Center for Global Health

Office of the Director

1ST QTR 2011

WELCOMEto the first quarter 2011 Global Health E–Brief, designed 

to inform readers about key global health activities at 

the Centers for Disease Control and Prevention (CDC). One year after a 7.0 magnitude earthquake struck the island nation of Haiti; upwards of 1.5 million people 

continue to live in displaced persons camps while the country faces the added 

burden of a cholera crisis. CDC and a wide range of partners are helping Haiti 

reorganize, reconstruct, and restore systems to meet these enormous challenges.

Haiti’s Ministry of Health requested CDC assistance in responding to control 

disease outbreaks. CDC has sent more than 277 technical staff to support public 

health in Haiti since the earthquake. Additionally, CDC and partners continue to 

work toward restoring the entire public health system that enables disease monitoring and response. 

Dr. Jordan Tappero, CDC medical epidemiologist and leader of the CDC cholera 

response team in Haiti states, “Our primary focus here is to save lives and control 

the spread of disease.” This quarter’s E–brief highlights the health impact of this 

work in Haiti.

CS219380

Haiti: One Year after the Earthquake

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on CDC Washington’s website:

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A young girl looks on as CDC staff meet with camp leaders in the Aviation camp in working in Port au Prince, 

Haiti, 5 weeks after the earthquake that killed more than 230,000 people in the city. The CDC worked to set 

up disease surveillance networks in the weeks after the earthquake to prevent outbreaks in the crowded and 

unsanitary camps.

Photo Credit: © 2010 David Snyder, CDC Foundation

In This Issue

One Year Later: Haiti Public 

Health System Rebounds with 

Help from US, Other Partners ........ 2

Basic Public Health Actions 

Rapidly Mobilized to Lessen 

Impact of Cholera in 

Earthquake-Devastated Haiti ........ 3

Training Teaches Haitian Health 

Care Workers: “No one need die 

from diarrheal disease” .................. 4

Earthquake Can’t Stop Progress 

to Eliminate Lymphatic Filariasis 

in Haiti ............................................. 5

With CDC Assistance, 

Haiti Successfully Tests and 

Adopts Rapid Diagnostic 

Tests for Malaria .............................. 6

Review of Earthquake 

Injuries Data Informs Future 

Responses to Disasters ................... 7

Newsbytes ....................................... 8

CDC Global Health E-Brief
One Year Later: Haiti 

Public Health System 

Rebounds with Help from 

US, Other Partners

On January 12, 2010, Haiti was hit by a 

magnitude-7.0 earthquake. More than 

half a million people died or were injured, 

and approximately 2 million people were 

displaced from their homes. Overcrowded 

and poor living conditions increased 

Haitians’ risk for communicable diseases. 

The earthquake destroyed most government buildings, schools, homes, hospitals, 

and transportation and communication 

infrastructure in the Western part of the 

country, including the capital Port-auPrince and much of the Southeastern part 

of the country.

Immediately after the earthquake, the 

Ministry of Public Health and Population 

(MSPP) turned to the Centers for Disease 

Control and Prevention’s (CDC’s) Haiti 

Office in Port-au-Prince for help in 

strengthening the country’s public health 

workforce. Within 2 weeks, the ministry, the 

Pan-American Health Organization (PAHO), 

CDC, and other national and international 

agencies had launched the National 

Sentinel Site Surveillance (NSSS) System. 

The NSSS has since enabled Haiti to 

monitor injury and disease trends and 

to detect outbreaks such as the cholera 

epidemic. It also has provided vital 

information about disaster-affected 

populations throughout Haiti so that 

relief efforts could be better targeted. The 

ministry is now maintaining the NSSS, with 

collaboration and support from CDC and 

other partners. The goal is for the system 

to be a long-term national surveillance 

system for Haiti, generating data that will 

help decision makers allocate resources 

and identify effective public health 

interventions. 

“The NSSS could not have been launched 

so quickly if it weren’t for the surveillance 

sites that had already been established by 

hospitals and clinics affiliated with PEPFAR, 

the US President’s Emergency Plan for 

AIDS Relief,” noted Daphne B. Moffett, PhD, 

Captain in the US Public Health Service and 

Deputy Director for CDC’s Health Systems 

Reconstruction Office. In the months 

immediately following the earthquake, 51 

PEPFAR sites provided the ministry and its 

public health partners with daily information via e-mail and phone, so they could 

target disaster relief resources where they 

were most needed. 

