{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T04:46:05Z","timestamp":1786769165573,"version":"build-2736575974"},"reference-count":19,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>We investigated a resurgence of cholera in Haiti in 2022, occurring after 3 years without cases. We analyzed data from the National Cholera Surveillance System for the first reported cases in 2022 and interviewed field epidemiology teams. We used logistic regression to identify risk factors associated with confirmed cholera. Few suspected cases reported ever receiving oral cholera vaccine (14%) or previous hospitalization for cholera (7%). Recently changing water sources were associated with culture-confirmed cholera (odds ratio 5.55, 95% CI 2.13\u201315.12). Spatial analysis of cholera cases revealed significant clustering (<jats:italic>P<\/jats:italic> = 0.001) and low prevalence (11%, 15 of 136) of residual chlorine in private water points in the affected area. Qualitative analysis suggested a link between cholera resurgence and an acute lack of access to safe water because of gang violence. Ongoing response to cholera in Haiti is crucial, alongside sustained investment in long-term solutions like improved water and sanitation infrastructure and addressing socioeconomic issues.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0755","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:04:49Z","timestamp":1751371489000},"page":"689-693","source":"Crossref","is-referenced-by-count":2,"title":["Water Insecurity, Sociopolitical Instability, and Resurgence of Cholera in Haiti, 2022: An Outbreak Investigation"],"prefix":"10.4269","volume":"113","author":[{"given":"Stanley","family":"Juin","sequence":"first","affiliation":[{"name":"Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwige","family":"Michel","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfredo R.","family":"Matias","sequence":"additional","affiliation":[{"name":"Center for Global Health Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts;"},{"name":"Division of Infectious Diseases, Brigham Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evenel","family":"Thermidor","sequence":"additional","affiliation":[{"name":"Direction Nationale d\u2019Eau Potable, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly F.","family":"Franke","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle V.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hetsner","family":"Denis","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yodeline","family":"Guillaume","sequence":"additional","affiliation":[{"name":"Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Bouilly","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wisnel","family":"Mathurin","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katilla","family":"Pierre","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valusnor","family":"Compere","sequence":"additional","affiliation":[{"name":"Laboratoire National de Sant\u00e9 Publique, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenold","family":"Rendel","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hebrelienne","family":"Amelus","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesly","family":"Andrecy","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard A.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Laboratoire National de Sant\u00e9 Publique, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Boncy","sequence":"additional","affiliation":[{"name":"Laboratoire National de Sant\u00e9 Publique, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Lafontant","sequence":"additional","affiliation":[{"name":"Direction d\u2019\u00c9pid\u00e9miologie des Laboratoires et de Recherche, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise C.","family":"Ivers","sequence":"additional","affiliation":[{"name":"Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Haiti: Cholera Outbreak Situation Report No. 1.","year":"2022"},{"key":"b2","series-title":"N Engl J Med","first-page":"2389","article-title":"Resurgence of cholera in Haiti amidst humanitarian crises","volume":"387","author":"Severe","year":"2022"},{"key":"b3","series-title":"Emerg Infect Dis","first-page":"1929","article-title":"Seroprevalence of Vibrio cholerae in adults, Haiti, 2017","volume":"29","author":"Matias","year":"2023"},{"key":"b4","series-title":"medRxiv.","article-title":"Inferring the proportion of undetected cholera infections from serological and clinical surveillance in an immunologically naive population","author":"Finger","year":"2023"},{"key":"b5","series-title":"eLife","first-page":"e50243","article-title":"Estimating effectiveness of case-area targeted response interventions against cholera in Haiti","volume":"8","author":"Michel","year":"2019"},{"key":"b6","series-title":"National Plan for the Elimination of Cholera in Haiti, 2012\u20132023","article-title":"Ministry of Public Health and Population & National Directorate for Water Supply and Sanitation"},{"key":"b7","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"21","article-title":"Cholera outbreak\u2014Haiti, September 2022\u2013January 2023","volume":"72","author":"Vega Ocasio","year":"2023"},{"key":"b8","article-title":"SitRep Cholera Haiti","year":"2022"},{"key":"b9","author":"M\u00e9rancourt","year":"2022"},{"key":"b10","series-title":"N Engl J Med","first-page":"2387","article-title":"Reemergence of cholera in Haiti","volume":"387","author":"Rubin","year":"2022"},{"key":"b11","series-title":"J Clin Microbiol","first-page":"e0014223","article-title":"Genome sequences from a reemergence of Vibrio cholerae in Haiti, 2022 reveal relatedness to previously circulating 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Port Au Prince, Haiti: Minist\u00e8re de la Sant\u00e9 Publique et de la Population (MSPP)","year":"2023"},{"key":"b13","series-title":"BMC Public Health","first-page":"1128","article-title":"The quality of drinking and domestic water from the surface water sources (lakes, rivers, irrigation canals and ponds) and springs in cholera prone communities of Uganda: An analysis of vital physicochemical parameters","volume":"20","author":"Bwire","year":"2020"},{"key":"b14","series-title":"Int J Disaster Risk Sci","first-page":"28","article-title":"Climate change, water scarcity, and health adaptation in southwestern coastal Bangladesh","volume":"10","author":"Abedin","year":"2019"},{"key":"b15","series-title":"Lancet Reg Health Am","first-page":"100811","article-title":"Impact of gang violence in Haiti on healthcare delivery and medical education","volume":"36","author":"Medeus","year":"2024"},{"key":"b16","series-title":"Am J Public Health","first-page":"168","article-title":"Emerging diseases and ecosystem instability: New threats to public health","volume":"85","author":"Epstein","year":"1995"},{"key":"b17","series-title":"Bull World Health Organ","first-page":"446","article-title":"Crisis-driven cholera resurgence switches focus to oral vaccine","volume":"96","year":"2018"},{"key":"b18","series-title":"Lancet","first-page":"223","article-title":"Cholera","volume":"363","author":"Sack","year":"2004"},{"key":"b19","series-title":"J Infect Dis","first-page":"818","article-title":"Duration of infection-derived immunity to cholera","volume":"143","author":"Levine","year":"1981"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/3\/article-p689.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/3\/article-p689.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/3\/article-p689.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T13:14:19Z","timestamp":1756905259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/3\/article-p689.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":19,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0755","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]}}}