{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:19:47Z","timestamp":1774610387251,"version":"3.50.1"},"reference-count":29,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,10,9]]},"abstract":"<jats:p>The start of the cholera epidemic in Haiti quickly highlighted the necessity of the implementation of an Alert and Response (A&amp;R) System to complement the existing national surveillance system. The national system had been able to detect and confirm the outbreak etiology but required external support to monitor the spread of cholera and coordinate response, because much of the information produced was insufficiently timely for real-time monitoring and directing of a rapid, targeted response. The A&amp;R System was designed by the Pan American Health Organization\/World Health Organization in collaboration with the Haiti Ministry of Health, and it was based on a network of partners, including any institution, structure, or individual that could identify, verify, and respond to alerts. The defined objectives were to (1) save lives through early detection and treatment of cases and (2) control the spread through early intervention at the community level. The operational structure could be broken down into three principle categories: (1) alert (early warning), (2) verification and assessment of the information, and (3) efficient and timely response in coordination with partners to avoid duplication. Information generated by the A&amp;R System was analyzed and interpreted, and the qualitative information was critical in qualifying the epidemic and defining vulnerable areas, particularly because the national surveillance system reported incomplete data for more than one department. The A&amp;R System detected a number of alerts unrelated to cholera and facilitated rapid access to that information. The sensitivity of the system and its ability to react quickly was shown in May of 2011, when an abnormal increase in alerts coming from several communes in the Sud-Est Department in epidemiological weeks (EWs) 17 and 18 were noted and disseminated network-wide and response activities were implemented. The national cholera surveillance system did not register the increase until EWs 21 and 22, and the information did not become available until EWs 23 and 24, when the peak of cases had already been reached. Although many of the partners reporting alerts during the peak of the cholera epidemic have since left Haiti, the A&amp;R System has continued to function as an Early Warning (EWARN) System, and it continues to be developed with recent activities, such as the distribution of cell phones to enhance alert communication.<\/jats:p>","DOI":"10.4269\/ajtmh.13-0267","type":"journal-article","created":{"date-parts":[[2013,10,9]],"date-time":"2013-10-09T02:18:18Z","timestamp":1381285098000},"page":"688-697","source":"Crossref","is-referenced-by-count":22,"title":["Implementation of an Alert and Response System in Haiti during the Early Stage of the Response to the Cholera Epidemic"],"prefix":"10.4269","volume":"89","author":[{"given":"Patricia","family":"Santa-Olalla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Gayer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roc","family":"Magloire","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Barrais","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Valenciano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Aramburu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Luc","family":"Poncelet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Carlos","family":"Gustavo Alonso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Van Alphen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florence","family":"Heuschen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Andraghetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Drury","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvain","family":"Aldighieri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"R1","series-title":"International Health Regulations (2005)","author":"World Health Organization","year":"2008"},{"key":"R2","series-title":"Haiti Earthquake PDNA: Assessment of Damage, Losses, General and Sectoral Needs. Annex to the Action Plan for National Recovery and Development of Haiti","author":"Haiti Office of the Prime Minister","year":"2010"},{"key":"R3","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"933","article-title":"Launching a national surveillance system after an earthquake\u2014Haiti","volume":"59","author":"CDC","year":"2010"},{"key":"R4","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"939","article-title":"Rapid establishment of an internally displaced persons disease surveillance system after an earthquake\u2014Haiti, 2010","volume":"59","author":"CDC","year":"2010"},{"key":"R5","series-title":"Emerg Infect Dis","first-page":"2087","article-title":"Lessons learned during public health response to cholera epidemic in Haiti and the Dominican Republic","volume":"17","author":"Tappero","year":"2011"},{"key":"R6","series-title":"Emerg Infect Dis","first-page":"2130","article-title":"Cholera in Haiti and other Caribbean