Over the past year, the ministry, PAHO, 

CDC, and partners have collaborated 

to establish two additional surveillance 

systems that complement the NSSS. The 

Internally Displaced Persons Surveillance 

System (IDPSS) allows non-governmental 

organizations to share and track illness 

data. Clinics voluntarily report diagnoses 

that pose the greatest public health risk 

to internally displaced persons who face 

overcrowded living conditions, poor 

hygiene and sanitation, malnutrition, 

exposure to mosquitoes, and incomplete 

vaccination coverage. 

In addition, Haiti’s nationwide cholera 

surveillance system allows hospitals and 

clinics to send daily cholera case counts to 

local ministry officials. Aggregate data are 

sent on to department-level officials and 

then to central government officials. The 

ministry posts daily and cumulative tallies 

of cholera reports on its public website.

Strengthening Epidemiology and 

Laboratory Capacity

Over the past year, CDC also has worked 

closely with the ministry and other partners 

to expand the capacity of Haiti’s National 

Public Health Laboratory. One of the goals is 

to improve the quality of diagnostic testing 

for TB, HIV/AIDS, malaria, and rabies, which 

are major public health problems in Haiti.

In addition, CDC is launching a Field 

Epidemiology and Laboratory Training 

Program (FELTP) in Haiti. Working with the 

country’s Ministry of Health, FELTPs have 

a proven track record of strengthening 

a country’s capacity to respond to 

public health priorities and emergencies 

through mentoring and training of 

epidemiologists. Developing partnerships 

is an important element of establishing, 

supporting, and sustaining FELTPs, and 

CDC regularly collaborates with national 

and international organizations and other 

federal agencies, including the US Agency 

for International Development (USAID).

Strong Capacity Means Fast 

Response

Because surveillance and laboratory system investments for outbreak-prone disease were established by the Haitian MSPP 

in collaboration with CDC last fall following the earthquake, health officials were 

able to rapidly identify cholera. Jordan 

W. Tappero, MD, MPH, recalls how quickly 

the events unfolded after an Epidemic 

Intelligence Service (EIS) officer called him 

one evening in October 2010 to give him 

a heads up about reports received by the 

MSPP of watery diarrhea among patients in 

the Artibonite Department of Haiti.

“Within 30 minutes, two EIS officers were 

in a car with laboratory media (collected 

from the National Public Health Laboratory) 

needed to identify cholera. The two EIS 

offers went immediately to the facility that 

had reported patients with rice water diarrhea,” said Tappero, Director for CDC’s Health 

Systems Reconstruction Office. Rapid tests 

of the first 11 specimens were positive for 

Vibrio cholerae. “They brought the specimens 

to Haiti’s National Public Health Laboratory. 

Within 36 hours, colonies were growing in 

culture media, confirming cholera,” he said. 

Forty-eight hours after that phone call from 

the EIS officer, CDC’s resident laboratory 

advisor Georges Dahourou, PharmD, MSc, 

working side by side with ministry laboratorians at Haiti’s National Public Health 

Laboratory, was able to confirm the cholera 

outbreak for public health officials. CDC 

Director Tom Frieden advised the Haitian 

MSPP to report the findings to the World 

Health Organization. It was the first cholera 

outbreak in Haiti in at least a century.

“Having a public health infrastructure and 

partnerships in place was critical after the 

earthquake hit the Port-au-Prince area,” 

said Brian Wheeler, MPH, Deputy Director 

for the CDC Haiti Office in Port-au-Prince.

Partnerships and infrastructure will be 

critical to Haiti’s long-term reconstruction 

efforts and success in managing many 

longstanding health problems — such as 

HIV/AIDS, malaria, TB, and malnutrition — 

as well as new challenges such as cholera.

For more information on CDC’s role in 

strengthening health systems in Haiti, see 

http://www.cdc.gov/globalhealth/hsr.

