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Imported Rabies: 1970 to 2011

An ongoing chronology of cross-border rabies cases reported during 1970 to July 2011 includes 59 cases of human infection, from 20 countries; and 29 importations of rabid animals (27 dogs, 1 horse and 1 cat) from 14 countries. Gideon The most common countries for human exposure were India and the Philippines (8 cases each), followed by Mexico (6) and Morocco (4). Seven rabid animals originated in Morocco. The case detailed in ProMED is the third to originate in Haiti (the two previous patients also died in the United States), and the thirteenth case of imported rabies in the U.S. since 1983. [1,2]

1. Berger SA. Rabies: Global Status, 2011. 366 pp, 546 graphs, 1056 references. Gideon e-book series, Berger SA. Infectious Diseases of the United States, 2011. 1030 pages, 464 graphs, 8237 references,

Cholera – Not Just Haiti

Although the world is currently focused on a serious outbreak of cholera in Haiti, the disease continues to be active in several other areas of the world. The following outbreaks were posted during November, concurrent to the events in Haiti:

  • Benin – An outbreak (846 cases, 7 fatal) was reported.
  • Cameroon – An outbreak (10,000 cases, 597 fatal)
  • Chad – An outbreak (4,000 cases, 135 fatal) was reported.
  • China – Outbreaks were reported in Jiangsu and Anhui
  • Ghana – An outbreak was reported in the Eastern region
  • Haiti – 16,799 cases, 1,034 fatal
  • India – Outbreaks were reported in Jammu and Kashmir, Maharashtra, Assam, Orissa, Tamil Nadu and Gujarat.
  • Nigeria – Outbreaks (38,173 cases, 1,555 fatal) involved 11 states.
  • Pakistan – Large outbreaks have followed local flooding.
  • Papua New Guinea – Outbreaks (2,000 cases, 40 fatal) were reported in East Sepik, Madang and Morobe Provinces.
  • Zambia – An outbreak (70 cases) was reported in Copperbelt.
  • Zimbabwe – Multiple outbreaks, over 100,000 cases (4,500 fatal) total since 2008.

Vaccination Coverage in Haiti

Although vaccination coverage for major infectious diseases in Haiti was below that of other countries in the region, recent WHO estimates had shown some improvement in recent years. Most recent data are summarized in the following chart:

Also check out GIDEON’s free ebook: Infectious Diseases of Haiti

Tuberculosis in Haiti

As pointed out by ProMED, tuberculosis rates in Haiti were already highest in the region before the current disaster. In the following graph, I’ve contrasted reports for Haiti with those of neighboring countries.

Don’t forget to check out GIDEON’s free e-book: Infectious Diseases of Haiti

E-book: Infectious Diseases of Haiti by GIDEON

When the humanitarian disaster in Haiti began to unfold, we accelerated development of a comprehensive book on the diseases of that country. This will be one in a series of ebooks which present the status of all infectious diseases…in all individual countries. This ebook, Infectious Diseases of Haiti, will be offered free of charge to all health professionals concerned with the current disaster.

There are 347 forms of human infectious disease in the world today – and 198 of these (more than half) are known to occur in Haiti. Sadly, one of the “side effects” of living in a poor and disaster-ridden economy is a lack of useful facts regarding the local status of individual diseases. GIDEON (Global Infectious Diseases and Epidemiology Online Network) is a Web-based application which follows diseases – both on a global level and within each country. Data are updated daily and are derived from all relevant journals, websites, Health Ministry reports and publications of the World Health Organization. The electronic book (ebook) is generated from information in the GIDEON database, and will serve as the first comprehensive review of infectious diseases in Haiti. Similar ebooks are now available by country and disease.

Download the 2017 edition for free in PDF: Infectious Diseases of Haiti by GIDEON

2010 legacy editions

Traveling to Haiti

Even before the earthquake, travelers to Haiti were advised to consult with an expert in Travel Medicine.  The new situation has significantly increased the risk for a variety of infectious diseases – both common and “exotic.”   Needless to say, there are many health risks which are not related to infection – excessive heat and sun exposure, political violence, psychological trauma, etc.

Clearly, the most common problems will be related to contamination of food and water: dysentery, salmonellosis and other forms of gastroenteritis.  Cholera is not currently encountered in Haiti.  There is no vaccine for these diseases, and preventative measures (if possible) will include adequate heating of food, bottled water, etc.  Many experts would also suggest that the traveler carry antibiotics (Azithromycin or Ciprofloxacin) to be taken in the event of symptoms.

Among the food / water-borne diseases, Hepatitis A (and possibly Hepatitis E) and typhoid constitute a genuine risk.  All travelers should be vaccinated as far in advance as possible before embarking for Haiti.  Several food borne parasitic infections are also common in Haiti.

The rate of AIDS in Haiti is particularly high.  Although most HIV infection in Haiti has been acquired through sex, exposure to blood will now become a major risk factor.

Malaria is endemic to 75% of Haiti.  Although the local parasite strain is often associated with severe illness, and even death, it is sensitive to anti-malarial drugs.   People traveling to Haiti should take two tablets of Choroquine, once weekly.  Another common mosquito-borne disease, dengue, can only be prevented by vigorous use of insect repellents.  Such measures might also prevent a number of local exotic parasitic diseases (Wuchereriasis, Mansonelliasis).

Animal contact should also be avoided – rabies, anthrax and other “zoonoses” are not uncommon in this country.

Contrary to common belief, contact with dead bodies is not considered a health risk.  A person who did not have cholera or typhoid in life will not begin to spread these diseases because she has died.

Anyone returning from Haiti should arrange for a stool examination – even if they feel well. Parasitic infestation is not necessarily associated with symptoms.  Needless to say, if fever, diarrhea, headache or any other symptom of infection develops, a physician should be consulted.

Also check out GIDEON’s free ebook: Infectious Diseases of Haiti