Cuba’s silence on cholera dangerous to your health

Posted on Saturday, 08.17.13
CHOLERA, DENGUE, MALARIA

Cuba's silence on cholera dangerous to your health
BY SHERRI L. PORCELAIN
SPORCELA@MED.MIAMI.EDU

After a century hiatus, cholera has returned to Cuba. Along with the
re-emergence of dengue, a mosquito-born disease, both the local
population and tourists visiting the island remain at risk today. This
is no surprise since Cuba's deteriorated water, sewage, sanitation and
housing systems all create the ideal environment for rapid disease spread.

Luis Suarez Rosas, a physician with Cuba's National School of Medicine,
captures the paradox of Cuban healthcare today in using the term
"epidemiologic silence" to describe Cuba's official position on
reporting disease outbreak information.

Cuba is a unique case study because of its long history of highly
trained infectious disease specialists from the yellow fever response in
the early 1900s to the prominence of the Pedro Kouri Tropical Medicine
Institute founded in 1937. Yet, today, the policy to call dengue
euphemistically as a febrile illness or cholera as a gastrointestinal
illness represents an unethical national public health policy affecting
individuals beyond their national borders. This choice to withhold good
epidemiologic data derails global public health goals to inform and
protect travelers; it also encourages rumors and creates confusion.

In June 2013 an independent journalist from Hablemos Press reported
approximately 30 cases of malaria in Cuba. The Cuban government claimed
these cases are imported by tourists or from returning residents who
traveled to an endemic area. While imported cases of malaria are not
new, the history of Cuba's denials of other re-emerging diseases compels
one to question the veracity of the government's official report.

Malaria expert John Beier, Professor of Public Health Sciences at the
University of Miami Miller School of Medicine, states that "Cuba is
receptive to malaria since the mosquito has not been eliminated. It is
also important to acknowledge that local pockets of transmissions can
exist through imported cases from other areas in the region, such as
Hispaniola where malaria is known to exist." During rainy season, and
when vector population increases, the risk of transmission increases as
well. Still no official government report exists.

Cuba's governmental policy to withhold information for the purpose of
protecting the country's health image, or its tourism industry, is
unacceptable in an era where rapid and frequent transport across borders
occurs. International travelers and concerned citizens everywhere must
realize that microbes and mosquitoes do not require their own passport
stamp for entry into the United States, and the intrepid stowaways may
arrive before their presence is detected.

Based upon what we know and don't know, we need to:

• Promote greater awareness about mosquito avoidance and cholera
prevention for travelers to Cuba. While other countries may have higher
reported cases, their risk is documented through transparency in their
reporting. On June 27, 2013 the U.S. Interests Section in Havana posted
an alert message for U.S. citizens regarding road safety and traffic
deaths and injuries. This is an important health and safety message, so
why not extend this to other public health issues?

• Consider the use of Rapid Diagnostic Kits (RDK) for early
identification of such diseases as dengue and malaria. This could be
especially important to U.S. travel medicine clinics where licensed and
trained health professionals have the ability to do accurate testing and
patient histories.

Dr. Kunjana Mavunda, medical director and tropical disease specialists
at International Travel Clinic in South Miami, supports this approach.
"I've been looking at these rapid diagnostic kits as part of the patient
care, and it is important that you get a good history of the patient and
identify potential exposure risks." She indicated that Cuba's neglected
infrastructure makes it ripe for potential disease spread.

• Generate a wider dialogue concerning Cuba's epidemiologic silence.
Will anyone hold the Cuban government accountable for its failure to
report an early outbreak of an infectious disease?

Global health security depends upon the rigor of good science, the
willingness of nations to uphold policies to protect both their citizens
and visitors, and the timely reporting of potential health threats. A
world that is forced to rely on rumors puts everyone at risk.
Consequently, silence is dangerous to your health.

Sherri L. Porcelain is a senior lecturer in global public health in
world affairs and a senior research associate at the Institute for Cuban
and Cuban-American Studies, University of Miami.

Source: "Cuba's silence on cholera dangerous to your health - Other
Views - MiamiHerald.com" -
http://www.miamiherald.com/2013/08/17/3567587/cubas-silence-on-cholera-dangerous.html