regions, 19th century","volume":"17","author":"Jenson","year":"2011"},{"key":"R7","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"1586","article-title":"Update: outbreak of cholera\u2014Haiti, 2010","volume":"59","author":"CDC","year":"2010"},{"key":"R8","series-title":"Wkly Epidemiol Rec","first-page":"437","article-title":"Outbreak news: Cholera, Haiti","volume":"85","author":"World Health Organization","year":"2010"},{"key":"R9","series-title":"Rapports cholera, Rapports du 31 octobre 2010","author":"MSPP","year":"2010"},{"key":"R10","series-title":"Fiche d'investigation des cas suspects de Cholera","author":"MSPP","year":"2010"},{"key":"R11","series-title":"Outbreak Surveillance and Response in Humanitarian Emergencies. WHO Guidelines for EWARN Implementation","author":"World Health Organization","year":"2012"},{"key":"R12","series-title":"Wkly Epidemiol Rec","first-page":"129","article-title":"Early warning surveillance and response in emergencies: WHO technical workshop, December 2009","volume":"85","author":"World Health Organization","year":"2010"},{"key":"R13","series-title":"Euro Surveill","first-page":"212","article-title":"Epidemic intelligence: a new framework for strengthening disease surveillance in Europe","volume":"11","author":"Paquet","year":"2006"},{"key":"R14","series-title":"Emerg Infect Dis","first-page":"1590","article-title":"International epidemic intelligence at the Institut de Veille Sanitaire, France","volume":"13","author":"Rotureau","year":"2007"},{"key":"R15","series-title":"Emerg Infect Dis","first-page":"97","article-title":"Rumors of disease in the global village: outbreak verification","volume":"6","author":"Grein","year":"2000"},{"key":"R16","series-title":"Emerg Infect Dis","first-page":"689","article-title":"Use of unstructured event-based reports for global infectious disease surveillance","volume":"15","author":"Keller","year":"2009"},{"key":"R17","series-title":"Proc Natl Acad Sci USA","first-page":"21701","article-title":"Global capacity for emerging infectious disease detection","volume":"107","author":"Chan","year":"2010"},{"key":"R18","series-title":"CMAJ","first-page":"44","article-title":"Protecting global health security through the International Health Regulations: requirements and challenges","volume":"179","author":"Wilson","year":"2008"},{"key":"R19","series-title":"Emerg Infect Dis","first-page":"1447","article-title":"Global public health security","volume":"13","author":"Rodier","year":"2007"},{"key":"R20","series-title":"Emerg Infect Dis","first-page":"1058","article-title":"Global public health surveillance under new international health regulations","volume":"12","author":"Baker","year":"2006"},{"key":"R21","series-title":"Strengthening of the Coordination of Emergency Humanitarian Assistance of the United Nations. 46th United Nations General Assembly, 78th Plenary Meeting; 19 December 1991. New York (NY), UN; (Resolution A\/RES\/46\/182)","author":"United Nations","year":"1991"},{"key":"R22","series-title":"IASC Guidance Note on Using the Cluster Approach to Strengthen Humanitarian Response","author":"Inter-Agency Standing Committee","year":"2006"},{"key":"R23","series-title":"Coordination of International Humanitarian Assistance in Health in Case of Disasters","author":"Pan American Health Organization","year":"2012"},{"key":"R24","series-title":"Epidemic and Pandemic Alert and Response. Communicable Disease Surveillance and Response Systems. Guide to Monitoring and Evaluating","author":"World Health Organization","year":"2006"},{"key":"R25","series-title":"Health Policy Plan","first-page":"505","article-title":"Strengthening the International Health Regulations: lessons from the H1N1 pandemic","volume":"25","author":"Wilson","year":"2010"},{"key":"R26","series-title":"Epidemiol Rev","first-page":"93","article-title":"Trends and directions of global public health surveillance","volume":"32","author":"Castillo-Salgado","year":"2010"},{"key":"R27","series-title":"Disaster Manag Response","first-page":"41","article-title":"The threat of communicable diseases following natural disasters: a public health response","volume":"3","author":"Waring","year":"2005"},{"key":"R28","series-title":"Haiti. Health in the Americas. Volume II\u2014Countries","first-page":"412","author":"Pan American Health Organization","year":"2007"},{"key":"R29","series-title":"Plan Strat\u00e9gique National pour la R\u00e9forme du Secteur de la Sant\u00e9. Port-au-Prince, Haiti: Minist\u00e8re de la Sant\u00e9 Publique et de la Population","author":"MSPP","year":"2005"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/89\/4\/article-p688.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/89\/4\/article-p688.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/89\/4\/article-p688.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T18:22:15Z","timestamp":1723054935000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/89\/4\/article-p688.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,9]]},"references-count":29,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.13-0267","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,9]]}}}