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 2
Basic Public Health 

Actions Rapidly Mobilized 

to Lessen Impact of 

Cholera in EarthquakeDevastated Haiti 

When the January 2010 earthquake struck 

Haiti, the first priorities of Haitian public 

health officials and their partners, including CDC and USAID, were improving 

access to clean water and sanitation and 

promoting basic hygiene. They knew these 

basic public health actions could protect 

Haitians from threats they faced as a result 

of living in crowded, temporary camps.

Even before the January 2010 earthquake 

devastated much of Port-au-Prince, many 

Haitians lived without access to basic water 

and sanitation services. According to the 

WHO/UNICEF Joint Monitoring Program, 

only 71% of Haitians living in urban settings had access to an improved drinking 

water source—household connection, 

public standpipe, borehole, protected 

dug well, protected spring, or rainwater 

collection. Access for rural Haitians was 

even lower –only 55%. In addition, Haitians 

had limited access to resources that could 

turn any of these water sources into safe 

drinking water. Haitians’ access to improved 

sanitation—connection to a public sewer or 

septic system, pour-flush latrine, simple pit 

latrine or ventilated improved pit latrine—

was even more limited. Only 24% of urban 

Haitians had access to improved sanitation. 

Of Haitians living in rural Haiti (53% of the 

total population), only 51% had any type of 

sanitation coverage; an estimated 49% of 

rural Haitians rely on open defecation.

Dr. Eric Mintz, CDC epidemiologist and 

cholera expert, remarked, “Poor water 

and sanitation conditions are the reasons 

why cholera is such a big problem in Haiti. 

“Fortunately, we are helping the government of Haiti take the steps needed to 

improve access to safe water and educate 

the public about basic hygiene that can prevent cholera and other diarrheal diseases.”

Despite the challenging circumstances, the 

Haitian Ministry of Health and Population 

(MSPP) and the National Directorate for 

Water and Sanitation (DINEPA) immediately 

set in place procedures to improve water 

quality through disinfection at the source 

and household level. CDC supported the 

Ministry’s efforts to test drinking water 

supplies in the Port-au-Prince camps established for Haitians displaced by the earthquake and helped to establish a portable 

lab to identify the organisms that affect 

water quality and cause disease, including 

cholera. CDC also trained people to monitor drinking water outside of Port-au-Prince.

When the first cases of cholera were 

confirmed by the Haitian National Public 

Health Laboratory in October 2010, the 

Government of Haiti, CDC, USAID, and 

other partners quickly developed educational materials for clinicians (http://www.

cdc.gov/haiticholera/training/hcp_materials.htm). Within a month, more than 400 

clinicians were trained and spread across 

the country to share their new skills with 

other health workers.

In addition, USAID rapidly mobilized to distribute soap, chlorine-based disinfectants, 

and other supplies to ensure Haitians could 

protect themselves through hand washing, 

cleaning, and purifying and safely storing 

water. Although some cholera cases have 

occurred in the camps that still serve as 

home for over 1 million persons displaced 

by the earthquake, major outbreaks in those 

camps have thus far been avoided and case 

fatality rates have been relatively low. 

Mintz notes that much has been accomplished, but additional short- and longterm efforts are needed to address the 

cholera outbreak, which is expected to 

Georges Dahourou, PharmD, MS, Lab Advisor for CDC Haiti, carries the first 80 

cholera isolates from Haiti’s National Public Health Laboratory. Working side by 

side with ministry laboratorians at the national laboratory, he was able to confirm 

the cholera outbreak for public health officials. It was Haiti’s first cholera outbreak 

in at least a century.

Photo Credit: Nancy Strockbine, CDC

CDC Responds to Public Health Challenges in Haiti

HIV/AIDS Epidemic

Haiti has the highest HIV prevalence rate in the Western Hemisphere (2.2%), 

with an estimated 120,000 persons living with HIV/AIDS.

In 2002, the CDC Global AIDS Program (GAP) opened CDC’s first office in Haiti 

to assist the country in addressing the HIV/AIDS epidemic. 

In 2003, GAP resources were increased in Haiti under the President’s 

Emergency Plan for AIDS Relief (PEPFAR).

