Did the cholera epidemic in Haiti really start in the Artibonite Department?

The last cholera epidemic in the Western Hemisphere began in 1991 and lasted for nearly a decade, spreading across Central and South America, but not to the Caribbean islands [1]. epidemiologist of the Cuban Medical Brigade (CMB) warned the participants about an unusual increase in the number of severe watery diarrhoea cases with dehydration and three deaths at the community reference hospital (CRH) of Mirebalais, located in Haiti's Centre Department. A multidisciplinary team of the CMB was dispatched to the affected area on 19 October to investigate. In addition, the Haitian Ministry of Public Health and Population (MSPP) declared a health alert and provided guidance to health authorities of the Centre Department for field analysis and decision making. The Cuban Co-director of the CRH in Mirebalais explained that the first case with severe watery diarrhoea and dehydration was admitted to the hospital on 16 October but the majority of hospitalized cases and deaths occurred on 18 October. Some patients were reported in serious condition and required life support. Findings from our research investigation showed that clinical manifestations began 12 to 24 hours before clinical admission of these patients to the hospital. From 17 to 18 October, two children of three and five years of age died. On 19 October, exchange between the Cuban team and local health authorities of the Centre Department, which conducted parallel investigations, revealed the following measures taken: 1) collection and shipping of stool samples to the LNSP for laboratory isolation and confirmation; 2) dissemination of messages to the community, by radio and talks, about the control and prevention of diarrhoeal diseases, spoken in the Creole language; 3) supplying of chlorine to treat drinking water in the affected sites. The CMB inspected five sites where cases and deaths related to the diarrhoea occurred: Meille, Montagne Terrible, Rue Louverture, Chateau, and Gravelot. They were located less than 100 meters from the Latem and Jamba Rivers, in Mirebalais, which are tributaries of the Artibonite River. Families living in these areas lacked basic hygiene habits, with evident household overcrowding. The presence of outdoor defecation and abundant vectors (flies) were observed in all dwellings visited. Most importantly, this population used the water of the Artibonite River for their daily activities: drinking, bathing, and washing their clothes. It was noted and later reported by Piarroux et al. [2] that sewage water dripped into the Artibonite River, and its tributaries, in several places …