Date: Tue 18 Dec 2018
Source: Pan American Health Organization (PAHO), WHO [edited]
<https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=diphtheria-8968&alias=47346-18-december-2018-diphtheria-epidemiological-update&Itemid=270&lang=en>

Epidemiological update: diphtheria
----------------------------------
Between epidemiological week (EW) 1 [31 Dec 2017-6 Jan 2018] and EW 49 [2 Dec-8 Dec 2018] of 2018, 3 countries in the region of the Americas (Colombia, Haiti, and the Bolivarian Republic of Venezuela) have reported confirmed cases of diphtheria. In Haiti and Venezuela, the outbreaks are ongoing.

The following is a summary of the epidemiological situation in these countries:

Colombia
--------
In Colombia: 8 confirmed cases, including 3 deaths, were reported this year [2018]; however, since July 2018, no additional cases of diphtheria have been reported.

Haiti
-----
In Haiti: between EW 51 [14 Dec-20 Dec] of 2014 and EW 49 [2 Dec-8 Dec] of 2018, 774 probable cases were reported, including 105 deaths; of these, 261 were confirmed (254 by laboratory criteria and 7 by epidemiological link) (see table 1 at the source URL).

The number of probable cases reported in 2018 is higher than the total number of cases reported in 2017 and 2016 -- an increase that is attributed to greater sensitivity of the national surveillance system. The case fatality rate among cases confirmed by laboratory or epidemiological link was 23% in 2015, 39% in 2016, 8% in 2017, and 15% in 2018.

In 2018, there were 362 probable cases reported (between EW 1 and EW 49), including 96 confirmed cases (91 by laboratory and 5 by epidemiological link). During the same period, there were 28 deaths reported (14 confirmed by laboratory or epidemiological link, 8 with no viable laboratory samples, 5 that remain under investigation, and one that was discarded).

Among confirmed cases in 2018, the highest incidence is observed in the age group of 6-14 year olds, followed by 1-5 year olds. The majority of deaths (63%) occurred among those aged 6-14 years, followed by 1-5 year olds.

In 2018, the highest cumulative incidences per 100 000 population were reported in the municipalities of Gros-Morne, Artibonite Department (19.9), Valliere, Nord-Est Department (17), La Victoire, Nord Department (9.5), and Cerca-Carvajal (12.9), Thomonde (9.7), and Savanette (8.3) in Centre Department.

Venezuela
---------
In Venezuela: the diphtheria outbreak that began in July 2016 continues (see figure 2 at the source URL). Since the beginning of the outbreak until EW 48 of 2018, a total of 2360 suspected cases were reported (324 cases in 2016, 1040 in 2017, and 996 in 2018); of these, 1310 were confirmed. A total of 238 deaths were reported (17 in 2016, 103 in 2017, and 118 in 2018 [see ref. 2 at the source URL]); 345 cases were discarded in 2018. The case fatality rate was 18.2% in 2016, 13% in 2017, and 21% in 2018.

In 2016, cases were reported in 5 [Venezuelan] states (Anzoategui, Bolivar, Delta Amacuro, Monagas, and Sucre), while in 2017, cases were reported in 22 states and the Capital District. In 2018, 22 federal entities and 99 municipalities have reported confirmed cases. Cases have been reported among all age groups, but the most affected age group is 1-39 years, among whom the highest incidence is reported among 11-39 year olds. In EW 48 of 2018, there were 17 federal entities and 35 municipalities affected; accordingly, vaccination and control activities continue to be implemented.

[The full report, including all figures, table, references, advice for member states, and footnotes can be found at the source URL. - ProMED Mod.ML]
==========================
[HealthMap/ProMED-mail maps:
Colombia: <http://healthmap.org/promed/p/16>
Haiti: <http://healthmap.org/promed/p/25>
Venezuela: <http://healthmap.org/promed/p/29>]
Date: Tue, 9 Oct 2018 23:45:45 +0200

Port-au-Prince, Oct 9, 2018 (AFP) - The death toll from the earthquake that struck northwest Haiti over the weekend has risen to 17, with nearly 350 others injured, the interior ministry said Tuesday.   Nine people were killed in the coastal city of Port-de-Paix, the closest major town to the quake's epicenter.    Seven more died in Gros-Morne, about 50 kilometers (30 miles) to the southeast and one was killed in the city of Saint-Louis du Nord, the ministry said.

Emergency personnel deployed to the quake zone have said roughly 7,800 homes were either destroyed or damaged in the 5.9-magnitude tremor, according to the authorities.   In Haiti, the poorest country in the Americas, building codes are often not respected, meaning that an earthquake of even a moderate size can result in fatalities and level buildings.

The country's Nord-Ouest department, where Port-de-Paix is located, is the worst-off part of Haiti, with many areas isolated due to the dire state of the roads.   The quake and several aftershocks were felt as far away as the capital Port-au-Prince, sparking fear among residents still reeling from the massive 2010 earthquake that left at least 200,000 people dead.
Date: Mon, 8 Oct 2018 06:51:33 +0200
By Amelie BARON

Port de Paix, Haiti, Oct 8, 2018 (AFP) - In Port-de-Paix, the Haitian city hardest hit by a strong earthquake, medical personnel at the Immaculate Conception Hospital of Port-de-Paix are struggling to treat the wounded -- and helplessly looked on as some didn't make it.   Not only are doctors and nurses lacking the supplies they need, the damage caused by the 5.9-magnitude tremor late Saturday made conditions even more challenging.   "There was no electricity here, so we couldn't receive the huge crowd that came last night," said Paul Miclaude, a doctor working in the emergency room.

