Determining the origin and the means of spread of the cholera epidemic in Haiti was necessary to direct the cholera response, including lasting control of an indigenous bacterium and the fight for elimination of an accidentally imported disease, even if we acknowledge that the latter might secondarily become endemic.
Putting an end to the controversy over the cholera origin could ease prevention and treatment by decreasing the distrust associated with the widespread suspicions of a cover-up of a deliberate importation of cholera (15,16). Demonstrating an imported origin would additionally compel international organizations to reappraise their procedures.
Furthermore, it could help to contain disproportionate fear toward rice culture in the future, a phenomenon responsible for important crop losses this year (17).
Notably, recent publications supporting an imported origin (7) did not worsen social unrest, contrary to what some dreaded (18–20).
Our epidemiologic study provides several additional arguments confirming an importation of cholera in Haiti. There was an exact correlation in time and places between the arrival of a Nepalese battalion from an area experiencing a cholera outbreak and the appearance of the first cases in Meille a few days after.
The remoteness of Meille in central Haiti and the absence of report of other incomers make it unlikely that a cholera strain might have been brought there another way.
DNA fingerprinting of V. cholerae isolates in Haiti (1) and genotyping (7,21) corroborate our findings because the fingerprinting and genotyping suggest an introduction from a distant source in a single event (22).
At the beginning, importation of the strain might have involved asymptomatic carriage by departing soldiers whose stools were not tested for the presence of V. cholerae, as the Nepalese army's chief medical officer told the British Broadcasting Corporation (23).
The risk for transmission associated with asymptomatic carriage has been known for decades (24), but asymptomatic patients typically shed bacteria in their stool at ≈103 V. cholerae bacteria per gram of stool (25) and, by definition, have no diarrhea. This small level of shedding would be unlikely to cause interhuman contamination of persons outside the military camp having few contacts, if any, with MINUSTAH peacekeepers.
By contrast, considering the presence of pipes pouring sewage from the MINUSTAH camp to the stream, the rapid dissemination of the disease in Meille and downstream, and the probable contamination of prisoners by the stream water, we believe that Meille River acted as the vector of cholera during the first days of the epidemic by carrying sufficient concentrations of the bacterium to induce cholera in persons who drank it.
To our knowledge, only infectious doses >104 bacteria were shown to produce mild patent infection in healthy volunteers, and higher doses are required to provoke severe infections (26,27). Reaching such doses in the Meille River is hardly compatible with the amount of bacteria excreted by asymptomatic carriers, whereas if 1 or several arriving soldiers were incubating the disease, they would have subsequently excreted diarrheal stools containing 1010–1012 bacteria per liter (25).
We therefore believe that symptomatic cases occurred inside the MINUSTAH camp.If this peer-reviewed article is correct, the UN in general and MINUSTAH and WHO in particular are complicit in a public-health catastrophe as well as a shameful cover-up. The UN imported Nepali mercenaries (call them what they are) and failed to ensure that they were at least healthy when they left Kathmandu in the midst of a local cholera outbreak.
Extracted from Crawford Kilian's blog in Haiti Rewired