Date: 9 Sep 2018
[There has been significant chatter on social media from individuals working in Haiti and their colleagues, friends and family, suggesting there is a "new, as yet undiagnosed outbreak," possibly of a mosquito-borne disease, in the expat and local Haitian communities. Some of the content of this social media chatter is excerpted below [edited for clarity/readability - CopyEd.MSP]. - ProMED Mod.MPP]
"...there is some sort of new mosquito-borne virus in Haiti. Do I know for sure that it is a virus caused by a flying insect? No. Do I have a lot of unqualified and under-documented personal research to back up my belief nonetheless? Yes. If you know a guy or gal at the CDC, tell them to come chat with me. Something is going around, and many people are not well. It is eerily similar to chikungunya and malaria."
"I have been saying the same thing! Well, when my fever brain has been capable of putting thoughts together this week. 2014 was ChikV; 2016 was Zika, so it does seem time for a new one. This new one is no fun at all."
"My person is negative for everything, Zika, chikV, malaria, dengue. It started with high fever, aches, joint pain, then progressed to stomach ache, headache. Now it's just persistent joint aches and sharp stabbing pain."
"We have this all over Mirebalais as well. Here, it also seems to be often accompanied by severe lower abdominal pain."
"Yes! My son just asked me if there is another mosquito borne illness yesterday!"
"Several of our girls have been sick with these same symptoms! It's awful."
"We all had it too and are seeing a lot of patients at our clinic with it!"
"I was sick for days before the uprising in July  ... totally felt like malaria but tested negative. My BP was 80/40 at best, and it was pa bon [not good]."
"Yes! I've been sick this week as well as a few others I know! Lots of body pain."
"People thought that I was crazy!"
"You're not crazy! Several cases showing up at the Maternity Center here, and I also think there is influenza A going around. Some cases have respiratory stuff (to me that is the flu/influenza A), and several cases have nothing respiratory but have the fever and aches and terrible headache."
[According to Wikipedia (in an unsubstantiated report without references) "Mirebalais is a commune in the Centre department of Haiti, approximately 60 km northeast of Port-au-Prince on National Road 3. The city was established in 1702. During the United Nations occupation of 2005, Nepalese troops were stationed in the city, using the city jail as their headquarters," (<https://en.wikipedia.org/wiki/Mirebalais
"Mirebalais is served by the teaching hospital Hopital Universitaire de Mirebalais, the largest solar-operated hospital in the world," a hospital that is run by the US-based Partners in Health, (<https://www.pih.org/pages/mirebalais
>From the sound of the social media chatter, there is an as yet undiagnosed outbreak affecting parts of Haiti. Trying to connect the dots, there is concern that it is malaria-like (fever, chills and headaches), but in those that have been tested for malaria, laboratory results have not supported the diagnosis, and possibly dengue- or chikungunya-like (fever, headache, joint pains) with the addition of complaints of lower abdominal pain (notably described in Mayaro virus disease.
If the symptoms are similar to those of dengue, chikungunya, and Zika virus infections, they need to be ruled out by laboratory testing. There is the possibility that Mayaro virus (MAYV) may be circulating in Haiti. Mayaro virus was isolated from a child with acute febrile illness in rural Haiti. The case report stated that "on 8 Jan 2015, an 8-year-old boy was examined at the school clinic because of fever and abdominal pain. His temperature was 100.4 F [38 C]; lung sounds were clear, and his abdomen was soft and not tender. He had no rash and no conjunctivitis. On the basis of this clinical presentation, the clinic physician empirically diagnosed typhoid and administered co-trimoxazole... MAYV was detected in viral RNA extracted from infected Vero cells.
A question now is: if this is another MAYV infection, is this a continuation of the 2015 transmission or a new introduction into Haiti? Clearly, laboratory follow up is needed to establish the etiology of the current cases of febrile disease to determine an etiology and rule out other pathogens. If MAYV presence is established, surveillance is needed to determine the extent of its distribution, and health care providers and laboratories in Haiti, the Dominican Republic, and other countries in the Caribbean Basin need to be informed to be on the alert and to be prepared to make a diagnosis should any cases occur there.
Of additional curiosity is a recent media report in the Jamaican Star relating a tale of 3 Haitians recently arrived claiming illness, with malaria suspected in one of them. Testing is still pending, but given the social media chatter, one can't help but wonder whether this isn't malaria. Could it be part of the same as of yet undiagnosed outbreak reported in the above chatter? ...
1- Lednicky J, De Rochars V, Elbadry M, Loeb J, Telisma T, Chavannes S, et al. Mayaro Virus in Child with Acute Febrile Illness, Haiti, 2015. Emerg Infect Dis. 2016;22(11):2000-2002.
2- Mavian C, Rife BD, Dollar JJ, Cella E, Ciccozzi M, Prosperi MCF, Lednicky J, Morris JG, Capua I, Salemi M. Emergence of recombinant Mayaro virus strains from the Amazon basin. Sci Rep. 2017 Aug 18;7(1):8718. doi: 10.1038/s41598-017-07152-5.
A HealthMap/ProMED map of Haiti can be found at:
More information from knowledgeable sources would be greatly appreciated, especially results of laboratory testing on individuals presenting with the above-mentioned symptoms, and results of clinical as well as epidemiologic investigations. - ProMED Mods.MPP/TY]