Voodoo killings reportedly rise in Haiti epidemic
Posted: Dec 24, 2010 11:50 AM PST
Updated: Dec 27, 2010 3:31 PM PST
http://www.ktnv.com/story/13738389/voodoo-killings-reportedly-rise-in-haiti-epidemic
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10/10 HAITI CHOLERA OUTBREAK:
The following is a list of resources for Signs, Symptoms, Treatment, and Educational Information to share with Haiti Responders and Haiti populations.
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CCCM Cluster Meeting
Tuesday, 23 November, 2010 – 10:00 a.m. at OCHA tent
Chaired By: Bradley Mellicker – CCCM Emergency Preparedness Officer
Action items
For urgent cases that do not have transport, partners should call 34827636 / 38515331.
If deaths occur in camps, partners should call 38799177.
1. General update on cholera situation Patrick DUIGAN (Tel. (509) 38499115. pduigan@iom.int) – Health Program Manager, IOM
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Link to this Databases' list of Cholera Treatment Centers and Responding organizations can be found on the Quick Start page. https://reliefdb.org/quick/start
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Link to the CAT FACILITY RECORD for Cholera, Acronyms/Definitions of Cholera facilities from PAHO: https://reliefdb.org/shelters/6790
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CHOLERA OUTBREAK MAP - PAHO: http://haiti.mphise.net/cholera-outbreak-haiti-pahoorg-map
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HAITI CHOLERA UPDATES/DEDICATED WEBSITES:
HAITI - OPERATIONAL BIOSURVEILLANCE (Maps/Updates/Alerts):
http://biosurveillance.typepad.com/haiti_operational_biosurv/
H5N1 - News and Resources about Influenza, Infectious Diseases and Public Health: http://crofsblogs.typepad.com/h5n1/
10/23/10 CDC TRAVELERS ADVICE:
http://wwwnc.cdc.gov/travel/content/outbreak-notice/haiti-cholera.aspx
Haiti MPHISE (Active Forums addressing 'everything Cholera' in Haiti):
http://haiti.mphise.net/
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TREATING CHOLERA
Treatment ( from CDC and WHO)
Administer Oral Rehydration Salts (ORS) and, when necessary intravenous fluids and electrolytes, in a timely manner and in adequate volumes. This will reduce case–fatality rates to <1%. Antibiotic therapy will reduce fluid requirements and duration of illness and is indicated for severe cases. If possible, use antimicrobial susceptibility testing to inform treatment choices (special considerations for doxycycline and erythromycin testing, see
http://www.who.int/drugresistance/publications/WHO_CDS_CSR_RMD_2003_6/en/).
WHO Fluid Replacement or Treatment Recommendations No dehydration Oral rehydration salts Children<2 years: 50–100 ml, up to 500 mL / day
Children 2–9 years: 100–200 ml, up to 1000 mL / day
Patients >9 years: As much as wanted, to 2000 mL / day
Some dehydration Oral rehydration salts
(amount in first 4 hours)
Infants<4 mos (<5 kg): 200–400 mL
Infants 4–11 mos (5–7.9 kg): 400–600 mL
Children 1–2 yrs (8–10.9 kg): 600–800 mL
Children 2–4 yrs (11–15.9 kg): 800–1200 mL
Children 5–14 yrs (16–29.9 kg): 1200–2200 mL
Patients >14 yrs (30 kg or more): 2200–4000 mL
Severe dehydration IV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined above Age < 12 months: 30 mL/kg within 1 hour*, then 70 ml/kg over 5 hours
Age > 1 year: 30 mL/kg within 30 min*, then 70 ml/kg over two-and-a-half hours
*Repeat once if radial pulse is still very weak or not detectable
Reassess the patient every 1-2 hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200ml/kg or more may be needed during the first 24 hours of treatment
After 6 hours (infants) or 3 hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink
Antibiotics:
CDC first choices for oral antibiotic treatment are:
- adults (non-pregnant), doxycycline 300 mg by mouth in one dose;
- pregnant women, azithromycin 1 gram in one dose
- children (all ages): azithromycin 20 mg/kg in one dose (not to exceed 1 gram), erythromycin 12.5 mg/kg (not to exceed 500 mg) 4 times a day for 3 days, or doxycycline 2-4 mg/kg in one dose (not to exceed 300 mg).
