U.S. issues travel alert for cholera in Cuba

The U.S. diplomatic mission in Havana has issued an alert for cholera, triggering fresh allegations that Havana is hushing up an outbreak of the potentially fatal disease to avoid damaging its $2.5 billion-a-year tourism industry.

Officials at the Florida Department of Health said Wednesday that they have received no reports of cholera imported from the island — although tens of thousands of Cuban-Americans visited there during this summer’s vacation period.

Cuba’s government has said almost nothing in public about the recent cases of cholera, which causes intense diarrhea that can lead to dehydration and death. The state-controlled news media has referred only to “acute diarrheic diseases.”

“Of course nobody wants to say they have outbreaks because outbreaks cause a decline in tourism,” said Sherri Porcelain, a senior lecturer in global public health in world affairs at the University of Miami who has been tracking the cholera outbreak in Cuba.

But Havana will find it difficult to avoid all the negative publicity this month: the U.S. warning, reports of five cases in people who flew from Cuba to Venezuela, Chile and Italy, and a report by the Pan American Health Organization (PAHO).

The statement from the U.S. Interests Section in Havana urged U.S. citizens living in or visiting Cuba to follow public health recommendations, such as frequent hand washing and special care with food and water to be consumed.

“Media reports have indicated that cases of cholera have been identified in the city of Havana, possibly linked to a reported outbreak of cholera in eastern Cuba,” said the statement dated Tuesday and posted on the mission’s Web page Wednesday.

The statement gave no further details on the cases, although independent journalists on the island have been reporting scores of cases over the past year and especially this summer, when high temperatures and rains appear to have helped spread the disease.

PAHO, the regional arm of the World Health Organization, reported that Venezuela confirmed on Aug. 9 two cases of cholera in travelers who arrived from Cuba, and that Italy reported one more, a man who arrived from Havana on July 13.

Chile reported another two arrivals from Cuba with cholera, PAHO added. The airport in Santiago later declared a state of “epidemiological vigilance” on Cuban arrivals, according to news reports. And Canada issued an advisory to travelers heading to Cuba.

The PAHO report also noted that 51 cases were detected in Havana early this year “related to the handling of food,” and 47 more were reported in the eastern provinces of Camagüey, Guantánamo and Santiago de Cuba in the wake of Hurricane Sandy.

Cuba’s government never commented publicly on those two outbreaks, although independent journalists reported on them as well as others in Matanzas, Jovellanos, Cardenas, Sierra de Cubitas, Cabaiguan, Jagüey Grande and elsewhere.

Cholera can be treated with hydration and antibiotics, but can spread so quickly and be so deadly that it is on a worldwide list of reportable diseases that also includes the bubonic plague, typhoid and yellow fever.

The disease is thought to have been brought to Cuba by medical personnel who served in Haiti, where cholera has killed more than 8,200 since 2010. Havana has confirmed only three deaths in Cuba, all from the initial outbreak in the eastern cities of Bayamo and Manzanillo. Dissidents put that death toll at more than 15.

PAHO’s report noted that the Cuban government “maintains an active and strict clinical-epidemiological vigilance of acute diarrheic diseases.” It made no mention of Havana’s almost total refusal to comment publicly and in detail on the cholera cases.

“The lack of transparency coming from Cuba is truly bothersome,” Porcelain said. “Sharing of information in a timely fashion is most essential for prevention … yet they post no information, no information at all.”

“The government of Cuba has not been particularly transparent about the ongoing cholera in the island,” added a post in ProMED, a website started by the Federation of American Scientists to disseminate information on outbreaks of infectious diseases.

Havana’s official silence on the cholera as well as dengue fever made it all the more unusual that two Cubans — a government doctor and a reporter for a state-run newspaper — had recently complained about the secrecy.

Dr. Luis Suárez Rosas, a professor at the National School of Medicine, wrote an article titled “The epidemiological silence and the ethics of Cuba’s public health” and published it in the latest edition of the Cuban Magazine for Public Health.

Using dengue as an example and never mentioning cholera, Suarez Rosas argued that the secrecy tends to hide the risks and severity of the mosquito-borne disease, and does not help patients understand their condition.

“The existence or not of a number of cases of a disease is one of the aspects and issues of public health susceptible to a … specific ethical consideration requiring transparent, responsible and truthful information,” he wrote. “Many times this becomes a matter of life or death.”

Mariurka Martínez Alemán, a reporter for the Invasór newspaper in the province of Ciego de Avila, was slightly less direct in her Aug. 5 report on the sudden closing of Bolivia Beach on the northern shore of the province.

By the time authorities announced that the beach would be closed because of “a high-risk epidemiological situation,” Martínez wrote, some vacationers had already arrived with supplies for long summer stays and rumors had started to fly.

“Perhaps if someone would have opted to call together the vacationers to a meeting on the main plaza there would not have been so many distortions,” she wrote. “It would have been enough to hear that 18 cases of cholera had been detected on the beach, that the sea water had been tested and turned up positive.”

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