on Friday to stem a cholera epidemic that has killed over 150 people and sickened hundreds, with experts saying more cases could be expected before it was contained.
Although the main outbreak area was north of Port-au-Prince, which bore the brunt of the January 12 earthquake, humanitarian agencies were on high alert to prevent the disease from spreading to crowded survivors' camps in the capital.
The cholera epidemic, which had already affected more than 1,500 people in central Haiti, was the worst medical emergency to strike the poor, disaster-prone Caribbean nation since the devastating earthquake that killed up to 300,000 people.
It was also the first cholera epidemic in Haiti in a century, the World Health Organization said. But no cases had been reported in Haiti's rubble-strewn capital, where 1.3 million quake homeless are living in tent cities.
Health teams were closely monitoring the survivor camps and oral rehydration liquids were being prepared for quick use.
The Pan American Health Organization, the regional office for the WHO, said it had deployed medical teams, medicines and clean water to the outbreak zone around Saint-Marc in the central Artibonite region, and to the Central Plateau to deal with more cases of the virulent diarrheal disease. If left untreated, it can kill victims in hours through dehydration.
"We expect it to get bigger, we have to expect that," PAHO Deputy Director Jon Andrus told a briefing in Washington.
He added the neighboring Dominican Republic, which shares the island of Hispaniola with Haiti, should be alert to the risk of cholera spreading across the border.
"So far, we have more than 1,500 cases and the number is increasing, and more than 150 deaths that we have confirmed," Dr. Carleene Dei, Haiti mission director for the U.S. Agency for International Development, said in a teleconference.
One humanitarian worker who visited the main hospital in Saint-Marc called it a "horror scene."
"The courtyard was lined with patients hooked up to intravenous drips. It had just rained and there were people lying on the ground on soggy sheets, half-soaked with feces," David Darg of the U.S.-based humanitarian organization Operation Blessing International, wrote in an account published on the Thomson Reuters Foundation's AlertNet website.
Darg said villagers in the countryside around Saint-Marc were begging for clean water.
The central region is Haiti's breadbasket and had received tens of thousands of fleeing survivors from the January quake.
Besides medicines and rehydration fluids, the United Nations and aid agencies were rushing clean drinking water, and chlorine to purify water, to affected areas.
"Now the emphasis has to be on treatment, containment and potentially mass vaccination," Dr. Peter Hotez, president of the Sabin Vaccine Institute and chair of the George Washington University Department of Microbiology, Immunology, and Tropical Medicine, told Reuters. He said PAHO needed to consider the viability of an anti-cholera vaccination program in Haiti.
The U.S. government Centers for Disease Control and Prevention said it was sending a team of epidemiologists, health communicators and a cholera laboratory expert to assist the Haitian authorities in fighting the outbreak.
"We are just at the beginning," Rob Quick of the CDC's Waterborne Diseases Prevention Branch said.
It was not clear whether the outbreak would affect the presidential and legislative elections scheduled for November 28 but Haitian Health Minister Alex Larsen appealed to candidates in cholera-affected areas to suspend public rallies.
"Unless the epidemic really gets out of control and incapacitates a huge part of the country, I would think that elections would go on as scheduled," Hotez said, noting that cholera was not transmitted by person-to-person contact but through contaminated water and food.
Earlier, President Rene Preval confirmed cholera was the cause of the acute diarrhea that had overwhelmed hospitals in central Haiti with weakened, dehydrated patients.
"This highlights the vulnerability of everyone in Haiti to a disease like this," Imogen Wall, the U.N. humanitarian spokeswoman in Haiti, told Reuters. "The fact that it's unfamiliar means that it scares people."
Announcing a national emergency prevention program, Larsen urged people to wash their hands, not eat raw vegetables, boil all food and drinking water, and avoid bathing in and drinking from rivers. The Artibonite River, which irrigates all of central Haiti, was believed to be contaminated.
Larsen urged people not to panic, saying the deadly dehydration caused by cholera could be easily treated by drinking boiled water mixed with sugar and salt.
(Additional reporting by Stephanie Nebehay in Geneva and Pascal Fletcher and Tom Brown in Miami; Writing by Pascal Fletcher; Editing by Peter Cooney)