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Haitian cholera outbreak—United Nations admits involvement
JIPH-652; No. of Pages 2
ARTICLE IN PRESS
Journal of Infection and Public Health (2016) xxx, xxx—xxx
LETTER TO THE EDITOR Haitian cholera outbreak—–United Nations admits involvement The United Nation’s recent admittance of its involvement in the Haiti cholera outbreak has led to harsh criticism of the world body. Despite claiming immunity against legal action, it took more than five years for the UN to accept that it played a key role in bringing cholera to the region [1]. The first case of cholera was seen in Haiti in October 2010, following a devastating earthquake that struck earlier in the year [2]. By December 2010, 121,518 cases had been reported with the death toll rising to 2591. Not only had the epidemic affected all 10 provinces of Haiti, but had also by then spread to the adjoining Dominican Republic and Florida, United States [3]. Five years later, almost 10,000 people have died, and hundreds of thousands have been affected by the disease, with 14,000 cases reported in 2016 alone [2]. When investigated, two possible hypotheses arose, regarding how the bacteria, and consequently the potentially life-threatening diarrheal disease reached Haiti. The initial ‘environmental’ hypothesis claimed that the virulent strain responsible for the epidemic had previously existed in the waters around Haiti, and the January 2010 earthquake had caused the bacteria to contaminate the drinking water. DNA sequencing of stool samples from Haitian patients supported this; studies revealed the presence of both infectious and noninfectious environmental strains, but did not ascertain which of the two caused the disease [2]. The second hypothesis, the ‘peacekeeper’s hypothesis’, provided a more believable explanation. The earthquake had attracted international aid from many organizations, including the United Nations, which sent troops to the region. The last troop of peacekeepers had come from Nepal, a cholera endemic region. They reached Haiti in October, just days before the first case was reported.
On testing for similarities in DNA sequence between five Nepalese strains, and three Haitian strains, it was discovered that the strains differed only at 1—2 base pairs; practically confirming that the strains found in Haiti had come from Nepal [4]. Another supportive study also established similarities in antimicrobial resistance activity in Haitian and Nepalese strains [5]. The scientific community and the world, have long since concluded that the peacekeeper’s hypothesis is the more plausible explanation. Had the UN screened its Nepalese peacekeepers, for a cost of only about $2000, this crisis could have been averted [1]. Since accepting responsibility, the UN has promised to raise funds and use them to implement large-scale vaccination, and treatment of Haitian people, but has failed to make much progress in doing so.
Funding No funding sources.
Competing interests None declared.
Ethical approval Not required.
Authors’ contributions Designated authors have contributed equally in conceiving the idea and drafting the manuscript. All authors met the criteria for authorship furnished in the ICMJE Recommendations.
http://dx.doi.org/10.1016/j.jiph.2016.10.003 1876-0341/© 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.
Please cite this article in press as: Qadir TF, et al. Haitian cholera outbreak—–United Nations admits involvement. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.10.003
JIPH-652; No. of Pages 2
ARTICLE IN PRESS
2
Letter to the Editor
References
from Nepal in 2010: evidence on the origin of the Haitian outbreak. MBio 2011;2:e00157—11.
[1] UN makes first public admission of blame for Haiti cholera outbreak. The Guardian; 2016. https://www.theguardian. com/world/2016/aug/18/un-public-admission-haiticholera-outbreak [accessed 4.10.16]. [2] LeMieux Julianna. Cholera in Haiti: the UN finally concedes what science showed years ago. American Council on Science and Health; 2016. http://acsh.org/node/9866 [accessed 4.10.16]. [3] Jenkins PH, Montejano HJ, Abbasi MJ, Crowley MS, O’Brien MG, Conte V, et al. Update on cholera—–Haiti, Dominican Republic, and Florida, 2010. MMWR Morb Mortal Wkly Rep 2010;59:1637—41. [4] Chin CS, Sorenson J, Harris JB, Robins WP, Charles RC, JeanCharles RR, et al. The origin of the Haitian cholera outbreak strain. N Engl J Med 2011;364:33—42. [5] Hendriksen RS, Price LB, Schupp JM, Gillece JD, Kaas RS, Engelthaler DM, et al. Population genetics of Vibrio cholerae
Tooba F. Qadir Syed B. Pasha Huda Fatima Saba Ahmed ∗ Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan ∗ Corresponding
author. Permanent address: 22-B/1, Main Khayaban-e-Bahria Phase VII, Defence Housing Authority, Karachi, Pakistan. E-mail address: [email protected] (S. Ahmed) 4 October 2016
Available online at www.sciencedirect.com
ScienceDirect
Please cite this article in press as: Qadir TF, et al. Haitian cholera outbreak—–United Nations admits involvement. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.10.003
