Hope for Haiti

Spraying DDT in 1958 as part of The United States' National Malaria Eradication Program

The source article for this post should be considered an editorial, and it expresses the opinions of Henry I Miller.

Is there a hope for Haiti?

"On top of the almost unimaginable devastation caused by January's earthquake in Haiti, the nation is bracing for the ravages of the rainy season." Torrential downpours already flood homes and turn "tent cities into muddy misery. Ominously, the number of cases of malaria, which is spread by the bite of mosquitoes and which was endemic in Haiti even before the earthquake, is increasing."

Aid groups plan to distribute over three million bed nets in order to minimize the number of malaria cases. However, this "ultra-low-tech" solution stands as "only modestly effective intervention". "What is really needed is the chemical DDT, an old, cheap and safe tool to control the vector -- the Anopheles mosquito -- that spreads the disease."

"Malaria is a scourge of humanity, particularly for the inhabitants of poor tropical countries." Over forty percent of the world's population lives at-risk for contracting malaria. 350 to 500 million cases of malaria occur worldwide each year. It is "a crushing economic burden on malaria-endemic countries" and impedes economic growth.

Once contracted, malaria is treatable. "A drug called chloroquine is a useful preventive but many strains of the malaria parasite in Haiti have developed resistance to it." Artemisinin-combination medicines "are safe and exhibit potent, rapid antimalarial activity", but resistance to these drugs is also rising. It is clear "that in the absence of a vaccine", "elimination of the mosquitoes that spread the disease is the key to preventing epidemics."

"Unfortunately, flawed public policy limits the available options."

Humans, armed with the weapon of DDT, are capable of destroying the deadly mosquito population; however, "on the basis of data on toxicity to fish and migrating birds" the U.S. Environmental Protection Agency (EPA) banned "virtually all uses of the pesticide DDT" in 1972. Subsequently, DDT was banned for "agricultural use worldwide under the 2001 Stockholm Convention on Persistent Organic Pollutants, which stigmatized the chemical and effectively constituted a prohibition."

"Although DDT is a (modestly) toxic substance, there is a vast difference between applying large amounts of it in the environment -- as farmers did before it was banned -- and using it carefully and sparingly to fight mosquitoes and other disease-carrying insects."

DDT is an effective pesticide because it is long lasting, and it works by poisoning and repelling mosquitoes. Treatment of mosquito breeding grounds prevents malaria transmission by reducing the insect population. Spraying DDT in homes and on door frames repels adult mosquitoes and prevents malaria transmission within the home. Because of its dual effectiveness, it is logical to assume that DDT will help prevent malaria even if mosquitoes develop resistance to it…a resistance that is yet to manifest.

"Since the banning of DDT, insect-borne diseases such as malaria and dengue have been on the rise. In fact, the huge toll of diseases spread by mosquitoes caused some public health officials to rethink DDT's use…In 2006, after some 50 million preventable deaths, the U.N.'s World Health Organization reversed course and endorsed the use of DDT to kill and repel malaria-causing mosquitoes."

"Poor tropical countries like Haiti where malaria is endemic desperately need cheap, effective control of mosquitoes. Instead of continuing the politically correct stigmatization of DDT, United Nations agencies and NGOs such as the Red Cross should be rushing supplies of it to Haiti."

Henry I. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution. He was an official at the NIH and FDA.

Read more: http://www.miamiherald.com/2010/05/03/v-fullstory/1610610/ddt-can-stymie-malaria-carrying.html#ixzz0mvfg9aS4

Source:
Miller, Henry I. "DDT can stymie malaria-carrying mosquitoes in Haiti." Miami Herald. 3 May 2010.

Banishing malaria

"On Hispaniola, home to the nations of Haiti and the Dominican Republic, malaria is caused by a single mosquito-borne parasite, Plasmodium falciparum" (Joseph). Hispaniola remains as "the last island in the Caribbean where the disease occurs regularly." Researchers from Tulane University claim that "success in eliminating malaria from Hispaniola would demonstrate that it is possible to defeat malaria in other regions of the world where it remains a dire threat. There is also evidence in Haiti that the parasite is becoming resistant to chloroquine, an inexpensive treatment for the disease. Eliminating malaria now would save these impoverished nations from having to resort to more expensive drug therapies."

In order to banish malaria from Hispanola, the countries must adopt more intensive mosquito-control methods. Every suspected malaria case should be diagnosed properly and treated.

"Success will require the 'unwavering political will' of both governments on the island, and will 'set a precedent for health diplomacy'"(Tulane).


