Cholera Returns to Haiti: The Outbreak of September 2022–January 2023

Haiti's first cholera outbreak began in October 2010, ten months after an earthquake that killed more than 200,000 people. It caused more than 820,000 cases and about 10,000 deaths. On February 4, 2022, after three years without a confirmed case, Haiti was declared cholera-free. Eight months later, cholera was back.

Two deaths in Port-au-Prince

• September 29–30, 2022: Doctors Without Borders (MSF) reports two fatal cases of acute watery diarrhea — a child from Carrefour Feuille and a patient from Cité Soleil, a densely populated commune of the capital.
• October 2: Haiti's National Public Health Laboratory confirms Vibrio cholerae O1, El Tor biotype, Ogawa serotype. Sequencing later shows a strain very similar to the one of 2010.

The outbreak by January 3, 2023

Suspected cases by date of notification, and the 14-day case fatality ratio (CFR), September 2022–January 2023. CDC.

• Children: about a third of patients were under 10. Children aged 1–4 had the most cases (4,009, 20%) and deaths (48, 17%).
• Where: the Port-au-Prince metropolitan area reported 63% of suspected cases (12,695) and 51% of deaths (144). Cases peaked on November 8 and then declined.
• Spread: confirmed cases in nine of ten departments (all but Nord-Est); suspected cases in all ten.

Rolling 14-day cholera incidence per 100,000 people, by department. CDC.

The true count is likely far higher: with 79% of patients hospitalized, surveillance was catching mostly severe cases in treatment centers, not the mild ones that keep transmission going.

Why it came back

Gang violence, displacement and insecurity — especially in Port-au-Prince neighborhoods such as Belair, Martissant and Cité Soleil — damaged public health services. Fuel shortages halted water treatment, pushing more people onto untreated water.

The response

CDC is working with Haiti's Ministry of Public Health and Population, USAID, MSF and the Pan American Health Organization to:

• expand surveillance and laboratory testing;
• make sure there are enough treatment centers, beds and oral rehydration points;
• improve water, sanitation and hygiene, and community engagement;
• run oral cholera vaccine campaigns, the first launched in mid-December in high-transmission areas.

Prompt rehydration cuts cholera deaths from more than 50% to under 1% — the target. Antibiotics are for severe cases only. The spikes in the fatality ratio in early December and January may partly reflect backlogged death reports.

Sources

Based on Vega Ocasio D, Juin S, Berendes D, et al. "Cholera Outbreak — Haiti, September 2022–January 2023." MMWR; a work of the United States government in the public domain. Deaths in the department table come from case-based surveillance, a different system from the alert-based death counts above.