Cholera, Fear Spread Beyond the Border

A Southwest Florida woman who visited family in the disease-stricken Artibonite Valley of Haiti and a Haitian construction worker who lives in the eastern Dominican Republic but recently spent two weeks in Port-au-Prince became the first people to import deadly cholera.

The spread is worrying public health specialists in several countries who fear the illness could spread internationally.

The acute intestinal infection first surfaced in Haiti four weeks ago and has killed 1,110 people and hospitalized 18,382 since.

The Collier County woman does not work in a job that puts her in close contact with the public, so the chance that she might pass on the disease is small, Florida health officials said. Several more cases are under investigation in other counties, said Dr. Thomas Torok, a cholera expert in the Florida Department of Health's Bureau of Epidemiology.

In the Dominican Republic, where clean water and sanitation are in short supply in rural villages, news of the case was cause for panic.

The Dominican Republic banned Haitian street vendors in border markets from selling food, juice and used clothes. Mats soaked in bleach were placed at the border entry so that people's feet and car tires would be sanitized upon entering.

The chaotic border market in Dajabón was moved to a lot equipped with latrines, sinks and soap. Health experts are boarding Dominican-bound buses and asking riders: Are you sick?

``Several weeks into this, we have just one imported case,'' Dominican Health Minister Bautista Rojas Gómez said by phone from Santo Domingo. ``If we stay vigilant, we should be able to have just isolated cases.''

Dominican President Leonel Fernández met with top ministers Wednesday, who emerged from the gathering urging employers not to hire unknown Haitian laborers. But experts warned that stop-gap measures are likely futile, and that the keys to stopping the spread of the deadly disease are clean drinking water and sewage treatment.

``You can't keep something out -- you can make sure it doesn't spread when it's in,'' said Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations. ``To see a single imported case is a cause for concern, but it certainly should not be a cause for alarm. If there is evidence of transmission in Florida or the Dominican Republic, then you have a very big problem.''

A Centers for Disease Control and Prevention report says there were 40 cases of cholera in the United States from 1996 to 2006.

The illness is spread through infected fecal matter, making the threat less of a concern in Florida, where sanitation systems are more developed than on Hispaniola.

``Despite that, we are still taking additional precautions to make sure it has no opportunity to spread by monitoring travelers who return from Haiti,'' Torok said.

Last week, the state health department issued an advisory requiring Florida doctors and hospitals to quickly test patients showing cholera symptoms -- primarily profuse diarrhea, dehydration and fever.

Torok said the patient returned from Haiti about a week ago showing cholera symptoms. The Collier County Health Department confirmed the case and sent samples on to the CDC in Atlanta for further testing.

``She's doing quite well,'' he added.

Torok declined to comment further about the additional suspected cases, citing department policy.

New cases are expected in Florida, because the state has about 241,000 Haitian-born residents, many of whom travel back and forth frequently, particularly since the Jan. 12 earthquake.

The last major nearby cholera epidemic -- in Latin America in the early 1990s -- transmitted about 20 cases to Florida, he said. None of those cases spread from person to person in the United States.

That outbreak began in Peru, when cargo ships dumped bilge off the coast of Lima, affecting shellfish in a country known for its ceviche. The cause of the outbreak in Haiti is unknown, although authorities know the strain is not indigenous to the island.

``With the globalization of trade, we also have a globalization of threat,'' Garrett said. ``One day a person could be responding to a tragedy in Indonesia, then a tragedy in the Middle East the next day, and a tragedy in the Caribbean the next day. Each one may be the unknowing carrier of disease from one part of the world to another.''

In Cap Haitien, protesters blamed U.N. peace keepers.

The case in the Dominican Republic was first spotted Saturday, a day after a 32-year-old construction worker who spent two weeks in Port-au-Prince returned from vacation. Traveling by bus, he stopped at a clinic in Santo Domingo but was released, because his symptoms were not severe.

The next day, medical authorities in the man's home city of Higüey suspected he had cholera.

``Right now he is in perfect condition,'' Rojas said.

Twelve other suspected cases were tested but turned out negative, the health ministry said.