Cholera in Haiti
Authors: Jean Hugues Henrys, Gérald Lerebours, Mélody Aude Achille, Kenny Moise, Christian Raccurt
Journal: The Lancet Global Health (2020)

We were very surprised to read the recently published Article by Elizabeth Lee and colleagues1Lee EC, Chao DL, Lemaitre JC, et al. Achieving coordinated national immunity and cholera elimination in Haiti through vaccination: a modelling study. Lancet Glob Health 8: e1081–89.Google Scholar and the linked Comment by Jeannot François.2Francois J Cholera remains a public health threat in Haiti.Lancet Glob Health. 2020; 8: e984Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar We believe both pieces might deeply mislead readers about the current epidemiological situation of cholera in Haiti. In the Article, Lee and colleagues acknowledge that "the lowest number of cholera cases in Haiti since the outbreak began was reported in 2019" and "from… February, 2019, to the time of writing (June 2020), no confirmed cases of cholera have been reported in Haiti".1Lee EC, Chao DL, Lemaitre JC, et al. Achieving coordinated national immunity and cholera elimination in Haiti through vaccination: a modelling study. Lancet Glob Health 8: e1081–89.Google Scholar However, they only report epidemiological data for 2018 and calibrated their models up until January, 2019. Without any supporting evidence, the Article and the related Comment postulate "an increasing number of unreported cases due to a poor surveillance system".2Francois J Cholera remains a public health threat in Haiti.Lancet Glob Health. 2020; 8: e984Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Because the study defines elimination as "less than one infection with [Vibrio] cholerae (including reported and unreported infections) over at least 52 consecutive weeks",1Lee EC, Chao DL, Lemaitre JC, et al. Achieving coordinated national immunity and cholera elimination in Haiti through vaccination: a modelling study. Lancet Glob Health 8: e1081–89.Google Scholar one cannot help but wonder which system will certify this elimination even if it is achieved through vaccination. Conversely, the imperfect yet efficient surveillance system of the Haitian Ministry of Health managed to confirm the onset of the epidemic within 48 h in October, 2010, and recorded on a daily basis over 800 000 suspected cases, with over 9000 bacteriologically confirmed cases, nearly 10 000 deaths, and countless other qualitative essential information ever since.3Barzilay EJ Schaad N Magloire R et al.Cholera surveillance during the Haiti epidemic — the first 2 years.N Engl J Med. 2013; 368: 599-669Crossref PubMed Scopus (149) Google Scholar, 4Juin S Schaad N Lafontant D et al.Strengthening national disease surveillance and response—Haiti, 2010–2015.Am J Trop Med Hyg. 2017; 97: 12-20Crossref PubMed Scopus (5) Google Scholar Despite the recent economic crisis, political unrest, and COVID-19 epidemic, the Haitian Ministry of Health still provides epidemiological reports on its website that have no clusters of suspected cholera cases, nor cholera deaths since February, 2019. Additionally, cultures from nearly 2000 consecutive stool samples taken throughout the country have remained negative for V cholerae O1 since February, 2019.5Ministère de la Santé Publique et de la PopulationDocumentation- rapports choléra. Ministère de la Santé Publique et de la Population, Port-au-PrinceOct 3, 2020Google Scholar Lee and colleagues should be aware of this essential information, since several of them are affiliated to Partners in Health, an organisation actively involved in the cholera microbiological surveillance in Haiti. Therefore, we consider these omissions in the Article as a crucial misinformation. We strongly agree with Lee and colleagues that the UN should fulfil its promise of compensation to those affected, and that investment in large-scale public water and sanitation systems would benefit Haitians' health. However, we sincerely doubt that a nationwide vaccination campaign would currently meet the basic conditions of the principle of beneficence. We declare no competing interests. Achieving coordinated national immunity and cholera elimination in Haiti through vaccination: a modelling studyModels suggest that the probability of achieving zero transmission of Vibrio cholerae in Haiti with current methods of control is low, and that bolder action is needed to promote elimination of cholera from the region. Large-scale cholera vaccination campaigns in Haiti would offer the opportunity to synchronise nationwide immunity, providing near-term population protection while improvements to water and sanitation promote long-term cholera elimination. Full-Text PDF Open AccessCholera in HaitiWe carefully read the recently published study by Elizabeth Lee and colleagues (August, 2020).1 We have substantial concerns about the results of the four models, which are in contrast with the current absence of actual cholera cases in Haiti since February, 2019. Full-Text PDF Open AccessCholera in Haiti – Authors' replyWe appreciate the careful consideration of our Article1 from Stanislas Rebaudet and colleagues and Jean Hugues Henrys and colleagues, but we must respectfully disagree with most of their concerns about our study. Full-Text PDF Open Access