"It was really difficult for us to send them to another hospital," Miclaude added. "With time running out, some died here."   So far, the quake has claimed 12 lives, according to Haitian officials. Eight of the victims died in Port-de-Paix.   Miclaude said that even on Sunday, doctors were without needed supplies.   "Patients are out buying medications, gloves, you name it -- they have to, despite their trauma and their destroyed homes," he said.   "Clearly, we aren't ready for such a catastrophe."

- 'He died on the spot' -
Looking on with a blank stare, Pamelia Donne leaves a small room filled with stretchers, dragging her leg behind her. Her foot is bandaged.    She had arrived several hours before -- with the body of her 20-year-old son.    "When everything started to shake, my child was about to leave the room. Then all of a sudden, he flew in the air and because the walls were falling down, he fell on a piece of rebar," Donne recounted.   "It pierced his back and came out by his ribs. He died on the spot."   In the palm of her hand, she crumpled the prescription handed to her by the nurse who bandaged her foot into a ball.   "I'm going to go get the medicine," Donne said, her voice barely audible.   "Actually, I have no way to get there to buy them and my husband, who suffered a leg injury, also has a prescription."

- Fear of aftershocks -
Just as police began to restore order at the entrance to the hospital, and several crates of medicine arrived from the health ministry, the glimmer of hope was quickly dashed by a 5.3-magnitude aftershock -- and chaos reigned once again.   Both doctors and patients ran into the street, fearful that part of the building could collapse.

Standing near mattresses on the ground in the yard, where patients received IV drips, the hospital's medical chief Polycarpe Saaely says he hopes more help is on the way.   "With all the aftershocks, we can't really stay inside, so we are putting up tents to receive the various patients who arrive," said Saaely.    "These buildings date back to the American occupation (1915-1934).

We evacuated two patients from the surgical wing because the building is really falling apart."   Indeed, the building was completely empty -- the ceiling had caved in in several places.   As Sunday dragged on, residents followed the parade of ambulances that arrived, their sirens blaring, and then departed for the private hospital located about a 30-minute drive away.   President Jovenel Moise's visit to Port-de-Paix helped mitigate the public anger borne from years spent living in extreme poverty without any real signs of improvement.

Haiti is the poorest country in the Americas.   But residents were still angry.   "Everyone can see that we don't have a real hospital," one resident, Francois Lubensron, told AFP near the hospital entrance.   "This shows we have no government. The president came to the city but he didn't even stop by to see what is going on here," the 28-year-old added.   "This behavior must end. We've had enough of a small group privatizing the country while we die. We are human beings. We have the right to live like those in all nations."

As they listened to the passionate debates of the small group gathered around Lubensron, elderly residents shook their heads. Some of them spread out small plastic tarps under which they could take refuge. They will spend the night outside, with more aftershocks a near-certainty.
Date: 9 Sep 2018
Source: ProMED-mail promed@promedmail.org

[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."

"Mayaro virus?"

"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 [2018] ... 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? ...
(<http://jamaica-star.com/article/news/20180905/police-fear-malaria-outbreak-foreign-inmate-may-have-disease>).

References:
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.
<https://dx.doi.org/10.3201/eid2211.161015>.

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:
<http://healthmap.org/promed/p/25>.

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]
Date: Sun, 8 Jul 2018 20:08:06 +0200
By Amelie BARON

Port-au-Prince, July 8, 2018 (AFP) - Fresh looting broke out on the streets of Haiti's capital Sunday as protestors called for a two-day general strike despite the government's climbdown over controversial fuel price hikes.   Facing unrest that has now left at least three dead, leaders of the Caribbean country suspended the price spikes "until further notice" -- but the about-face has failed to quell the anger of residents.

In the heart of Port-au-Prince, AFP journalists saw shops ransacked as protestors, some armed with knives, were met by police who fired weapons into the air and detonated tear gas.   Many Haitians are now demanding the immediate departure of President Jovenel Moise and calling for a two-day general strike to begin Monday.   "If the president stays one more day, the game will take on a new appearance: we will cut off the roads and burn everything, because we have nothing else to lose," said one masked protestor.   Moise had urged demonstrators late Saturday to "go home," saying the price hike suspension had "corrected what had to be corrected."

The televised speech disappointed much of the population and the political class: "We were expecting another speech, a serene analysis of the situation that has prevailed in the country in the last two days and caused so much loss of life and materials," lawmaker Jerry Tardieu told AFP.   The renewed violence follows two days of paralysis in the city, sparked Friday by a government announcement that gasoline prices would rise by 38 percent, diesel by 47 percent and kerosene by 51 percent starting this weekend.   Airlines including Air France and American Airlines canceled several Sunday morning flights, with additional cancellations possible into the afternoon over staffing shortages.

- 'Carried away' -
In announcing the suspension of the price hikes, Prime Minister Jack Guy Lafontant emphasized that "violence and democracy are fundamentally incompatible."   Even before the fuel price controversy, deputies had already begun a debate on his future, and Saturday's U-turn could lead to the government's fall.   On Friday night, the bodyguard of an opposition-party politician died in an altercation with demonstrators in central Port-au-Prince as he attempted to get through a roadblock. His body was then burned in the road. 

On Saturday afternoon, an AFP journalist saw a young man who had been shot dead.   Parliamentary discussions are underway to determine the next steps aimed at calming the crisis, with some elected officials urging the immediate resignation of the prime minister.   As protests gained pace Sunday one Haitian, Alphonse Charles, expressed both the frustrations and the sense of fatalism felt by many of his countrymen.

Standing next to the remains of his torched car near burned and looted shops, he laid blame on politicians but lamented that people had gotten "carried away."   "It's the reality of the country: when we live in Haiti we are angry, frustrated with the way things are managed by politicians."   But "I have to go on living," he added. "We will not get carried away just for that."
More ...