Modeling the Influence of Environment and Intervention on Cholera in Haiti

TL;DR

This study models cholera spread in Haiti by incorporating environmental factors and vaccination effects, revealing lag times between rainfall and cases, and emphasizing early vaccination for better control.

Contribution

Introduces a simple, environment-sensitive cholera model fitted to Haitian data, assessing vaccination impact and optimal timing in epidemic control.

Findings

Rainfall lag times range from 3.4 to 8.4 weeks in Artibonite and 5.1 to 7.4 weeks in Ouest.

Tidal influences significantly affect cholera dynamics in Ouest.

Vaccination reduces cases by approximately 2,400 in Ouest and 2,000 in Artibonite over 18 months.

Abstract

We propose a simple model with two infective classes in order to model the cholera epidemic in Haiti. We include the impact of environmental events (rainfall, temperature and tidal range) on the epidemic in the Artibonite and Ouest regions by introducing terms in the transmission rate that vary with environmental conditions. We fit the model on weekly data from the beginning of the epidemic until December 2013, including the vaccination programs that were recently undertaken in the Ouest and Artibonite regions. We then modified these projections excluding vaccination to assess the programs' effectiveness. Using real-time daily rainfall, we found lag times between precipitation events and new cases that range from 3.4 to 8.4 weeks in Artibonite and 5.1 to 7.4 in Ouest. In addition, it appears that, in the Ouest region, tidal influences play a significant role in the dynamics of the disease. Intervention efforts of all types have reduced case numbers in both regions; however, persistent outbreaks continue. In Ouest, where the population at risk seems particularly besieged and the overall population is larger, vaccination efforts seem to be taking hold more slowly than in Artibonite, where a smaller core population was vaccinated. The models including the vaccination programs predicted that a year and six months later, the mean number of cases in Artibonite would be reduced by about two thousand cases, and in Ouest by twenty four hundred cases below that predicted by the models without vaccination. We also found that vaccination is best when done in the early spring, and as early as possible in the epidemic. Comparing vaccination between the first spring and the second, there is a drop of about 40% in the case reduction due to the vaccine and about 10% per year after that.