EXTENDED CASE STUDY

The cholera outbreak in Haiti, October 2010

Haiti was hit by a devastating earthquake of magnitude 7.0 at 16:53 local time,
on 12 January 2010. The epicentre was 25 km west of the capital, Port-au-
Prince. The number killed is estimated to have been between 100 000 and 160
000 (government figures state even more but there are concerns that these
figures are inflated).
At the time of the earthquake, the sanitation in Haiti was very poor. Only 71%
of the population had access to improved water and 24% to improved
sanitation.
Despite this, there had not been a case of cholera in Haiti for nearly a century
prior to the earthquake. Within 10 months of the earthquake, however, a
cholera outbreak had begun. This spread quickly to the whole country over
only 4 weeks.
By August 2015, over 700 000 cases, and about 9000 deaths, had been
reported. Several suggestions were made about the origins of the bacteria that
had caused the outbreak.
Figure 1 A world map showing where cholera has occurred in the recent past. Also shown is where some aid workers
travelled from to help in the cholera outbreak of 2010 in Haiti.

It was discovered that

sewage had leaked from
the military base camp into
the Artibonite River. Most
of the affected people in
the original outbreak had
drunk from the river. The
bacterial strain responsible
for the outbreak was
identified as one closely
Figure 2 The picture shows the Artibonite River, the source of the Haitian
related to a Nepalese
outbreak. Help was provided by many nations. This included a group of UN aid strain.
workers flown in from Nepal. Their military base in Haiti was located on a
tributary of the Artibonite River
Several strategies were
used to try and control the
cholera. These included:
• installation of latrines
• thorough cooking of food
• education about hand washing.
By 2014 the number of cases had been significantly reduced to only about 10%
of the peak in 2011. However, every rainy season leads to an increase in the
number of cases. Disappointingly, the number of cases also rose dramatically
in the last few months of 2014.

Figure 3 New cholera cases in Haiti every month from January 2012 to August 2015.

This is thought to have been caused by:

• heavy, late rainfall
• continued inadequate sanitation
• an assumption that the disease was now under control.
•

Questions
1.a. It has been suggested that some aid workers, carrying the infection,
caused the cholera outbreak. Explain why this suggestion has been made.
b. It was also suggested that the cholera bacteria might have come from a
source in South America. Using Figure 2 suggest how the cholera bacteria
might have reached Haiti from a source in South America.
2. Describe how strategies used to control the outbreak could reduce the
numbers of people infected.
3.a. From Figure 3 state the month and maximum number of cases in 2012.
b. From Figure 3 state the month and maximum number of cases in 2014.
4. Calculate the percentage reduction in cholera cases from the peak in 2012 to
the lowest number in 2014.
5. Describe the pattern of cholera cases recorded in 2015.
6. In 2012 rainfall peaked in May and in November. How does this explain the
pattern of cholera cases in that year?
7. To what extent do you agree with the statement that 'Haiti has managed to
control the cholera outbreak which began in 2010'?