Earthquake’s Aftermath

In January 2010, Haiti was hit by a 7.0 earthquake. The Haitian government 

estimated that 230,000 people died and 300,000 were injured. 

Less than 2 weeks after the quake hit, Haiti’s public health officials had 

launched a national surveillance system with assistance from CDC, PAHO, and 

other partners. 

Cholera

In October 2010, Haiti’s first case of cholera was confirmed by Haiti’s National 

Public Health Laboratory. 

CDC experts deployed to Haiti to provide in-country assistance include 

medical officers, epidemiologists, laboratory scientists, environmental health 

specialists, communication specialists, public health advisors, planners, 

information technology specialists, and support staff. 

Longstanding Public Health Challenges

Other public health challenges in Haiti include tuberculosis, opportunistic 

infections; malaria; dengue; rabies; lymphatic filariasis; water, sanitation, 

and hygiene practices; chronic malnutrition; reproductive health; child and 

maternal health; diabetes; and high blood pressure.

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 3
continue for a period of years unless the 

poor water and sanitation conditions are 

resolved. 

CDC and USAID are working together on 

hygiene promotion and cholera prevention campaigns. The short- and long-term 

cholera response in Haiti requires the 

Haitian government and the international 

community to expand the focus to water, 

sanitation, and hygiene efforts. USAID and 

CDC are currently assessing how to support the Haitian government and leverage 

efforts of other international partners to 

ensure the short- term effectiveness and 

continued sustainability of water, sanitation, and hygiene activities. Activities being 

considered include expanding household 

water treatment and safe water storage 

throughout Haiti, expanding the number 

of latrines and sanitation at heath facilities, 

chlorination of piped water supplies, wider 

distribution of soap for hand washing, and 

promotion of safe food-handling practices. 

Other long-term efforts, in partnership 

with the Haitian government, could include 

construction of physical infrastructure, 

training the Haitian workforce to operate 

and maintain the infrastructure and ongoing health education to improve hygiene 

behaviors. 

The Haitian government and its partners 

are well aware that the country has a long 

way to go to reduce the burden of cholera 

and improve water, sanitation, and hygiene. 

However past responses to cholera outbreaks in Mexico and Chile show that 

improvements in water, sanitation, and 

hygiene are achievable. In Mexico, the 

government dramatically increased access 

to safe drinking water and sanitation, 

reducing deaths from diarrhea by 18% 

with only rare cases of cholera. In Chile, a 

similar response led to a similar reduction 

in cholera and decreases of 87% in typhoid 

fever and 61% in hepatitis A. 

“The good news is that we have seen other 

countries affected by cholera outbreaks 

successfully, over time, reduce deaths from 

cholera and eventually the impact of future 

outbreaks,” Mintz said. 

Training Teaches Haitian 

Health Care Workers: 

“No one need die from 

diarrheal disease” 

In late October 2010, the public health laboratory of Haiti’s Ministry of Public Health 

and Population (or MSPP) identified the 

presence of the bacteria that causes cholera 

in samples from people with acute watery 

diarrhea in the Artibonite Department. 

When a cholera outbreak occurs in 

resource-limited countries like Haiti, where 

sanitary conditions are poor and safe water 

systems do not exist, public health officials 

must act quickly to save lives. 

One of MSPP’s first requests of CDC and 

partners was for help to educate health 

care workers to manage cholera clinically 

and to teach Haitians how to prevent the 

illness. 

“Education is the key here,” says Dr. Robert 

Tauxe, a CDC expert in waterborne diseases. 

“Cholera is a fairly simple disease requiring 

a fairly simple response. But without an 

understanding of how to mount an effective 

response, cholera can be quite devastating. 

It is not only that the general population 

is unfamiliar with the disease but also that 

the health care system in Haiti—from staff 

to facilities—is unprepared to deal with an 

outbreak. And because cholera can spread 

fast and kill fast, fluids need to be replaced 

in the body quickly. If untreated, mortality 

can reach 20 percent or more. But with 

treatment, primarily oral or intravenous, 

mortality can be less than 1 percent.”

