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New.gbgm-umc.orgThe Haiti Response Plan office in Haiti is aware of the unfortunate outbreak of cholera which began
occurred in the Artibonite region of Haiti and continues to be a health concern in the country. The Haiti
Response Plan staff at the Methodist Guest House in Petionville have been assured that as long as safe
drinking water and properly cooked food are available that there is no danger of contracting the
disease. Precautions are being shared with teams already onsite and will be shared with other teams
before and as they arrive.
UMVIM teams who have served in Haiti have suffered no adverse effects from cholera. However, we
remain vigilent and are publishing this update for the information of our team members.
A Few Words about Cholera
By Dr. Sylvia Reimer, GBGM missionary health advisor Update, August 25, 2011 The current recommendation is for a single 300 mg dose of Doxycycline (Doxy) - that would be 3 tablets. That is much easier, and many of our team members will be using Doxycycline for malaria prophylaxis anyway, so will have it available. If someone can't take Doxy, the alternatives are a single 1 gram dose of Azithromycin (Zithromax), or Erythromycin 500 mg four times a day for 3 days. Most people should be okay with Doxy, but it does sometimes irritate the stomach - especially one that's already not feeling well. Note below: the deletion of the Cipro statement out and the insertion of the dose of Doxycycline. If someone has a question about that, they can write to me, Dr. Sylvia Reimer, October 23, 2010 Cholera is caused by a small bacterium and is transmitted by getting contaminated food or water into your gastrointestinal tract. The bacteria never leave your GI tract, and so don’t cause damage to your other body organs, but can cause severe diarrhea and vomiting. The cause of death from cholera is always dehydration. Many more people are infected than develop symptoms of the disease; people who are well nourished and generally healthy are usually able to contend with the infection without becoming deathly ill. Nevertheless, it is much better avoided! Given the current state of sanitation in Haiti, UMVIM teams going there during a cholera epidemic need to be especially careful of what they eat and drink. Some of us who travel often to developing countries get a little too relaxed as we get more comfortable with them. This is not the time to be relaxed! Be sure all the food you eat is prepared with clean hands and is thoroughly cooked. Avoid salads unless you prepare them yourselves and wash each vegetable with Clorox treated water. Your water must be either boiled or chemically treated; unless you bring it from the USA (a terrible waste of luggage space) do not consider bottled water safe. If you usually use a filter water bottle, be sure the specifications include the ability to filter out Vibrio Cholera; many do not. You can treat it with iodine tablets (available at sporting goods stores) or by using 2 drops of chlorine bleach per liter of water. This means any water that goes into your mouth! It should include the water used to wash your dishes as well as that you drink or brush your teeth with. A good rule when brushing teeth is to hold your tooth brush in one hand and water bottle in the other – then you don’t have any hands available to inadvertently turn on the tap! And no singing in the shower! Be sure to wash your hands thoroughly after using the bathroom and before eating or preparing food. Since you will probably be using tap water for this, use plenty of soap and apply hand sanitizer after drying your hands. You should also consider all rivers and streams to be contaminated, as well as the ocean near any river outlets. So no swimming (except in the pool at the Guest House in Port au Prince). If you even dabble your hands in the ocean or a river, wash them before getting them near your mouth. The most important treatment is rehydration, which should start immediately. Using oral rehydration salts gives you needed electrolytes as well as water replacement, and teams should probably take a supply of these with them, so that what is already present in Haiti can be used for the population there. The directions for use are on the package. Antibiotics will stop the infection more quickly, and this is one of the few times I recommend using them as soon as any diarrhea begins. Most of our teams carry a supply of Cipro; the dosage is 500 mg twice a day for 5 days (deleted August 25, 2011, replace with a single 300 mg dose of Doxycycline (Doxy) - that would be 3 tablets. I don’t recommend using it “just in case” – it is unnecessary and increases the development of resistant strains of the bacteria. Most healthy UMVIM team members should not have a problem with this disease if they carry out precautions such as given above. Cholera cannot be transmitted person to person except by the contamination of food or water, so there should be no fear in normal interactions. Go ahead and hug – it’s good for everyone!
Journal of Antimicrobial Chemotherapy Advance Access published September 23, 2010 or possible neoplasm, and extensive workup showed no evidenceof vascular abnormality or CNS vasculitis. The patient had no riskfactors for HIV infection and past medical history was unremark-able. The patient was transferred to our institution for furtherUpon admission, the patient presented with slurred speech