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The
Center for Disease Control and Prevention (CDC) is the leading U.S.
government agency with the mission to protect and secure the health of
Americans at home and abroad. CDC also functions as a key informational
source, for clinicians and travelers, providing up to date facts and
advice about health issues both nationally and internationally. Yet, CDC
has not posted a notification about cholera in Cuba for summer 2013,
even though other countries and the Pan American Health Organization
(PAHO) have confirmed the vibrio cholerae bacterium infecting
international travelers visiting Cuba this summer.
CDC
refined their travel announcements on April 5, 2013, with the purpose to
clarify both health risks and precautions:
(1)
- Level
1: “Watch” is a reminder to use precautions when traveling to a
specific destination;
- Level
2: “Alert” to recommend applying enhanced precautions;
- Level
3: “Warning” to avoid any non-essential travel to a specific country.
Cholera
is one of the oldest reportable diseases along with the plague and
yellow fever. Under the International Health Regulations (IHR), the
regulatory arm of the World Health Organization, the rapid spread of
cholera has a long history. Cuba’s decaying infrastructure of poor
water, sewage, sanitation and housing conditions coupled with heavy
rains and international medical missions, makes cholera ripe for rapid
spread.
Recent
laboratory evidence confirmed that travelers carried more than their
luggage home from Cuba. In the past two weeks:
- August
14, 2013: PAHO reports that Italy, Venezuela and Chile cases support
previous rumors and pleas from dissidents that cholera continues to
spread in Cuba. (2)
- August
20, 2013: U.S. Interests Section in Havana issued a cholera health
warning. (3)
- August
23, 2013: PAHO reports additional information that Spain, Germany and
Netherlands confirmed cholera from returning travelers from Cuba, and
identified cholera in provinces of Havana, Santiago and Camaguey.
(4)
- August
27, 2013: Juan Tamayo, Miami Herald reporter, interviewed a New
York teacher hospitalized in Cuba for six days. The Cuban-American was
stricken with cholera, along with other family members, after eating
at a state-owned restaurant. (5)
- August
29, 2013: European surveillance reports that the 40-year-old male who
spent a two-week vacation in Cuba, arrived home to Tieste, Italy in
July with cholera and severe renal failure. He was hospitalized for 10
days and has recovered. (6)
The
latest PAHO surveillance reports 163 cases of cholera in Cuba for the
year 2013; however, it is not clear how many cases are linked to this
summer outbreak, and little epidemiologic details are presented. The
Italian case study provides important epidemiologic evidence,
identifying the likelihood of fresh seafood as the infected food source
and the Havana waters as a possible point of concern.
(7)
No one
is questioning the active and vigilant epidemiologic surveillance of
infectious diseases in Cuba. Conspicuously, it is this evidence- based
research that does not mirror the government’s lack of transparency in
reporting.
We know
that cholera re-emerged in Cuba, after a century’s absence, prompting
CDC to issue a travel advisory for Cuba in July 2012. Shortly after, the
Cuban government reported no more cases of cholera. New scientific and
epidemiological evidence this summer revealed European, Latin American,
and U.S. travelers visiting Cuba were infected with cholera. Does anyone
believe that the recent cholera outbreak started with international
visitors from Italy, Venezuela or Chile this summer?
Cuban
dissidents, independent journalist, and Promed mail (8), working
under the auspices of the International Society for Infectious Diseases,
have tried to engage the international community- and expose a fact that
the 2012 Cuban cholera epidemic did not vanish so quickly. Cholera never
does so in countries with poor infrastructure.
Unmistakably,
we cannot depend upon an early official notification from the Cuban
government. Therefore, we must rely on the international scientific
evidence and U.S. government’s responsiveness to disseminate travel
advisories.
The U.S.
Interests Section announced a cholera warning for Cuba on August 20,
2013. However, the CDC, whom I highly respect for both their excellent
research and up-to date- information sharing about global public health
issues, has yet to release a “watch” notification. While on June 19,
2013 CDC announced a cholera watch for Haiti and Dominican Republic.
Based upon the evidence, risks and precautions necessary to avoid
cholera in Cuba, I would assume a cholera travel health notice is
warranted from CDC.
Notes
1)
Center for Disease Control and Prevention (CDC) Traveler’s Health
Notice. http://wwwnc.cdc.gov/travel/notices.
Accessed August 31, 2013.
2) Pan American Health Organization
(PAHO). Epidemiological Update. Cholera, August 14, 2013. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22575&Itemid.
3) U.S. Interests Section, Havana Cuba, Security Message-Cholera
Outbreak. August 20, 2013. Accessed August 20, 2013.
4) PAHO,
Epidemiological Update, Cholera August 23, 2013. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22752.
5)
Juan Tamayo. Cuba reports more cholera among foreign visitors. Miami
Herald, August 26, 2013. http://www.miamiherald.com/2013/08/26/3587434/cuba-reports-more-cholera-among.html.
6)
M Mascarello, M L Deianam C Maurel, C Lucarelli , I Luzzi R Luzzati,
Cholera with Severe Renal Failure in An Italian Tourist Returning from
Cuba, Eurosurveillance, July 2013. Volume 18, Issue 35, August 29, 2013.
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20572.
7)
Ibid
8) ProMed mail post. International Society for Infectious
Diseases. http://www.promedmail.org.
_________________________________________________
*Sherri
Porcelain is
Senior Lecturer of Global Public Health in World Affairs & Senior
Research Associate at the Institute for Cuban and Cuban-American
Studies, University of Miami. Professor Porcelain is currently writing a
book on U.S. Foreign Policy and Global Health: The Nexus of Infectious
Diseases.
_________________________________________________
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Una respuesta para Una monja afirma que las “pruebas” del ataque químico en Damasco “fueron elaboradas intencionalmente”