Thursday, August 22, 2013

U.S. issues travel alert for cholera in Cuba

Posted on Wednesday, 08.21.13

U.S. issues travel alert for cholera in Cuba

The U.S. diplomatic mission in Havana has issued an alert for cholera,
triggering fresh allegations that Havana is hushing up an outbreak of
the potentially fatal disease to avoid damaging its $2.5 billion-a-year
tourism industry.

Officials at the Florida Department of Health said Wednesday that they
have received no reports of cholera imported from the island — although
tens of thousands of Cuban-Americans visited there during this summer's
vacation period.

Cuba's government has said almost nothing in public about the recent
cases of cholera, which causes intense diarrhea that can lead to
dehydration and death. The state-controlled news media has referred only
to "acute diarrheic diseases."

"Of course nobody wants to say they have outbreaks because outbreaks
cause a decline in tourism," said Sherri Porcelain, a senior lecturer in
global public health in world affairs at the University of Miami who has
been tracking the cholera outbreak in Cuba.

But Havana will find it difficult to avoid all the negative publicity
this month: the U.S. warning, reports of five cases in people who flew
from Cuba to Venezuela, Chile and Italy, and a report by the Pan
American Health Organization (PAHO).

The statement from the U.S. Interests Section in Havana urged U.S.
citizens living in or visiting Cuba to follow public health
recommendations, such as frequent hand washing and special care with
food and water to be consumed.

"Media reports have indicated that cases of cholera have been identified
in the city of Havana, possibly linked to a reported outbreak of cholera
in eastern Cuba," said the statement dated Tuesday and posted on the
mission's Web page Wednesday.

The statement gave no further details on the cases, although independent
journalists on the island have been reporting scores of cases over the
past year and especially this summer, when high temperatures and rains
appear to have helped spread the disease.

PAHO, the regional arm of the World Health Organization, reported that
Venezuela confirmed on Aug. 9 two cases of cholera in travelers who
arrived from Cuba, and that Italy reported one more, a man who arrived
from Havana on July 13.

Chile reported another two arrivals from Cuba with cholera, PAHO added.
The airport in Santiago later declared a state of "epidemiological
vigilance" on Cuban arrivals, according to news reports. And Canada
issued an advisory to travelers heading to Cuba.

The PAHO report also noted that 51 cases were detected in Havana early
this year "related to the handling of food," and 47 more were reported
in the eastern provinces of Camagüey, Guantánamo and Santiago de Cuba in
the wake of Hurricane Sandy.

Cuba's government never commented publicly on those two outbreaks,
although independent journalists reported on them as well as others in
Matanzas, Jovellanos, Cardenas, Sierra de Cubitas, Cabaiguan, Jagüey
Grande and elsewhere.

Cholera can be treated with hydration and antibiotics, but can spread so
quickly and be so deadly that it is on a worldwide list of reportable
diseases that also includes the bubonic plague, typhoid and yellow fever.

The disease is thought to have been brought to Cuba by medical personnel
who served in Haiti, where cholera has killed more than 8,200 since
2010. Havana has confirmed only three deaths in Cuba, all from the
initial outbreak in the eastern cities of Bayamo and Manzanillo.
Dissidents put that death toll at more than 15.

PAHO's report noted that the Cuban government "maintains an active and
strict clinical-epidemiological vigilance of acute diarrheic diseases."
It made no mention of Havana's almost total refusal to comment publicly
and in detail on the cholera cases.

"The lack of transparency coming from Cuba is truly bothersome,"
Porcelain said. "Sharing of information in a timely fashion is most
essential for prevention … yet they post no information, no information
at all."

"The government of Cuba has not been particularly transparent about the
ongoing cholera in the island," added a post in ProMED, a website
started by the Federation of American Scientists to disseminate
information on outbreaks of infectious diseases.

Havana's official silence on the cholera as well as dengue fever made it
all the more unusual that two Cubans — a government doctor and a
reporter for a state-run newspaper — had recently complained about the

Dr. Luis Suárez Rosas, a professor at the National School of Medicine,
wrote an article titled "The epidemiological silence and the ethics of
Cuba's public health" and published it in the latest edition of the
Cuban Magazine for Public Health.

Using dengue as an example and never mentioning cholera, Suarez Rosas
argued that the secrecy tends to hide the risks and severity of the
mosquito-borne disease, and does not help patients understand their

"The existence or not of a number of cases of a disease is one of the
aspects and issues of public health susceptible to a … specific ethical
consideration requiring transparent, responsible and truthful
information," he wrote. "Many times this becomes a matter of life or death."

Mariurka Martínez Alemán, a reporter for the Invasór newspaper in the
province of Ciego de Avila, was slightly less direct in her Aug. 5
report on the sudden closing of Bolivia Beach on the northern shore of
the province.

By the time authorities announced that the beach would be closed because
of "a high-risk epidemiological situation," Martínez wrote, some
vacationers had already arrived with supplies for long summer stays and
rumors had started to fly.

"Perhaps if someone would have opted to call together the vacationers to
a meeting on the main plaza there would not have been so many
distortions," she wrote. "It would have been enough to hear that 18
cases of cholera had been detected on the beach, that the sea water had
been tested and turned up positive."

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