A cholera epidemic that has killed nearly 600 people in Haiti has gained a foothold in earthquake-ravaged Port-au-Prince and is expected to spread widely and quickly in the sprawling city of three million people, health authorities said Tuesday.
The three-week-old epidemic, which had so far mostly hit Haiti's rural central regions, now menaced crowded slum areas of the capital, as well as tent and tarpaulin camps there housing more than 1.3 million survivors of the Jan. 12 quake.
"The disease has reached the metropolitan area," Gabriel Thimote, the director general of Haiti's health department, told reporters in Port-au-Prince.
The spreading epidemic, which experts predict will be worsened by flooding caused by Hurricane Tomas earlier this month, has piled another humanitarian emergency on the Western Hemisphere's poorest state as it struggles to recover from the devastating earthquake that killed more than 250,000 people.
Presidential and legislative elections scheduled for Nov. 28 in the Caribbean nation are set to go ahead.
Mr. Thimote said 115 cases and one death had been recorded at a hospital in the city's biggest slum, Cite Soleil, a labyrinth of brick, wood and tin-roof shanties bisected by rubbish-choked canals draining into the sea.
The Pan American Health Organization deputy director Jon Andrus said that the Haitian capital, which even before it was wrecked in the January earthquake had suffered from very poor sanitary conditions, was "ripe" for a rapid spread of the diarrheal disease, which is transmitted by contaminated water.
"We expect transmission to be extensive … we have to prepare for a large upswing in numbers of cases," he told a news briefing in Washington.
Mr. Andrus gave a figure of 73 cholera cases in Port-au-Prince, and said the Pan American Health Organization, the regional office of the World Health Organization, was working with local Haitian health authorities to reconcile reporting of cases.
Up to Nov. 7, cholera had killed 583 people in the country and sickened 9,123, Haiti's health ministry said.
The United Nations, aid agencies and private NGOs have set up special cholera treatment centres in the country, including Port-au-Prince.
Mr. Andrus said facilities were "stretched but sufficient."
"We expect patients to be treated in tents, in hospital compounds, outside the walls," he said.
He said vaccination was being ruled out at the moment, both because existing oral vaccines for cholera were not effective in the midst of an epidemic and on grounds of logistics, cost and training requirements.
There were also limited global supplies of the anti-cholera vaccine, Mr. Andrus said. Cholera can kill in hours, but if caught early can be easily treated through oral rehydration fluids.
Making a comparison with a previous cholera epidemic in the Americas that had started in Peru in 1991, the WHO official said "upwards of 270,000 cases" could be expected in Haiti if the epidemic ran for several years.