We usually do not post to PED-EM-L unless deemed relevant to US pediatric
emergency care, but this is an issue that may well effect those of us
treating patients mingling with the migrant worker community.


Haiti's Cholera Disaster Spreads to Mexico

Jim Wilson<*2_*2_*2_lna_PENDING_*2%2Egmr_1772548%2Egde_1772548_member_277863656>Director,
National Infectious Disease Forecast Center<>

It raises to 44 the number of cholera cases in Hidalgo

The Federal Ministry of Health supports the risk that the situation can be
extended to the rest of the country, however, rule out epidemic

MEXICO CITY, September 30. - The Federal Ministry of Health confirmed 44
cases of cholera in the state of Hidalgo. According to the agency, in the
state's 33 cases studied, 10 persons of them are actually hospitalized.

At a press conference, Secretary of Health, Mercedes Juan Lopez, warned of
the risk that this situation can be extended to the rest of the country,
"could come to pass, but all it is doing what we think is not going to move
to other states, then, until now, only in the state of Hidalgo on Vibrio
cholerae, which is what is also in other countries like Haiti, Dominican
Republic and Cuba. "

So far, however, the federal official denied that there outbreak or
epidemic cholera in the country.

Remember that this disease caused the first death in more than a decade of
not register. The victim was a 61 year old woman who suffered from chronic
renal failure, diabetes and obesity.

"There is an epidemic far and what they want is not there," he explained.<*2_*2_*2_lna_PENDING_*2%2Egmr_1772548>

Couple of points about this:

1. Totally expected to see expansion of the Nepalese cholera from Haiti to
the DR, to Cuba, and now to Mexico. It is likely to include many other
countries in that region before all is said and done.

2. It is likely to spread in Mexico in 'fits and starts' due to lack of
indigenous immunity and will cause disruption.

3. It will likely spread along trade and migrant labor routes to the US and
other countries doing business with Mexico.

4. Communities in the US may be caught unawareness due to basic expectation
of border communities in Texas serving as "canaries in a coal mine" for the
rest of the country. We propose the migrant labor routes penetrate deep
into the US and far from these border communities.

5. Haiti's cholera disaster already has touched the US via returning
humanitarian workers. We have not seen substantial community transmission
upon their arrival to the US.

6. Per #4 above, the issue is smoldering transmission in Spanish-only
speaking migrant labor communities, where we often see public health issues
arise and smolder for days-wks-months-(?) years without notice by local
public health.

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