ARTICLE IN PRESS
Journal of Infection and Public Health (2016) xxx, xxx—xxx
LETTER TO THE EDITOR Haitian cholera outbreak—–United Nations admits involvement The United Nation’s recent admittance of its involvement in the Haiti cholera outbreak has led to harsh criticism of the world body. Despite claiming immunity against legal action, it took more than five years for the UN to accept that it played a key role in bringing cholera to the region [1]. The first case of cholera was seen in Haiti in October 2010, following a devastating earthquake that struck earlier in the year [2]. By December 2010, 121,518 cases had been reported with the death toll rising to 2591. Not only had the epidemic affected all 10 provinces of Haiti, but had also by then spread to the adjoining Dominican Republic and Florida, United States [3]. Five years later, almost 10,000 people have died, and hundreds of thousands have been affected by the disease, with 14,000 cases reported in 2016 alone [2]. When investigated, two possible hypotheses arose, regarding how the bacteria, and consequently the potentially life-threatening diarrheal disease reached Haiti. The initial ‘environmental’ hypothesis claimed that the virulent strain responsible for the epidemic had previously existed in the waters around Haiti, and the January 2010 earthquake had caused the bacteria to contaminate the drinking water. DNA sequencing of stool samples from Haitian patients supported this; studies revealed the presence of both infectious and noninfectious environmental strains, but did not ascertain which of the two caused the disease [2]. The second hypothesis, the ‘peacekeeper’s hypothesis’, provided a more believable explanation. The earthquake had attracted international aid from many organizations, including the United Nations, which sent troops to the region. The last troop of peacekeepers had come from Nepal, a cholera endemic region. They reached Haiti in October, just days before the first case was reported.
On testing for similarities in DNA sequence between five Nepalese strains, and three Haitian strains, it was discovered that the strains differed only at 1—2 base pairs; practically confirming that the strains found in Haiti had come from Nepal [4]. Another supportive study also established similarities in antimicrobial resistance activity in Haitian and Nepalese strains [5]. The scientific community and the world, have long since concluded that the peacekeeper’s hypothesis is the more plausible explanation. Had the UN screened its Nepalese peacekeepers, for a cost of only about $2000, this crisis could have been averted [1]. Since accepting responsibility, the UN has promised to raise funds and use them to implement large-scale vaccination, and treatment of Haitian people, but has failed to make much progress in doing so.
Funding No funding sources.
Competing interests None declared.
Ethical approval Not required.
Authors’ contributions Designated authors have contributed equally in conceiving the idea and drafting the manuscript. All authors met the criteria for authorship furnished in the ICMJE Recommendations.
http://dx.doi.org/10.1016/j.jiph.2016.10.003 1876-0341/© 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.
Please cite this article in press as: Qadir TF, et al. Haitian cholera outbreak—–United Nations admits involvement. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.10.003
JIPH-652; No. of Pages 2
ARTICLE IN PRESS
2
Letter to the Editor
References
from Nepal in 2010: evidence on the origin of the Haitian outbreak. MBio 2011;2:e00157—11.
[1] UN makes first public admission of blame for Haiti cholera outbreak. The Guardian; 2016. https://www.theguardian. com/world/2016/aug/18/un-public-admission-haiticholera-outbreak [accessed 4.10.16]. [2] LeMieux Julianna. Cholera in Haiti: the UN finally concedes what science showed years ago. American Council on Science and Health; 2016. http://acsh.org/node/9866 [accessed 4.10.16]. [3] Jenkins PH, Montejano HJ, Abbasi MJ, Crowley MS, O’Brien MG, Conte V, et al. Update on cholera—–Haiti, Dominican Republic, and Florida, 2010. MMWR Morb Mortal Wkly Rep 2010;59:1637—41. [4] Chin CS, Sorenson J, Harris JB, Robins WP, Charles RC, JeanCharles RR, et al. The origin of the Haitian cholera outbreak strain. N Engl J Med 2011;364:33—42. [5] Hendriksen RS, Price LB, Schupp JM, Gillece JD, Kaas RS, Engelthaler DM, et al. Population genetics of Vibrio cholerae
Tooba F. Qadir Syed B. Pasha Huda Fatima Saba Ahmed ∗ Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan ∗ Corresponding
author. Permanent address: 22-B/1, Main Khayaban-e-Bahria Phase VII, Defence Housing Authority, Karachi, Pakistan. E-mail address: [email protected] (S. Ahmed) 4 October 2016
Available online at www.sciencedirect.com
ScienceDirect
Please cite this article in press as: Qadir TF, et al. Haitian cholera outbreak—–United Nations admits involvement. J Infect Public Health (2016), http://dx.doi.org/10.1016/j.jiph.2016.10.003