Three-Part Approach to Training

In November 2010, Tauxe was deployed 

to Haiti to lead a training campaign for 

Haitian health care workers. He was joined 

by Dr. Azharul Islam Khan, head of the 

Short Stay Unit, Clinical Sciences Division, 

Dhaka Hospital, Dhaka, Bangladesh, 

and representative of the respected 

International Centre for Diarrhoeal Disease 

Research, Bangladesh, and WHO’s Global 

Outbreak Alert and Response Network. 

Khan was invited to participate because 

of his expertise in cholera treatment and 

management. He arrived at CDC one week 

prior to deployment to Haiti with Tauxe to 

assist in the development of the training 

materials. Bangladesh is well known for the 

development of oral rehydration solution 

(ORS), an intervention credited with saving 

the lives of more than 20 million children 

struck with diarrheal diseases. CDC also 

reached out to Haitian experts, including 

Dr. Yves Lambert, infectious disease specialist at Haiti’s State University Hospital. 

CDC’s training complemented the 

Government of Haiti’s public awareness 

campaigns and messages emphasizing 

safe water, sanitation, hand-washing and 

proper food preparation. CDC coordinated message development and clinical 

Many Haitians, especially those living in rural parts of the country, get their drinking water from unprotected 

sources, such as this well. A lack of basic water and sanitation services, compounded by inadequate hygiene 

behaviors, has greatly contributed to the current cholera crisis and will make it challenging to contain.

Photo Credit: GDDER, CDC

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 4
guidelines among experts in Atlanta, WHO/

PAHO, MSPP, and many partners. Within 

days, Five Basic Prevention Messages were 

shared, immediately followed by Diagnosis 

and Testing guidelines, and Clinical 

Presentation & Management. Materials 

were translated into French, Haitian Creole, 

and Spanish. 

The training, which emphasizes that “no 

one need die from diarrheal disease,” is 

being rolled out in three phases. First, CDC 

and partners trained 33 “master trainers” 

selected by MSPP. Topics include: 

• The microbe and how it causes cholera

• Clinical presentation and treatment

• Transmission and prevention

• Laboratory diagnosis 

• Surveillance

• Clinical management of a single case

• Operation of a Cholera Treatment 

Center 

The master trainers then taught public 

health officials and clinical staff in Haiti’s 

ten departments.

The final phase involves the training of 

community health workers (CHW) across 

the country by department-level health 

officials. CHWs staff local health institutions 

that are either part of MSPP’s network, 

or sites funded by the U.S. President’s 

Emergency Plan for AIDS Relief (PEPFAR) 

(see related story for more on how this 

network of sites across Haiti assisted with 

the cholera response). Because a large 

percentage of Haiti’s population speaks 

Haitian Creole rather than French, CHW 

training materials, including laminated 

cards, were translated into Haitian Creole. 

This final stage of training covers a range 

of instructions, from hand-washing and 

proper water treatment to effective sanitation and preparation of a body for burial. 

Training Expected to Lead to Fewer 

Deaths

As participants share knowledge gained 

from the trainings, awareness of how to prevent and treat cholera will increase throughout Haiti. Similarly, feedback provided by 

master trainers, department-level health 

officials, and CHWs is being evaluated by 

CDC to strengthen the training for the ongoing and future responses. Already, improved 

understanding of cholera and its treatment 

is believed to be a factor in the decreasing 

case fatality rate documented for cholera 

since the beginning of the outbreak.

According to a partner from the 

International Rescue Committee who 

attended training in Port-au-Prince on 

November 22, “this training has been very 

useful; the presenters are great and very 

animated.” Of Khan, in particular, she said, 

“after listening to him, I feel like going out 

and saving the world.”

“Every person at every level has been so 

cooperative and supportive here,” Khan 

said of his experience at CDC’s headquarters and in Haiti. “Particularly useful were 

the daily calls between the team in Haiti 

and staff at headquarters.” “The two-way 

discussion has led to a valuable flow of 

information, which is the grounding for a 

successful intervention.”

“CDC’s unique combination of evidencebased approaches, surveillance, clinical 

training, and applied training in the field 

should serve as an example for the world.”

