Thursday, July 30, 2015

The Politics of Prevention - Cholera in Cuba

The Politics of Prevention: Cholera in Cuba
[30-07-2015 01:02:47]
Cuba Transition Project

( Even before the scheduled opening of the
US Embassy on July 20, 2015, there were advertisements, blog posts,
tweets, and news feeds welcoming U.S. residents to Cuba for cultural,
religious or educational opportunities. Cuba remains a popular
destination for Canadian and Western European tourists with its rich
cultural arts, gracious hosts and Caribbean beaches. However, a growing
interest in U.S. approved trips must consider Cuba's lack of safe
potable water, sanitation and sewage issues along with housing
challenges. This is important because while it is unreported, cholera
transmission exists within Cuba.
Cuba's lack of transparency in health outbreak reporting is in question
again. Laboratory confirmed cases continue to be shared with the
international community about tourists returning to Canada, Latin
America, and European countries after taking home more than sun and fun
from a Cuban vacation. Cuba consistently asserts that the cholera
outbreak of 2012 was quickly controlled within the country.

Where is the United States government on this issue today?

While a U.S. Center for Disease Control and Prevention (CDC) cholera
watch in Cuba has recently been removed from their website, (1) there is
still evidence that cholera is transmitted there. CDC travel notices
consists of three levels:

A "watch" level 1 informs travelers to use usual precautions, an "alert"
level 2 calls for enhanced precautions and a "warning" level 3 advises
travelers to avoid nonessential travel to an area where the risk is
high. These travel notices are important because the CDC notification
system is widely used by travelers as well as clinicians for up-to-date
international travel information.

Since 2013 there have been cases of confirmed cholera after visits to
Cuba. (2) In January 2015 the Canadian International Health Regulation
reported a case of a returning traveler, (3) as well as Pan American
Health Organization (PAHO) on their Epidemiologic Update Report (4)
documented this as the only case of cholera in Cuba for 2015. This
assumes only travelers and no locals have been infected. It is more
likely that the Cuban government does not share this information with
the international community, and is only compelled to cooperate after
scientific proof is disseminated.

In June 2015 the United Kingdom reported a traveler who participated in
an all-inclusive resort stay in Varadero and spent two days in Havana
before getting sick and returned home with cholera. According to the
International Society for Infectious Disease, through their Program for
Monitoring Emerging Diseases (ProMed- mail) posting on July 3, 2015, the
patient indicated other family members were well. However, "several
other people staying in his hotel (not necessarily in the same tour
group) had reported severe gastroenteritis symptoms with a similar
period of onset," suggesting this may not be the only case. Pro-Med
seeks to share this information and advise others of the confirmed
cholera in Cuba and for health professionals to consider such a
diagnosis with travelers returning with diarrhea. (5)

The question is not whether cholera is a risk to locals and visitors.
Rather, the issue is why has the CDC removed the notification from its
website when outside country evidence continues to show cholera exists
within Cuba.

Are we left to speculate that the promotion of diplomatic relations- in
an attempt to not question Cuba's position on reporting disease
outbreaks as required by World Health Organization International Health
Regulations- is more important than the prevention and promotion of
health security? Let's not play politics with what we know is a best
practice in prevention. Give people access to reliable information so
they are well informed of their potential risks. Only then can good
decisions be made to prevent cholera-or for that matter dengue,
chikungunya or possibly zika virus (new mosquito born virus to reach the
Caribbean) when traveling to Cuba.


1) Center for Disease Control and Prevention (CDC), "Travel Notices-
Cholera in Cuba,", accessed July
14, 2015.

2) 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,

3) Public Health Agency for Canada, Travel Health Notice: Cholera in
Cuba, Dominican Republic, Haiti and Mexico, updated March 20, 2015

4) PAHO Epidemiologic Update. "Cholera in The Americas," June 24, 2015

5) ProMed- Mail. "Cholera, Diarrhea and dysentery update (24):
Americas," Archive Number: 20150703.3480336July 3, 2015


*Sherri L. Porcelain teaches global health in world affairs at the
University of Miami where she is also a Senior Research Associate at the
Institute for Cuban and Cuban-American Studies.

Source: The Politics of Prevention: Cholera in Cuba - Misceláneas de
Cuba -

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