Prof. Sherri L. Porcelain
Even before the scheduled opening of the US Embassy on July 20, 2015, there were advertisements, blog posts, tweets, and news feeds welcoming U.S. residents to Cuba for cultural, religious or educational opportunities. Cuba remains a popular destination for Canadian and Western European tourists with its rich cultural arts, gracious hosts and Caribbean beaches. However, a growing interest in U.S. approved trips must consider Cuba’s lack of safe potable water, sanitation and sewage issues along with housing challenges. This is important because while it is unreported, cholera transmission exists within Cuba.
Cuba’s lack of transparency in health outbreak reporting is in question again. Laboratory confirmed cases continue to be shared with the international community about tourists returning to Canada, Latin America, and European countries after taking home more than sun and fun from a Cuban vacation. Cuba consistently asserts that the cholera outbreak of 2012 was quickly controlled within the country.
Where is the United States government on this issue today?
While a U.S. Center for Disease Control and Prevention (CDC) cholera watch in Cuba has recently been removed from their website, (1) there is still evidence that cholera is transmitted there. CDC travel notices consists of three levels:
A “watch” level 1 informs travelers to use usual precautions, an “alert” level 2 calls for enhanced precautions and a “warning” level 3 advises travelers to avoid nonessential travel to an area where the risk is high. These travel notices are important because the CDC notification system is widely used by travelers as well as clinicians for up-to-date international travel information.
Since 2013 there have been cases of confirmed cholera after visits to Cuba. (2) In January 2015 the Canadian International Health Regulation reported a case of a returning traveler, (3) as well as Pan American Health Organization (PAHO) on their Epidemiologic Update Report (4) documented this as the only case of cholera in Cuba for 2015. This assumes only travelers and no locals have been infected. It is more likely that the Cuban government does not share this information with the international community, and is only compelled to cooperate after scientific proof is disseminated.
In June 2015 the United Kingdom reported a traveler who participated in an all-inclusive resort stay in Varadero and spent two days in Havana before getting sick and returned home with cholera. According to the International Society for Infectious Disease, through their Program for Monitoring Emerging Diseases (ProMed- mail) posting on July 3, 2015, the patient indicated other family members were well. However, “several other people staying in his hotel (not necessarily in the same tour group) had reported severe gastroenteritis symptoms with a similar period of onset,” suggesting this may not be the only case. Pro-Med seeks to share this information and advise others of the confirmed cholera in Cuba and for health professionals to consider such a diagnosis with travelers returning with diarrhea. (5)
The question is not whether cholera is a risk to locals and visitors. Rather, the issue is why has the CDC removed the notification from its website when outside country evidence continues to show cholera exists within Cuba.
Are we left to speculate that the promotion of diplomatic relations- in an attempt to not question Cuba’s position on reporting disease outbreaks as required by World Health Organization International Health Regulations- is more important than the prevention and promotion of health security? Let’s not play politics with what we know is a best practice in prevention. Give people access to reliable information so they are well informed of their potential risks. Only then can good decisions be made to prevent cholera-or for that matter dengue, chikungunya or possibly zika virus (new mosquito born virus to reach the Caribbean) when traveling to Cuba.
1) Center for Disease Control and Prevention (CDC), “Travel Notices- Cholera in Cuba,” http://wwwnc.cdc.gov/travel/notices/watch/cholera-cuba, accessed July 14, 2015.
2) M Mascarello, M L Deianam C Maurel, C Lucarelli , I Luzzi R Luzzati, “Cholera with Severe Renal Failure in An Italian Tourist Returning from Cuba,” Eurosurveillance, July 2013. Volume 18, Issue 35, August 29, 2013. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20572.
3) Public Health Agency for Canada, Travel Health Notice: Cholera in Cuba, Dominican Republic, Haiti and Mexico, updated March 20, 2015 http://www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=111.
4) PAHO Epidemiologic Update. “Cholera in The Americas,” June 24, 2015 http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=30752&lang=en
5) ProMed- Mail. “Cholera, Diarrhea and dysentery update (24): Americas,” Archive Number: 20150703.3480336July 3, 2015 http://www.promedmail.org.
*Sherri L. Porcelain teaches global health in world affairs at the University of Miami where she is also a Senior Research Associate at the Institute for Cuban and Cuban-American Studies.