PORT-AU-PRINCE The rate of deaths in Haiti's cholera epidemic slowed on Monday as a multinational medical operation scaled up to limit the spread of an outbreak that has killed 259 people in the earthquake-hit country.
Despite initial encouraging signs of a decrease in the week-old outbreak's lethality, Haitian and international health authorities warned they were still preparing for the deadly diarrheal disease to extend further before it was controlled.
"A nationwide outbreak with tens of thousands of cases is a real possibility," the United Nations humanitarian agency OCHA said in a statement.
The cholera epidemic has rocked the Western Hemisphere's poorest nation with another emergency nine-and-a-half months after the Caribbean country suffered a catastrophic January 12 earthquake that killed more than a half a million people.
Presidential and legislative elections are set for November 28. It was not clear whether the outbreak could affect them.
After several days in which fatalities had numbered dozens each day, only six cholera deaths were recorded in the last 24 hours in the main outbreak region of Artibonite in central Haiti, bringing total deaths to 259. Confirmed cases rose to 3,342, compared with 3,015 a day ago, health authorities said.
No new cases were immediately reported in the crowded, quake-ravaged capital Port-au-Prince, where experts are worried about the vulnerability of 1.3 million quake survivors living in tent and tarpaulin camps. Tens of thousands more live in slums beside filthy watercourses draining into the sea.
Authorities have isolated five cholera cases in the city, all of people who had traveled there from Artibonite.
"We think the situation is stabilizing," said Gabriel Thimote, Director General of Haiti's Health Department.
Dr. Rob Quick of the U.S. Centers for Disease Control and Prevention (CDC) said this appeared to reflect the impact of the medical response.
"People are getting the message that they need to seek care quickly if they develop diarrhea .... Also it's a measure of the supplies in place, the health workers, and being prepared to treat the disease," he told Reuters
But while welcoming the decrease in the fatality rate, international experts said it was premature to say the cholera epidemic, the first in Haiti in a century, had reached a peak.
"Our response is tailored to be prepared for a countrywide epidemic ... at the moment we consider everyone at risk," Dr. Michel Thieren, the Pan American Health Organization (PAHO)'s top medical officer in Haiti, told Reuters.
So far, the epidemic has mostly impacted two rural central Haitian provinces, Artibonite and Center, along with the few isolated cases in the capital Port-au-Prince. Suspected cases have also been reported in the Nord and Sud provinces.
PAHO, the regional office of the World Health Organization, said there was a "high risk" of the cholera spreading across the border of the island of Hispaniola to Dominican Republic.
PAHO was also alerting other states in the Caribbean about the epidemic, the first of cholera in the Americas since a 1991 outbreak in Peru, and was seeking resources to fight it from members like Brazil, Cuba, the United States and Canada.
"We are reaching out for support," PAHO Deputy Director Jon Andrus told a news briefing in Washington.
The United Nations, foreign NGOs and foreign governments like Cuba have rushed medical teams, medicines and clean water supplies to the main affected areas, and health authorities have launched a nationwide anti-cholera hygiene campaign.
Yele Haiti, a charity founded by Haitian hip hop star Wyclef Jean, was among organizations mobilizing water trucks.
Special cholera treatment centers have been set up in the main central outbreak areas and the capital, and health officials say sufficient supplies of antibiotic medicines exist in the country to treat up to 100,000 patients.
In an information campaign using TV and radio ads, and SMS messages sent to mobile phones, authorities urged people to wash their hands with soap, avoid eating raw vegetables, boil all food and drinking water and avoid drinking from rivers.
"Now I'm being very careful, I'm washing my hands all the time with soap, sometimes with lemon. I didn't do that before," said Jennette Pressoire, 29, a Port-au-Prince resident.
Kits of soap bars, water purification tablets and oral rehydration sachets were being distributed to families living along the Artibonite River, the suspected outbreak source.
Authorities were also calling on hospitals and relatives of deceased victims to dispose of bodies safely, disinfecting them with chlorine and sealing them in plastic bags, as fluids from cholera-infected bodies can propagate the disease.
(Additional reporting by Tom Brown in Miami; Writing by Pascal Fletcher; Editing by Jerry Norton)