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CHOLERA REHYDRATION RESOURCES:
ORT (Oral Rehydration Therapy)/REHYDRATION DRINK/COCKTAIL INGREDIENTS (If ORT Fluids aren't available):
1 liter water (purified/boiled)
1 teaspoon salt
8 teaspoon sugar
NOTE: A Bottlecap can be used in place of a teaspoon / This homemade ORT recipe should NEVER REPLACE medical care for Cholera. If the patient is mildly symptomatic or sent home after observation and released and Rehydration Salts (ORS) is not available, this is an alternative. The patient should ALWAYS seek the treatment of a medical professional (if available).
It is important that the solution is tasted after it's prepared. It should taste no saltier than tears. It's unlikely that people in Haiti would have actual measuring spoons, so families will need help determining how much "1 tsp" actually is.
Mashed banana can be given to patients as young as 4 mos. old if it is possible for the patient to eat. Carrot Soup, Fruit Juice and Coconut Water can also be given in addition to the homemade hydration cocktail (never in place of!) if the patient is able to eat.
This is a YouTube Video that is perfect for training the Haitian Community on how to make ORT very easily:
http://www.youtube.com/watch?v=yPrqgZL7G6E&feature=player_embedded#at=161
WIKIPEDIA: ORT (Oral Rehydration Therapy: http://en.wikipedia.org/wiki/Oral_rehydration_therapy
REDUCED OSMOLARITY ORAL REHYDRATION SOLUTION FOR TREATING CHOLERA: http://www2.cochrane.org/reviews/en/ab003754.html
WHO (WORLD HEALTH ORGANIZTION/U.N.) POSITION PAPER ON ORAL REHYDRATION SALTS TO REDUCE MORTALITY FROM CHOLERA: http://www.who.int/cholera/technical/en/index.html
SLEEPY DOC's BLOG (This isn't Grey's Anatomy): http://sleepydoctor.blogspot.com/?spref=fb
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CHOLERA - SIGNS & SYMPTOMS:
MAYO CLINIC - CHOLERA SIGNS (INCLUDES UNIQUE CHILDRENS SIGNS/SYMPTOMS): http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=symptoms
SLEEPY DOC's BLOG (This isn't Grey's Anatomy): http://sleepydoctor.blogspot.com/?spref=fb
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HAITI PUBLIC/HEALTH CARE WORKERS EDUCATIONAL MATERIALS:
WHO GUIDELINES HANDOUT - IF YOU SUSPECT CHOLERA:
http://www.who.int/topics/cholera/publications/en/first_steps.pdf
Kreyole Sanitation Handbook/Cholera Prevention Handout:
https://www.yousendit.com/transfer.php?action=batch_download&batch_id=ZGJkOU1lZ2pGOFN4dnc9PQ
Cholera Treatment Protocol Developed by MSF and MSPP: http://biosurveillance.typepad.com/.a/6a01053695fa5c970b0133f54c266c970b-pi
CARE-CHOLERA & BREASTFEEDING:
http://www.ibfanasia.org/ife/CARECholeraandBreastfeeding.pdf
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WASH CLUSTER INTERVENTION IN ARTIBONITE - MAPPED UPDATES:
http://biosurveillance.typepad.com/.a/6a01053695fa5c970b0134886c0887970c-pi
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WATER PURIFICATION OPTIONS IN HAITI
Gadyen Dlo/ Dlo Lavi/ Klorfasil/ Aquatabs/ Bleach
Cost per unit (cash req.) $0.12 $0.63 $2.50 $0.03 Variable
Cost per 1000 liter treated $0.13 $1.10 $0.24 $1.32 Variable
Est. annual cost per family $0.96 $8.03 $1.78 $9.64 Variable
Product shelf life (months) 12 18 60 36 6
The cash outlay for each purchase is critical in Haiti. Qualitative research indicates some people report Aquatabs are "more economical" than other chlorine options because one Aquatab (treating 20 liters) costs less than other options
treating higher quantities of water, despite the fact Aquatabs has the highest cost per liter treated.