Sources:

Joseph Keating, Donald J Krogstad, Thomas P Eisele. Malaria elimination on Hispaniola. The Lancet Infectious Diseases, 2010; 10 (5): 291-293 DOI: 10.1016/S1473-3099(10)70075-X

Tulane University (2010, April 28). Researchers call for eliminating malaria in Haiti and the Dominican Republic. ScienceDaily. Retrieved April 30, 2010, from http://www.sciencedaily.com­ /releases/2010/04/100428121457.htm

Malaria enters the US

"Nearly a dozen cases of Malaria has been confirmed here in the United States. All of the cases were acquired in Haiti after the January 12th, 2010 earthquake" (Gibbons). "Seven emergency responders, three Haitian residents now in the United States and one American traveler are known to have caught malaria in Haiti after the Jan. 12 earthquake, United States health officials said Thursday. Malaria is endemic throughout Haiti, so Haitians now living outdoors and relief workers are 'at substantial risk for the disease,' the Centers for Disease Control and Prevention said" (McNeil).

"Haiti already had a problem with malaria, which is spread by mosquitoes that will have more places to breed in the cities and towns wrecked by the giant quake" (Reuters). Displaced people living in temporary shelters our outdoors are at substantial risk of contracting malaria. Health workers who flooded to Haiti after the earthquake to offer aid are also at risk. "U.S. health officials advise people travelling to Haiti should take medications to prevent malaria" (UPI).

"Six out of eight patients, including seven emergency responders, had been advised to take drugs to prevent malaria but had not done so, the PAHO experts said." Three of the cases that the CDC cited "occurred among Haitian residents traveling to the United States and one case involved a U.S. resident who was visiting Haiti. All are expected to recover fully" (Reuters).

Individuals in Haiti are still at risk. "Each year, Haiti reports about 30,000 confirmed cases of malaria to the Pan American Health Organization, but the CDC estimates as many as 200,000 may occur each year. According to the CDC, malaria transmission peaks after the two rainy seasons -- November to January and again during May to June" (Reuters). The peak season is still months away, but anti-malarial medications are already needed to treat those who are infected and reduce the number of possible cases.

"There is no vaccine against the parasite that causes the illness[,] and it quickly evolves resistance against drugs"; however some drugs are known to treat and reduce malaria illness (Reuters).

The CDC indicates that "anyone traveling to Haiti should take drugs to help prevent infection" (Reuters).


Sources:
Gibbons, Sabrina. WSB News. "Malaria from Haiti Now in US." 4 March 2010.

McNeil, Donald G Jr. The New York Times. "U.S. Warns of Malaria Risk in Haiti". 4 March 2010.

Reuters. "Travelers from Haiti bringing Malaria to the US." 4 March 2010.

UPI. "Malaria Drugs for those going to Haiti." 4 March 2010.

Haiti in the wake of disaster

"Tuesday's earthquake could decimate what fragile medical care exists" in Haiti "and spawn a 'perfect storm' in a country already struggling to fight rare tropical and infectious diseases, health experts" warn. The Red Cross has estimated that "3 million people -- one-third of Haiti's population -- were affected by the quake", which was measured at a magnitude of 7.0 and "ripped apart buildings, shearing huge slabs of concrete off structures in the poorest country in the Western Hemisphere" (Park). The homeless are "clustering in public places without food, clean water or sanitation. It's the perfect environment for the spread of communicable disease." Photo by Pinheiro.

The earthquake has thwarted medical efforts in a place that already struggles to stave off infectious diseases. "Even before the earthquake, the country has been the subject of intense public health efforts, as nearly half the causes of deaths have been attributed to HIV/AIDS, respiratory infections, meningitis and diarrheal diseases, according to the World Health Organization." "Hundreds of thousands of people are sleeping in tents, or filling public squares waiting for some kind of help. There is no water, food or sanitation. Many of the survivors have broken arms and legs" (Kenny). "The earthquake decimated Haiti's capital just days ago[, but] it's an eternity in terms of getting medical care to the injured" (Pearson). Now, "if left untreated, minor injuries or fractures can become life-threatening because they're left open to bacterial infections such as tetanus".

Even the uninjured face severe medical risks.

