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The national alert-response strategy against cholera in Haiti: a four-year assessment of its implementation

View ORCID ProfileStanislas Rebaudet, Gregory Bulit, View ORCID ProfileJean Gaudart, Edwige Michel, View ORCID ProfilePierre Gazin, Claudia Evers, Samuel Beaulieu, Aaron Aruna Abedi, View ORCID ProfileLindsay Osei, Robert Barrais, Katilla Pierre, View ORCID ProfileSandra Moore, View ORCID ProfileJacques Boncy, Paul Adrien, Edouard Beigbeder, Florence Duperval Guillaume, View ORCID ProfileRenaud Piarroux
doi: https://doi.org/10.1101/259366
Stanislas Rebaudet
1Assistance Publique – Hôpitaux de Marseille (AP-HM), Marseille, France
2Hôpital Européen Marseille, Marseille, France
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  • For correspondence: stanreb@gmail.com
Gregory Bulit
3United Nations Children’s Fund, Haiti
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Jean Gaudart
4Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France
1Assistance Publique – Hôpitaux de Marseille (AP-HM), Marseille, France
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Edwige Michel
5Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Haiti
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Pierre Gazin
3United Nations Children’s Fund, Haiti
6Institut de Recherche pour le Développement (IRD), Marseille, France
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Claudia Evers
3United Nations Children’s Fund, Haiti
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Samuel Beaulieu
3United Nations Children’s Fund, Haiti
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Aaron Aruna Abedi
3United Nations Children’s Fund, Haiti
7Ministry of Health, Kinshasa, Democratic Republic of the Congo
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Lindsay Osei
1Assistance Publique – Hôpitaux de Marseille (AP-HM), Marseille, France
3United Nations Children’s Fund, Haiti
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Robert Barrais
5Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Haiti
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Katilla Pierre
5Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Haiti
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Sandra Moore
8Aix Marseille Univ, Marseille, France
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Jacques Boncy
9Ministry of Public Health and Population, National Laboratory of Public Health, Haiti
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Paul Adrien
5Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Haiti
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Edouard Beigbeder
3United Nations Children’s Fund, Haiti
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Florence Duperval Guillaume
10Ministry of Public Health and Population, former Minister, Haiti
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Renaud Piarroux
1Assistance Publique – Hôpitaux de Marseille (AP-HM), Marseille, France
11Sorbonne Université, INSERM, Institut Pierre-Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
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Abstract

Background A massive cholera epidemic struck Haiti on October 2010. As part of the national cholera elimination plan, the Haitian government, UNICEF and other international partners launched a nationwide alert-response strategy from July 2013. This strategy established a coordinated methodology to rapidly target cholera-affected communities with WaSH (water sanitation and hygiene) response interventions conducted by field mobile teams. An innovative red-orange-green alert system was established, based on routine surveillance data, to weekly monitor the epidemic.

Methodology/Principal findings We used cholera consolidated surveillance databases, alert records and details of 31,306 response interventions notified by WaSH mobile teams to describe and assess the implementation of this approach between July 2013 and June 2017. Response to red and orange alerts was heterogeneous across the country, but significantly improved throughout the study period so that 75% of red and orange alerts were responded within the same epidemiological week during the 1st semester of 2017. Numbers of persons educated about cholera, houses decontaminated by chlorine spraying, households which received water chlorination tablets and water sources that were chlorinated during the same week as cholera alerts significantly increased. Alerts appeared to be an interesting and simple indicator to monitor the dynamic of the epidemic and assess the implementation of response activities.

Conclusions/Significance The implementation of a nationwide alert-response strategy against cholera in Haiti was feasible albeit with certain obstacles. Its cost was less than USD 8 million per year. Continuing this strategy seems essential to eventually defeat cholera in Haiti while ambitious long-term water and sanitation projects are conducted in vulnerable areas. It constitutes a core element of the current national plan for cholera elimination of the Haitian Government.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
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Posted February 05, 2018.
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The national alert-response strategy against cholera in Haiti: a four-year assessment of its implementation
Stanislas Rebaudet, Gregory Bulit, Jean Gaudart, Edwige Michel, Pierre Gazin, Claudia Evers, Samuel Beaulieu, Aaron Aruna Abedi, Lindsay Osei, Robert Barrais, Katilla Pierre, Sandra Moore, Jacques Boncy, Paul Adrien, Edouard Beigbeder, Florence Duperval Guillaume, Renaud Piarroux
bioRxiv 259366; doi: https://doi.org/10.1101/259366
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The national alert-response strategy against cholera in Haiti: a four-year assessment of its implementation
Stanislas Rebaudet, Gregory Bulit, Jean Gaudart, Edwige Michel, Pierre Gazin, Claudia Evers, Samuel Beaulieu, Aaron Aruna Abedi, Lindsay Osei, Robert Barrais, Katilla Pierre, Sandra Moore, Jacques Boncy, Paul Adrien, Edouard Beigbeder, Florence Duperval Guillaume, Renaud Piarroux
bioRxiv 259366; doi: https://doi.org/10.1101/259366

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