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    The Politics of Prevention: Cholera in Cuba
    [30-07-2015 01:02:47]
    Cuba Transition Project

    (www.miscelaneasdecuba.net).- Even before the scheduled opening of the
    US Embassy on July 20, 2015, there were advertisements, blog posts,
    tweets, and news feeds welcoming U.S. residents to Cuba for cultural,
    religious or educational opportunities. Cuba remains a popular
    destination for Canadian and Western European tourists with its rich
    cultural arts, gracious hosts and Caribbean beaches. However, a growing
    interest in U.S. approved trips must consider Cuba’s lack of safe
    potable water, sanitation and sewage issues along with housing
    challenges. This is important because while it is unreported, cholera
    transmission exists within Cuba.
    Cuba’s lack of transparency in health outbreak reporting is in question
    again. Laboratory confirmed cases continue to be shared with the
    international community about tourists returning to Canada, Latin
    America, and European countries after taking home more than sun and fun
    from a Cuban vacation. Cuba consistently asserts that the cholera
    outbreak of 2012 was quickly controlled within the country.

    Where is the United States government on this issue today?

    While a U.S. Center for Disease Control and Prevention (CDC) cholera
    watch in Cuba has recently been removed from their website, (1) there is
    still evidence that cholera is transmitted there. CDC travel notices
    consists of three levels:

    A “watch” level 1 informs travelers to use usual precautions, an “alert”
    level 2 calls for enhanced precautions and a “warning” level 3 advises
    travelers to avoid nonessential travel to an area where the risk is
    high. These travel notices are important because the CDC notification
    system is widely used by travelers as well as clinicians for up-to-date
    international travel information.

    Since 2013 there have been cases of confirmed cholera after visits to
    Cuba. (2) In January 2015 the Canadian International Health Regulation
    reported a case of a returning traveler, (3) as well as Pan American
    Health Organization (PAHO) on their Epidemiologic Update Report (4)
    documented this as the only case of cholera in Cuba for 2015. This
    assumes only travelers and no locals have been infected. It is more
    likely that the Cuban government does not share this information with
    the international community, and is only compelled to cooperate after
    scientific proof is disseminated.

    In June 2015 the United Kingdom reported a traveler who participated in
    an all-inclusive resort stay in Varadero and spent two days in Havana
    before getting sick and returned home with cholera. According to the
    International Society for Infectious Disease, through their Program for
    Monitoring Emerging Diseases (ProMed- mail) posting on July 3, 2015, the
    patient indicated other family members were well. However, “several
    other people staying in his hotel (not necessarily in the same tour
    group) had reported severe gastroenteritis symptoms with a similar
    period of onset,” suggesting this may not be the only case. Pro-Med
    seeks to share this information and advise others of the confirmed
    cholera in Cuba and for health professionals to consider such a
    diagnosis with travelers returning with diarrhea. (5)

    The question is not whether cholera is a risk to locals and visitors.
    Rather, the issue is why has the CDC removed the notification from its
    website when outside country evidence continues to show cholera exists
    within Cuba.

    Are we left to speculate that the promotion of diplomatic relations- in
    an attempt to not question Cuba’s position on reporting disease
    outbreaks as required by World Health Organization International Health
    Regulations- is more important than the prevention and promotion of
    health security? Let’s not play politics with what we know is a best
    practice in prevention. Give people access to reliable information so
    they are well informed of their potential risks. Only then can good
    decisions be made to prevent cholera-or for that matter dengue,
    chikungunya or possibly zika virus (new mosquito born virus to reach the
    Caribbean) when traveling to Cuba.

    Notes

    1) Center for Disease Control and Prevention (CDC), “Travel Notices-
    Cholera in Cuba,”
    http://wwwnc.cdc.gov/travel/notices/watch/cholera-cuba, accessed July
    14, 2015.

    2) M Mascarello, M L Deianam C Maurel, C Lucarelli , I Luzzi R Luzzati,
    “Cholera with Severe Renal Failure in An Italian Tourist Returning from
    Cuba,” Eurosurveillance, July 2013. Volume 18, Issue 35, August 29,
    2013. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20572.

    3) Public Health Agency for Canada, Travel Health Notice: Cholera in
    Cuba, Dominican Republic, Haiti and Mexico, updated March 20, 2015
    http://www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=111.

    4) PAHO Epidemiologic Update. “Cholera in The Americas,” June 24, 2015
    http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=30752&lang=en

    5) ProMed- Mail. “Cholera, Diarrhea and dysentery update (24):
    Americas,” Archive Number: 20150703.3480336July 3, 2015
    http://www.promedmail.org.

    _________________________________________________

    *Sherri L. Porcelain teaches global health in world affairs at the
    University of Miami where she is also a Senior Research Associate at the
    Institute for Cuban and Cuban-American Studies.

    Source: The Politics of Prevention: Cholera in Cuba – Misceláneas de
    Cuba –
    http://www.miscelaneasdecuba.net/web/Article/Index/55b95b973a682e133c7fde64#.VboOKfmqqko

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