Extension of the Haiti Cholera Disaster to Mexico

Operational Biosurveillance - biosurveillance.typepad.com - October 1, 2013

Mexico is reporting upwards of 44 cases of cholera now with one fatality involving Hidalgo State and Mexico City.  The appearance of cholera in Mexico City is deeply concerning from the standpoint of the "tip of the iceberg": we only know of the recognized cases.  There are likely others out there.

A couple of points about this:

1. Totally expected to see expansion of the Nepalese cholera from Haiti to the DR, to Cuba, and now to Mexico. It is likely to include many other countries in that region before all is said and done.

2. It is likely to spread in Mexico in 'fits and starts' due to lack of indigenous immunity and will cause disruption.

3. It will likely spread along trade and migrant labor routes to the US and other countries doing business with Mexico.

4. Communities in the US may be caught unawareness due to basic expectation of border communities in Texas serving as "canaries in a coal mine" for the rest of the country. We propose the migrant labor routes penetrate deep into the US and far from these border communities.

5. Haiti's cholera disaster already has touched the US via returning humanitarian workers. We have not seen substantial community transmission upon their arrival to the US.

6. Per #4 above, the issue is smoldering transmission in Spanish-only speaking migrant labor communities, where we often see public health issues arise and smolder for days-wks-months-(?) years without notice by local public health.

7.  There is going to be risk of introduction into the US food supply without proper surveillance in-place as the situation evolves.

Below are the case count signatures over the last year for Hidalgo State for infectious enteritis, to give the reader an idea of what Hidalgo State normally sees.  We believe we are not in the peak season for general diarrheal disease in Hidalgo State, however we are continuing to evaluate the data.  Initial impression is we may only see limited transmission in the coming months, but may see a larger spike in May 2014.  It could be hypothesized that if cholera continues to transmit, Mexico will see an early seasonal spike more in the late March / April time frame.  Clearly an evolving situation.

(CLICK ON THE LINK BELOW FOR ADDITIONAL INFORMATION, AND TO VIEW THE GRAPHS)
http://biosurveillance.typepad.com/biosurveillance/2013/10/extension-of-the-haiti-cholera-disaster-to-mexico-biosurveillance-cholera-haiti.html

ALSO SEE - Signature Patterns for Diarrheal Disease in Mexico City
http://biosurveillance.typepad.com/biosurveillance/2013/10/signature-patterns-for-diarrheal-disease-in-mexico-city-cholera-haiti-biosurveillance.html