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UN troops may have brought cholera

CDC says strain in Haiti matches those in S. Asia

A woman waited for her cholera-stricken child to be treated at a hospital in Petite Riviere, Haiti, near the Artibonite River. A woman waited for her cholera-stricken child to be treated at a hospital in Petite Riviere, Haiti, near the Artibonite River. (Nicholas Kamm/AFP/Getty Images)
By Jonathan M. Katz
Associated Press / November 4, 2010

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PORT-AU-PRINCE, Haiti — Researchers should determine whether United Nations peacekeepers were the source of a deadly outbreak of cholera in Haiti, two public health specialists, including a UN official, said yesterday.

The US Centers for Disease Control and Prevention found that the strain of cholera that has killed at least 442 people the past three weeks matches strains found in South Asia. The CDC, World Health Organization, and United Nations say it is not possible to pinpoint the source and investigating further would distract from efforts to fight the disease.

But leading specialists on cholera and medicine consulted by the Associated Press challenged that position, saying it is both possible and necessary to track the source to prevent future deaths.

“That sounds like politics to me, not science,’’ Dr. Paul Farmer, a UN deputy special envoy to Haiti and a noted specialist on poverty and medicine, said of the reluctance to delve further into what caused the outbreak. “Knowing where the point source is — or source, or sources — would seem to be a good enterprise in terms of public health.’’

The suspicion that a Nepalese UN peacekeeping base on a tributary to the infected Artibonite River could have been a source of the infection fueled a protest last week during which hundreds of Haitians denounced the peacekeepers.

John Mekalanos, a cholera specialist and chairman of Harvard University’s microbiology department, said it is important to know exactly where and how the disease emerged because it is a novel, virulent strain previously unknown in the Western Hemisphere.

Interviewed by phone from Cambridge, Mekalanos said evidence suggests Nepalese soldiers carried the disease when they arrived in early October following outbreaks in their homeland.

“The organism that is causing the disease is very uncharacteristic of [Haiti and the Caribbean], and is quite characteristic of the region from where the soldiers in the base came,’’ said Mekalanos, a colleague of Farmer. “I don’t see there is any way to avoid the conclusion that an unfortunate and presumably accidental introduction of the organism occurred.’’

Cholera, which had never been documented in Haiti, has killed at least 442 people and hospitalized more than 6,742 with fever, diarrhea, and vomiting since late last month. It is now present in at least half of Haiti’s political regions.

Death occurs when patients go into shock from extreme dehydration. The epidemic has diverted resources needed for the expected strike of a hurricane this week, and could spread further if there is flooding.

Suspicions that the Nepalese base could have been a source of the infection intensified Monday after the CDC revealed the strain in Haiti matches those found in South Asia, including Nepal.

But nothing has been proven conclusively, and the case remains politically charged and diplomatically sensitive. The United Nations has a 12,000-strong force in Haiti that has provided badly needed security since 2004. But their presence is not universally welcomed, and some Haitian politicians have seized upon the cholera accusations, calling for a full-scale investigation and fomenting demonstrations.

Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, said that the disease was imported to Haiti but that it is not clear by whom or how. She said the epidemic will contain lessons for humanitarian relief work and disaster relief around the world.

“It has to be either peacekeepers or humanitarian relief workers, that’s the bottom line.’’

Mekalanos said researchers might be more aggressive in finding the source of the infection if the case was less sensitive.

“I think that it is an attempt to maybe do the politically right thing and leave some agencies a way out of this embarrassment. But they should understand that . . . there is a bigger picture here,’’ he said. “It’s a threat to the whole region.’’

He also cast doubt on UN military tests released this week that showed no sign of cholera. The tests were taken from leaking water and an underground waste container at the base a week after the epidemic was noted and processed in the Dominican Republic, UN spokesman Vincenzo Pugliese said.

Mekalanos said that it is difficult to accurately isolate cholera in environmental samples and that false negatives are common.

The Nepalese troops were not tested for cholera before their deployment if they did not have symptoms. Health officials say 75 percent of people infected do not show symptoms and can still pass on the disease for weeks.

A spokesman for the World Health Organization said finding the cause of the outbreak is “not important right now.’’

“Right now, there is no active investigation. I can’t say one way or another [if there will be]. It is not something we are thinking about at the moment. What we are thinking about is the public health response in Haiti,’’ said spokesman Gregory Hartl.

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