Earthquake Can’t Stop 

Progress to Eliminate 

Lymphatic Filariasis in 

Haiti

Not even an earthquake can stop an 

outstanding public health program. With 

strong support from local Haitian leaders 

and CDC and other U.S. partners, the 

program to eliminate lymphatic filariasis 

(LF) in Haiti has managed to stay on track, 

treating nearly three million persons since 

the earthquake struck in January 2010. 

LF is a mosquito-borne parasitic infection 

sometimes called elephantiasis. The disease 

causes hugely swollen limbs and fluid 

accumulation in the scrotal sac. It is disabling and stigmatizing. According to the 

World Health Organization (WHO), more 

than 8.6 million Haitians are at risk for LF, 

with a national prevalence of approximately 

10%. Infection levels in some communities 

are among the highest in the world: 30% 

of children are infected by age 4. Haiti is 

one of only four countries in the Americas 

where transmission of LF still occurs. 

Stopping transmission of the disease is a 

first step toward elimination. Transmission 

can be interrupted by treating the entire 

population in endemic communities once 

a year for 5 to 8 years with a two drugs: 

DEC and albendazole. Albendazole has 

the added benefit of eliminating intestinal 

worms that cause anemia and malnutrition 

in children. The genesis of the LF program 

in Haiti was a research effort carried out 

Dr. Azharul Islam Khan, head of the Short Stay Unit, Clinical Sciences Division, Dhaka Hospital, Dhaka, 

Bangladesh. Khan co-led training of health care workers in Port-au-Prince-au-Prince.

Photo Credit: Araceli Rey, CDC

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 5
by CDC scientists beginning in the 1980s. 

These studies contributed to understanding of the diagnosis and treatment of 

infection and informed the global strategy 

to eliminate LF.

From its beginning as a CDC-led research 

activity, the LF elimination program in Haiti 

gradually added partners and expanded 

to reach more communities. Key partners 

included the Haitian Ministry of Public 

Health and Population (MSPP); University 

of Notre Dame (funded by the Bill & 

Melinda Gates Foundation); IMA World 

Health (funded by RTI/USAID); PAHO and 

CDC. Despite the unprecedented devastation of the earthquake, the partners redoubled their efforts, and with new donors, 

the program is now poised to reach all of 

Haiti for the first time, making elimination 

of LF an achievable goal. 

Patrick Lammie, a CDC scientist involved 

with the program since its inception notes: 

“That the program in Haiti continues today 

is a testimony to the commitment and 

dedication of a small group of Haitian colleagues who continued to keep the focus 

on the program at considerable personal 

risk during periods of political instability.” 

In particular, Dr. Lammie cites Dr. Beau 

de Rochars, a Haitian physician who was 

instrumental in the success of the Haitian 

program. (Now Dr. Beau de Rochars is a 

CDC Epidemic Intelligence Officer.) 

Results from Haiti have documented a 

dramatic decline in levels of LF infection. 

In parallel, hookworm infection – a major 

cause of anemia in Haiti – has virtually 

disappeared. Infection with other intestinal 

worms has also declined. 

Dr. Beau DeRochars says the LF program 

has given Haitians good results. “Patients 

with LF complications are treated with 

respect and dignity; prevention is emphasized, especially for children; and by protecting kids from intestinal parasites, the LF 

program is offering children a better future.” 

Despite overwhelming odds, the LF program is now poised to offer Haiti a future 

free of this disabling and stigmatizing 

disease.

With CDC Assistance, 

Haiti Successfully Tests 

and Adopts Rapid 

Diagnostic Tests for 

Malaria 

Already a major public health problem 

in Haiti, malaria became a bigger challenge after much of Haiti’s public health 

infrastructure was destroyed after the 

January 12, 2010 earthquake. With CDC’s 

help, Haitian officials investigated whether 

rapid diagnostic tests (RDTs) could be used 

as one part of a national strategy to quickly 

and accurately diagnose and treat malaria. 

Plasmodium falciparum malaria, the most 

lethal of malaria parasites, is endemic to 

Haiti and remains a major concern for residents, displaced persons, and emergency 

responders one year after the January 12, 

2010, earthquake.