Gadyen Dlo: Locally produced sodium hypochlorite, DSI
Deep Springs International (DSI) produces 0.7% sodium hypochlorite locally and distributes in 8 oz. refillable bottles as ‘Gadyen Dlo’ (Water Guardian). Users add one cap of solution to a 5-gallon plastic storage container. One bottle treats 48 five gallon buckets and lasts a family 1-1.5 months. Benefits are ease-of-use, demonstrated acceptability to users, scalability, and greater control over costs and import challenges. Drawbacks include higher transportation costs and challenges compared to solid chlorine. Contact Michael Ritter at michael.ritter2@gmail.com or see www.jolivert.org.
Klorfasil: Imported granulated NaDCC The Klorfasil (‘Easy Chlorine’) project manufactures plastic bottles holding 70 grams of granulated chlorine disinfectant (NaDCC). Users invert the bottle and use the cap to dispense 1 dose (129 mg) of chlorine to 5 gallons of water. One bottle treats 540 five gallon buckets and lasts a family about 1.5 years. Benefits are low transportation costs compared to liquid and low frequency of need for refills. Drawbacks include high cost of dispensing bottle and reliance on imported chlorine and bottle pieces. Contact Jon Steele at jon@madewell.com or see www.klorfasil.org.
Dlo Lavi: Imported sodium hypochlorite, PSI Population Services International (PSI) imports and distributes 0.94% sodium hypochlorite in disposable 4 ounce Dlo Lavi (‘Water is Life’) bottles. Users add one cap of solution to 5 gallons of water. One bottle treats 30 five gallon buckets and lasts a family about 1 month. Benefits are ease-of-use and high quality marketing provided by PSI. Drawbacks include high cost, reliance on PSI’s supply chain, creation of plastic waste, and higher transportation costs and challenges compared to solid chlorine. Contact Natacha Riviere at nriviere@psihaiti.org or see www.psi.org/where_we_work/haiti.html.
Aquatabs: Solid NaDCC tablets, Medentech. Medentech, a for-profit company based in Ireland, markets solid NaDCC Aquatabs in Haiti. Various sizes of Aquatabs are available, allowing users to add one tablet to quantities of water
ranging from 1 liter to 5 gallons. Aquatabs are typically sold in sleeves of 10, but can also be purchased individually in Haiti or in bulk from Medentech. Benefits are ease-of-use, demonstrated acceptability to users, and low transportation costs compared to liquid chlorine. Drawbacks include high cost and reliance on imported product. Contact Paul at pedmondson@medentech.com or www.medentech.com/.
Jif or Clorox: Commercial bleach, US or DR. Commercial bleach (5.25% sodium hypochlorite) enters markets in Haiti from the United States and the Dominican Republic for various household uses. Users add 3-5 drops to 5 gallons of water. Some bleach bottles come with a top that dispenses by drops. If not,
users find other caps for measuring drops. Bleach is sold in bottles ranging from 4 oz. to 1 gallon. Benefits include local familiarity with product. Drawbacks include uncertain concentration and shelf life, susceptibility to gaps in supply chain, high transportation costs, and difficulty in dispensing precise quantities.
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CHOLERA MEDICAL SUPPLY LIST:
NOTE: See details of treatment with the above med's including complications and dosing at: http://sleepydoctor.blogspot.com/
RX:
ANTIMETICS:
Zofran (Ondansetron)
Reglan (Metoclopramide)
Compazine (Prochlorperazine)
ANTIBIOTICS:
Doxycycline (Sensitive to Cholera per CDC)
Ciprofloxacin (Sensitive to Cholera per CDC)
Tetracycline (Sensitive to Cholera per CDC)
Azithromycin
Erythromycin
Per CDC on 10-25-10: This 01 Cholera Strain is RESISTANT to Bactrum and Ampicillan.