"The disaster cut power, electricity and other utilities." Without clean drinking water, endemic diseases are hard to resist. "What you have is the perfect storm of infection. What you have is a breakdown. It is already a fragile infrastructure with high rates of infectious and neglected tropical disease. Now there are potential breakdowns in sanitation, clean water, housing and subsequent crowding. That's a terrible mix," says Dr Peter Hotez, head of the department of microbiology at George Washington University. "The potential new mass of displaced persons could create crowded, unsanitary conditions that facilitate the spread of contagious respiratory infections."

Cholera, typhoid fever, and other diarrheal diseases threaten the people. "Bacterial and mosquito-borne diseases such as dengue and malaria" are also major risk factors to the injured and uninjured alike.

Dirty water, broken drainage, and a tattered terrain create natural reservoirs where disease can breed. Malaria, an infectious disease that kills approximate one million people each year and is carried by mosquitoes, is expected to intensify in the aftermath of the quake. Malaria is already endemic in this region, and in the midst of this chaos, it will be difficult to avoid.

Doctors "worry that the major, long-term health initiatives to treat preventable diseases" like malaria and dengue "could be upended" by this disaster. "Any interruptions in fighting these preventable diseases has disastrous consequences", claims Hotez. "This is going to a big setback for public health control measures, and you will see the impact of this earthquake at least for months and possibly for years." Kaplan, who formed the Cap Haitien Health Network to tackle preventable diseases such as diarrhea, malaria and malnutrition agrees, "That's another tragedy of the earthquake."

"When the rubble is cleared and the bodies are buried," Haiti will still face the threat of devastating disease as it always has. But by that time, medical supplies and money will be expended on the newly injured, clinics and hospitals will need to rebuild, and the landscape will need to be reshaped in order to prevent water buildup, which fuels the spread of infectious diseases.

Despite it all, Kaplan has hope. He hopes that "this situation may lead to improvements, because it's bringing lots of attention and help to the area." "There's that silver lining," he said.

Want to help the relief & malaria prevention effort in Haiti? Support the Red Cross.
Send a $10 Donation by Texting 'Haiti' to 90999
You may also call 1-800-REDCROSS to make a donation over the phone.
Please DO NOT send donations for Haiti relief efforts to Infectious Bite. Donations to support the Infectious Bite malaria awareness campaign are always welcome.

Sources:
Kenny, Sean. Common Dreams. "Haiti's earthquake survivors face massive risk."
Park, Madison. CNN.com. "Haiti's earthquake could trigger 'Perfect Storm'." 13 January 2010.
Pearson, Carol. VOA News. "In Haiti, Wounds, Infectious Diseases are top concern." 15 January 2010.
Pinheiro, Roosewelt. Agência Brasil. [PHOTO]

Hispaniola

The island of Hispaniola is the home to the countries of Haiti and the Dominican Republic. It is also one of the few remaining regions in the Caribbean with endemic malaria.



"In September 2008, The Carter Center, in partnership with the Dominican Republic and Haiti, launched a historic one-year initiative to help the two countries and their other partners accelerate the elimination of two devastating mosquito-borne infections--malaria and lymphatic filariasis--from Hispaniola" (Carter). "Lymphatic Filariasis, known as Elephantiasis, puts at risk more than a billion people in more than 80 countries. Over 120 million have already been affected by it, over 40 million of them are seriously incapacitated and disfigured by the disease." Like malaria, lymphatic filariasis is caused by a blood parasite that is "transmitted by mosquitoes" (WHO).

"The leaders of Haiti and the Dominican Republic agreed Thursday to cooperate in a campaign aimed at eradicating the last vestiges of malaria from the islands of the Caribbean by 2020. What remains uncertain is how to fund the roughly $250 million effort, which also aims to eliminate lymphatic filariasis, on the two-nation island of Hispaniola" (Bluestein). Although the cost of eradication is high, it is diminutive when compared with the long-term economic damage that is caused by these parasites. "Malaria and lymphatic filariasis are costly economic burdens, as both diseases are caused by--and create--additional poverty. An outbreak of malaria on the island in 2004 cost the Dominican Republic an estimated US $200 million in lost revenue from tourism. Since then, two transient outbreaks of malaria in the Bahamas and another in Jamaica have been imported from Hispaniola, which also is the source of several cases of malaria imported to the U.S. each year" (Carter).

Sources:
Image: Filariasis parasite. Wikimedia Commons.
Bluestein, Greg. "Hispaniola leaders aim to eradicate malaria". Associated Press. 10 October 2009.
Carter Center, The. "The Hispaniola Initiative." http://www.cartercenter.org/health/hispaniola-initiative/index.html
WHO: World Health Organization. Lymphatic Filariasis