Technology in the Time of Cholera Part I: Using Technology to Diagnose, Treat, and Prevent Cholera in Haiti

| October 18, 2011 | 0 Comments

By Joy Ming
Technology & Global Health Columnist

This first segment of a two part series focuses on the recent use of genomic technology to trace the origins of the outbreak.

Electron microscope image of the Haitian V.cholerae strain (Courtesy of William P. Robins)

Electron microscope image of the Haitian V.cholerae strain. Image courtesy of William P. Robins.

On January12, 2010, a 7.0 earthquake struck Haiti, affecting three million people.[1]

Though nearly two years have passed since the earthquake, repercussions are still visible. Only approximately one-fourth of the rubble has been cleared away and many suffer from the communicable diseases that arose from and persisted in the aftermath of the earthquake.[2]

Just over 440,000 Haitians have contracted and nearly 6,300 have died from cholera, an acute, diarrheal illness caused by infection with the bacterium Vibrio cholerae. [3],[4],[5],[6] It is evident that the outbreak is not receding—as recent as this August, more than 5,400 patients were hospitalized in Partners in Health/Zamina Lasante’s treatment facilities, indicating that cholera will “continue to cause widespread disease and death”.[7]

The epidemic was not formally declared until mid-October of last year, because Haiti had not seen a cholera outbreak for 100 years.[8] Once it became clear that a cholera epidemic was arising, both the Haitian public officials and public health experts took interest in determining the origin of the strain. Recently, using the highest resolution DNA methods available of whole-genome sequence typing, pulsed-field gel electrophoresis, and antimicrobial susceptibility testing, scientists determined that contamination of the Artibonite River with a south Asian strain of cholera likely sparked the cholera outbreak.[9],[10],[11]

Mechanism involved in sequencing and assembling the genome. Image courtesy of William P. Robins.

The technology used to identify the strain that sparked the outbreak will continue to play an increasingly crucial role in the epidemiological battle against cholera. For example, the ability of whole-genome sequencing to help trace the origins of strains is a notable development.[12] In order to sequence and reassemble the genome, DNA had to be isolated and sheared into smaller fragments.

Dr. William P. Robins, a postdoctoral research Fellow in Microbiology and Immunobiology at Harvard Medical School describes the process in an interview with HCGHR:

“To provide an analogy, if you were to break Shakespeare’s work into short fragments of 5-6 words (no misspellings), it would be difficult to put back together with no idea what these fragments were pulled from. However, if given 2-3 paragraph segments with some misspelling as a reference, the feat would be come much simpler.”[13]

Innovative technology has allowed surveillance of genomic changes at a very fine resolution not only to trace the origin of the strains, but also “to better understand the biology of the bacterium, and to develop therapies such as more effective antibiotics and vaccines,” says Robins.[13] Identifying the toxic genes in V. cholerase can contribute to the creation of vaccines.[14]

“Vaccination needs to be part of that first response,” Robins claims, to halt the virulent spread of disease. “Following up with other preventative measures could be useful, especially if there are already problems with infrastructure and sanitation,” he states, and proposes a stockpile of vaccines for susceptible areas or in case another Haiti situation occurs.[13]

Technology, such as the genomic technology, is an essential tool for minimizing the effects of an epidemic. As the Haitian infrastructure was already weakened before it was devastated with the earthquake, interventions must not only look to affect “rapid treatment” but also the “long struggle”, creating sustainable technology and infrastructure for the future.[15]


[1] United Nations. Office for the Coordination of Humanitarian Affairs. “Haiti: One Year Later.” 18 January 2011. <>. 7 October 2011.

[2] Farmer, Paul. LECTURE. 1 September 2011.

[3] Republique D’Haiti. Ministere de la Santé Publique et de la Population. “Rapports journaliers du MSPP sur l’evolution du cholera en Haiti”. 2010. <>. 7 October 2011.

[4] Centers for Disease Control and Prevention. “Cholera: General Information”. 24 February 2011. <>. 7 October 2011.

[5] McNeil, Donald G. “Cholera Outbreak Kills 150 in Haiti.” The New York Times. 22 October 2010. <>. 7 October 2011.

[6] UNICEF. “Haiti Monthly Report: June 2011.” June 2011. <>. 7 October 2011.

[7] Partners in Health. “PIH Facilities Treat over 5,400 Cholera Patients in August.” 12 September 2011. <>. 7 October 2011.

[8] Trevelyan, Laura. “Cholera outbreak in Haiti ‘stabilising’.” BBC News: Latin America & Caribbean. 25 October 2010. <>. 7 October 2011.

[9] Hendriksen, Rene S., Price, Lance B., Schupp, James M., et al. “Populations Genetics of Vibrio cholerae from Nepal in 2010: Evidence on the Origin of the Haitian Outbreak.” mBio 2(2011):1-6.

[10] Swaine, Jon. “Haiti cholera outbreak linked to peacekeepers, UN admits.” The Telegraph. 5 May 2011. <>. 7 October 2011.

[11] TGen: The Translational Genomics Research Institute. “TGen and DTU researchers track source of Haitian cholera outbreak: Lessons from 2001 Antrax case help pinpoint source of disease.” <>. 16 October 2011.

[12] Heidelberg, John F., Eisen, Jonathan A., Nelson, William C., et. al. “DNA sequence of both chromosomes of the cholera pathogen Vibrio cholerae.” Nature 406(2000): 477-483.

[13] Robins, William Paul. Personal INTERVIEW. 13 October 2011.

[14] Cohen, Chad. “Cholera Genome Sequenced.” Genome News Network. 4 August 2000. <>. 16 October 2011.

[15] Farmer, Paul. “Haiti After the Earthquake.” Public Affairs: New York, 2011.

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