Reemergence of Cholera in Haiti

Reemergence of Cholera in HaitiTo the Editor: Cholera was absent from Haiti until an inadvertent introduction by United Nations security forces in October 2010.The ensuing epidemic sickened 820,000 people and caused 9792 reported deaths. 1 The last confirmed cholera case in Haiti was recorded in January 2019, and in February 2022, cholera was declared to have been eliminated in Haiti. 2 In late September 2022, a new outbreak began in Port-au-Prince and rapidly expanded to include 11,953 suspected cases by late November, more than 1000 of which were confirmed by culture. 3We conducted a genomic and phenotypic analysis of the Vibrio cholerae isolated from a stool specimen obtained on September 30, 2022, from an index patient -a child who presented with watery diarrhea and severe dehydration -to begin to address the origins of the epidemic.The 2022 V. cholerae isolate shares phenotypes with the 2010 outbreak strain.Both strains are V. cholerae serogroup O1 (El Tor biotype) of the Ogawa serotype and have similar antimicrobial resistance profiles, including resistance to trimethoprim-sulfamethoxazole and low-level resistance to ciprofloxacin (Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).This resistance profile is consistent among 130 isolates from the current outbreak, which suggests that the strain that was isolated from the index patient is representative of the ongoing epidemic.To decipher the relationship between the current outbreak strain and other toxigenic O1 El Tor strains from the ongoing seventh pandemic of cholera, we sequenced the isolate obtained on September 30, 2022, along with four isolates obtained in 2021 and 2022 from Dhaka, Bangladesh (Table S2).