Rapid, accurate diagnosis of malaria has 

historically been difficult. Until recently, 

the only way to diagnose the disease was 

for a skilled laboratory worker to use a 

microscope to look for malaria parasites 

in a blood sample. In addition, this was 

the only approved method for diagnosing malaria, according to Haiti’s national 

policy for the diagnosis and management 

of malaria. Unfortunately, many facilities in 

Haiti have neither functioning microscopes 

nor staff with the skills to use this diagnostic method. 

Recognizing that the millions of people 

displaced by the earthquake were at 

increased risk of malaria because they 

were sleeping in the open or in tents 

that mosquitoes could easily enter, CDC 

helped Haiti’s Ministry of Public Health and 

Population (MSPP) test RDTs to see if they 

could help meet the country’s acute need 

for quick malaria diagnostics. Dr. Michelle 

Chang, MD, medical epidemiologist, coordinated the technical assistance CDC’s 

Malaria Branch provided to Haiti’s MSPP. 

During 2 weeks in April, MSPP and CDC 

worked to gather in country, local data and 

experience that would lay the groundwork 

for a policy change. In Port-au-Prince and 

several towns affected by the earthquake, 

an assessment was conducted to compare 

expert microscopy with two brands of RDTs 

in four health facilities where local health 

workers were trained in RDT use. In two 

of the sites, one brand of RDTs showed 

acceptable sensitivity and specificity, indicating that it performed well. In a third 

EIS Officer Beau de Rochars, a leader in the drive to eliminate LF in Haiti, working recently with the CDC cholera 

outbreak team.

Photo Credit: Valerie Johnson, CDC

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 6
site, the other brand of RDT showed poor 

sensitivity, and in the fourth site there were 

not enough data. The findings convinced 

the MSPP that at least some RDTs could 

perform adequately in Haiti’s setting.

Given these results, which correlated with 

previously published, lab-based evaluations 

of RDTs, MSPP favored the use of RDTs as 

part of the national strategy at health centers 

and clinics where microscopy is not available. 

Considering the in-country experience along 

with the known evaluations of RDTS and 

WHO recommendations, the MSPP approved 

three RDTs for diagnosis of P. falciparum

malaria as part of their national policy.

“This policy change using in-country data 

and published reports greatly expands 

the opportunities for accurate malaria 

diagnosis across the country. This means 

that Haiti’s health system can more easily 

discern if a person with fever has malaria 

versus another disease, and can then treat 

that person accurately and appropriately. 

The ability to easily test people will also 

help the country maintain accurate surveillance on the burden of malaria in Haiti and 

mobilize resources accordingly.” said Dr. 

Chang.

Review of Earthquake 

Injuries Data Informs 

Future Responses to 

Disasters

The 7.0 magnitude earthquake that struck 

Haiti on January 12, 2010, caused an estimated 222,570 deaths and 300,000 injuries. 

In impoverished countries like Haiti, analyzing the causes of deaths and injuries postdisaster can help countries better prepare 

for disasters in the future.

Analysis of the injuries and surgical procedures common after the earthquake 

in Haiti was possible thanks to establishment of the first field hospital by the 

University of Miami Global Institute/Project 

Medishare (UMGI/PM). The facility, which 

had 280 beds, three operating rooms, 

and 220 volunteer, rotating staff from 

the United States and Canada, eventually 

handled many of the complex medical and 

surgical cases.

In June 2010, UMGI/PM approached CDC 

for assistance in conducting a retrospective review of available inpatient records 

between January 12 and May 28, 2010. 

Data collected from paper-based medical 

records were entered into an electronic 

database to characterize injuries and surgical procedures, and ultimately to guide 

future earthquake planning in resourcelimited settings.

Of the 1,369 admissions, injury-related 

diagnoses were recorded for 581 (42.4%) 

patients, of which 346 (59.6%) required 

a surgical procedure. The most common 

injury-related diagnoses were fracture/

dislocation; post-traumatic wound infection; 

and head, face, and brain injuries. The most 

common injury-related surgical procedures 

were skin surgeries, orthopedic, and surgical 

amputation. The exact number of amputees 

resulting from the earthquake is unknown, 

but aid agencies say Haiti ranks among the 

highest-ever for the number of limbs lost in 

a single natural disaster.

