Cuba’s cholera outbreak. How worried should you be?

On Tuesday, July 3, 2012, Cuban Health Ministry (MINSAP) officials acknowledged a cholera outbreak in Granma province [2], resulting in at least three deaths, in the far east of the island. See the INFOMED (Health Network of Cuba) website [3].

Cholera [4] is a highly contagious infection of the small intestine caused by a bacterium. Sufferers usually become infected by drinking or eating water or food (especially shellfish) contaminated by feces. It can be fatal within hours if untreated.

The outbreak is centered on the town of Manzanillo (132,000), where on June 29, the local provincial newspaper—La Demajagua [5]—admitted the existence of a diarrhea outbreak that had affected at least 1,000 people. The report did not mention the possible spread of cholera in the region. Apparently, La Demajagua has not reported further on the cholera outbreak in its own backyard.

The MINSAP report stated that 53 people in Granma province had been treated for cholera—which it claimed was caused by contaminated well water following heavy rains. It attributed the three deaths among the cholera sufferers to complications caused by other chronic health issues. It did not release the names of the dead.

Although MINSAP stated that the outbreak had been contained, on July 7, the BBC [6] reported a confirmed case of cholera in Havana [7], the Cuban capital, 470 miles west of Manzanillo.

The H5N1 [8] (News and Resources about Influenza, Infectious Diseases and Public Health) website reported on July 1—two days before any official announcement—that two people had died, adding: “Government authorities, together with health institutions, have declared the municipality of Manzanillo to be under quarantine, while police and agents of State Security are guarding the Celia Sánchez Manduley Provincial Surgical Hospital and Clinic.”

Meanwhile, an independent report by Calixto Martínez in Café Fuerte [9] on June 28 claimed that at least fifteen people had died of cholera in Granma province and that hundreds have been hospitalized with the disease. Martínez quotes local sources as saying that cholera cases have been identified throughout Granma province, as far afield as Pilón and Niquero.

Martínez also quotes anonymous hospital employees who claim that the death certificates for these cholera fatalities have been doctored to state that they died of respiratory failure. Martínez also claims that Ministry of Interior officials have seized documents relating to the illness from the Provincial Hospital Celia Sánchez, in Manzanillo, and have even arrested people talking publicly about the outbreak.

Alas, Cuba lacks an independent press and it is impossible to gauge the true depth and extent of the problem in a country where the government maintains a tight lid on access to information, especially if it is negative. Thus, official government announcements on such grave issues as a cholera outbreak must be treated with a certain amount of skepticism. Not least, the Communist government has a habit of not announcing public health hazards. A mass murderer could be at work in Havana, but you would never ever read about it in the press of this socialist paradise.

As Cuban dissident blogger Yoani Sánchez wrote last week: ”…triumphalism continues to set the standard for what appears in the mass media. A recent example is the outbreak of cholera that appeared in early June in the eastern provinces. The first evidence that something was happening was a text from an independent journalist. On the official digital sites this news was branded "another hoax from the imperialists." Only to have to recognize weeks later that there is, indeed, an outbreak of cholera in the City of Manzanillo.”

Meanwhile, the United Kingdom’s Foreign & Commonwealth Office [10] has issued a travel advisory regarding the cholera outbreak. And on July 6, Mexican authorities declared a sanitary alert at Cancún [11] and Merida airports for passengers arriving from Cuba.

So what advice do I have for foreigners contemplating travel to Cuba?

Fortunately, cholera outbreaks in Cuba [12] are extremely rare: According to MINSAP, the outbreak is the first in Cuba since shortly after the 1959 Revolution [13].

To put the outbreak in perspective, in neighboring Haiti [14] more than 7,000 people have died of cholera this year to date (the Pan American Health Organization [15] says the disease could strike more than 200,000 Haitians this year). Cuba is not Haiti, where millions of Haitians lack access to sanitized water, and where Cuban medical staff has been employed for several years fighting cholera and other diseases (some 400 or so Cuban doctors were already serving in Haiti when the devastating January 12, 2010, earthquake occurred). Could it be that one of the returning medical staff brought cholera from Haiti to Cuba?

Nonetheless, many Cuban cities are served by aged and leaking water delivery systems. Throughout coastal Cuba, sewers pump untreated human waste into the sea, where Cubans are apt to bathe in polluted waters. And Manzanillo is a major shrimping port, supplying the rest of the island with shellfish!

No wonder, then, that Cuba has been beset this year by outbreaks, if not epidemics, of diarrhea. In January 2012, for example, Canada’s Public Health Authority issued a sanitary alert after dozens of Canadian citizens returned home with gastrointestinal illness after vacationing at beach resorts at Guardalavaca [16], in Holguín province (Air Transat [17] even resorted to disinfecting its aircraft serving Cuba). And during a recent visit to the Hotel Playa Girón, at the “Bay of Pigs” (Girón) resort, in Matanzas province [18], I was told by vacationers there that many guests were suffering from diarrhea.

But that all paints far too bleak a picture. I’ve spent five full months in Cuba during the past year and never once got sick. In fact, during 20 years visiting the island, I only once remember having succumbed to a severe case of diarrhea. And one case of cholera in Havana does not an epidemic make!

So don’t let the outbreaks put you off visiting Cuba!

Still, if you’re planning on visiting Cuba, I recommend the following precautions:

• Drink only bottled water and avoid foods sold at street stalls

• Maintain personal hygiene including the use of an alcoholic disinfectant hand rinse.

• Given the current circumstance, you should also use only bottled water for brushing your teeth.

• For the immediate future, consider giving Granma province a wide berth.

Now that you’re ready to travel to Cuba, buy Moon Handbook Cuba [19]

For further information on Havana, buy Moon Spotlight Havana [19].

Learn more about Christopher P. Baker [20].

Disclosure: I occasionally accept free or discounted travel when it coincides with my editorial goals. However, my opinion is never for sale. The opinions you see in Cuba & Costa Rica Journal are my unbiased reflection of the good, the bad, and the ugly

Copyright © Christopher P. Baker [20]