According to the CDC's website, Azithromycin and Erythromycin can be used for cholera in Haiti: http://www.cdc.gov/haiticholera/clinicalmanagement/
MEDICAL SUPPLIES/SUPPLEMENTS (NOTE: The listed supplies below are the types of items clinics, hospitals, camps and orphanages are looking and asking for. If you are a donorm or responder, these are the types of items you'd want to collect to make an impact):
* Zinc (Supplementation to decrease volume and duration of Diarrhea)
* Sugar
* Oral Rehydration Salts
* Chlorine (Bleaching Powder)
* Ringers Lactate (10-20 litres per patient)
* IV Fluids (Normal Saline - NO DEXTROSE)
* Intracatheters for IV administration
* IV poles
* IV Start Kits
* IV Lines
* Foley Catheters (to control Diuresis - urine flow)
* Lubricators for the Foley Catheters
* Tournequets
* Gauze
* Iodine
* Hand Sanitizer
* Towelettes
* Alcohol Swabs
* Rectal Swabs (For surveillance, NOT acute care)
* Tape, Tegaderm (Silk works best in humidity)
* Non Sterile gloves in all sizes
* Cholera Beds
OTHER SUPPLIES:
*Adult Diapers
*Baby/Toddler Diapers
*Pedialyte
*Gatorade
*Sports Drinks (any fluids that replace Electrolytes)
*Soap
*Antibacterial Gel
*Hand Sanitizer
*Hygiene Kits
*Disinfectant Cleaner
*Chlorine Bleach (liquid Clorox)
*Buckets
*Waste Bags
*Large Waste Containers (for toxic materials)
*Tents (LARGE)
*Plastic Sheeting
*Ropes
TIP FROM HEAS GROUP:
Product: CREOLINA
EPA Registration Number: 01496104419
This pesticide is used as a: DISINFECTANT
As effective as Chlorine Bleach but smells better
SANITATION SUPPLIES:
*Purified Water
*Water Purification Equipment/Systems
*Water Purification Tablets (CHLORINE BASED ONLY - IODINE BASED IS NOT EFFECTIVE ON CHOLERA)
*Aquatablets
*Well Pumps
*Well Water Testing Supplies
*Water Tanks
*Water Bladders
*Cholera Prevention/Education Pamphlets for distribution
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"The Master Cholera Response Packing List for CTC/CTU (has been developed by MSPP, PAHO/WHO, UNICEF and other health partners. The list of supplies includes items for infection control (chlorine, disinfectant, a...nd sprayers), treatment support (waste bags, and buckets), module installation (plastic sheeting, ropes, tents, and cholera beds), water distribution (water tanks/bladder) and treatment and consumables (oral rehydration salts, ringer's lactate, antibiotics, and soap)."
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WHEN TO RELEASE PATIENTS
Posted on HEAS 11/12/10
by phuocvanle@gmail.com
Below discharge guideline is copied from the 2004 MSF cholera guidelines. we don't do any labs unless warranted for special cases like renal failure. it's a 3 meg file so if you'd like it please let me know. we've been following this protocol in St. Marc which seems to work. best of luck.
9. Discharging the patient
– If hospitalised, first transfer to recovery area and keep under observation and ORS for 6 hours.
– From recovery area, discharge when there are no more signs of dehydration and less than 3 liquid stools during the past 6 hours.
– Advise the patient or caregiver to come back to the treatment centre immediately if: ∑ vomiting restarts, ∑ diarrhoea worsens, ∑ patient is drinking or eating poorly
– Discharge with enough ORS bags for 2 days at home and instruct the patient to prepare the ORS solution with clean water.
Table 11. Number of ORS bags to give at home (from the WHO) Age Amount of solution after each loose stool ORS sachets needed Less than 24 months 50 to 100 ml Enough for 500 ml/day 2–9 years 100-200 ml Enough for 1000 ml/day 10 years or more As much as wanted Enough for 2000 ml/day
ORS bags are usually for 1 litre. In some countries ORS bags are conditioned for less than 1 litre.
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CHOLERA SUPPLIES FROM PROMESS
Simplified procedure to get cholera medical supplies from PROMESS
for organizations NOT registered with the Ministère de la santé publique et de la population (MSPP).
1) Go to the Cellule opérationnelle d`urgence nationale (COUN) of the MSPP
Contact person
Dr Claude Surena
Health Coordinator, MSPP
Rue Butte N# 7 Bourdon, Port au Prince, Haiti
Tel : +509-3701-7077
Assistant : Ms Margaret Beaudin : +509-3491-8955
Documents to provide:
· Photocopy of ID of the country director or person responsible for coordination of the organization.
· Legal recognition document from the country of origin.
· NGO Status.
· Project work plan (a summary of one page: activities and operations)
Upon approval, Dr Surena will issue the same day a temporary authorization to operate in the country.
2) Bring this authorization to PROMESS
This procedure can also be found at www.paho.org/promess.
Select “Simplified procedure for Cholera” on the left-hand side.
For those who are registered with the MSPP country, go directly to PROMESS or write to promess@paho.org.