Of the patient records that documented 

injuries, approximately 28% were earthquake related. Most patients with injuries 

related to the earthquake came to the 

hospital during the first four weeks of the 

response. In following weeks, other injuries 

(e.g., motor vehicle-related, violencerelated) were seen. Of all injured patients, 

more than three-fourths were discharged 

to a residential setting. Nearly three percent died. 

Health workers learn to use rapid diagnostic tests for malaria at the National Public Health Laboratory in Port-au-Prince, Haiti.

Photo Credit: Dr. Michelle Chang, CDC

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 7
Some important lessons emerged from the 

data reported through UMGI/PM. First, injuries following earthquakes (limb fractures 

and significant skin injuries) in resourcelimited areas often require urgent orthopedic and plastic surgery performed by highly 

skilled medical staff. While a surge of injuries 

and surgical procedures were noted immediately after the earthquake in Haiti, an 

important lesson for disaster preparedness 

and response is that sustained numbers of 

injuries caused by the disaster and injuries 

from violence and damaged infrastructure 

can be expected for several months. In areas 

like Haiti, with high levels of poverty, poor 

social and economic infrastructure, and 

history of social upheaval and high levels of 

interpersonal violence, the need for medical 

response to injuries can be prolonged and 

substantial. Therefore, field hospitals preparing for a long-term response to resourcelimited settings following an earthquake 

should be prepared to mobilize, deploy and 

utilize resources for many months following 

the disaster.

Earthquake survivor with left leg fractures is receiving physical therapy after surgery to aid in his rehabilitation.

Photo Credit: Victor Coronado, CDC

Now on YouTube: Malaria Eradication: 

Back to the Future 

Tune in to CDC’s Public Health Grand Rounds to hear four current and former CDC malaria experts review the history of the 

malaria eradication campaign, discuss current control successes 

and challenges, and explore strategies to eliminate , and eventually 

eradicate, this deadly disease, which caused approximately 781,000 

deaths in 2009. 

CDC has been a leader in the fight against malaria for more than 

60 years, ever since the agency’s early days as a federal program that 

led the successful elimination of malaria from the U.S. CDC scientists provide technical expertise to develop evidence-based policies 

and programs, critical scientific innovations to help guide future 

global malaria efforts, and monitoring and evaluation of progress 

toward global malaria goals. 

CDC is charged by U.S. Congress (through the Lantos-Hyde Act, 

2008) to take a leading role in strategic information (monitoring 

and evaluation, surveillance, and operations research), including 

advising the U.S. Malaria Coordinator on priorities for these activities and being a key implementer of such activities. 

To watch Malaria Eradication: Back to the Future, visit YouTube 

(http://www.youtube.com/watch?v=SyISSp2DPy8) or 

CDC’s web site (http://www.cdc.gov/about/grand-rounds/). 

For more on CDC’s malaria program, visit www.cdc.gov/malaria.

New CDC Regional Global Disease 

Detection Center Established in India

CDC’s Global Disease Detection (GDD) Regional Centers work 

with WHO and a network of international partners to build global 

public health capacity in alignment with the International Health 

Regulations (IHR). 

On November 9, 2010, a Memorandum of Understanding (MOU) 

was signed between CDC, the Department of Health and Human 

Services and the Indian National Centre for Disease Control 

(NCDC), Ministry of Health & Family Welfare, during President 

Obama’s visit to the country in November 2010. The MOU establishes the NCDC as the site for the new GDD Regional Center in 

New Delhi, India, which will expand geographic coverage of and 

strengthen the global network of existing GDD Regional Centers, 

currently located in Thailand, Kenya, Guatemala, China, Egypt, 

Kazakhstan, and South Africa. 

For leading the US year-long effort to bring to completion the 

GDD Memorandum of Understanding, Dr. Kenneth Earhart, 

director of the Indian GDD Center, received the Department of 

State Meritorious Honor Award. His leadership created tremendous 

goodwill with colleagues in the Ministry of Health and Family 

Welfare, enabled the timely signing of the MOU, and prepared a 

foundation for developing this important international partnership.

Newsbytes • Newsbytes • Newsbytes • Newsbytes 

www.cdc.gov/washington/globalhealth_ebrief.html Global Health E-Brief • 1st Quarter 2011 8