Global health officials anticipated the spread of the Zika virus to one of the most vulnerable and poorest nations: Haiti. Burdened with an abundance of mosquitoes, poor sanitation, frayed healthcare system, and urban overpopulation, the nation seemed to be primed for a Zika epidemic.
However, approximately six months following the first confirmed Zika case in Haiti, the grim predictions have not yet unfolded. While that is good news, it is concerning that the reasons for Haiti’s low infection rates are unknown.
Following an emergency committee with eighteen experts and advisors, the World Health Organization (WHO) declared a state of “Public Health Emergency and International Concern” in February 2016. At the time, Haiti was reporting 300 weekly infections. According to the Washington Post, that number has decreased to thirty weekly infections.
“The peak seems to have reached Haiti already. But we really don’t know,” said Dr. Jean-Luc Poncelet, a representative for the Pan American Health Organization (PAHO) in Haiti. Although Haiti has reported a dozen cases of Guillain Barré syndrome, a serious neurological disorder which can be triggered by the Zika virus, there has not been a single registered case of Zika-related microcephaly, a birth defect resulting from the virus interfering with normal brain development.
In the late onset of summer, Haiti experiences late afternoon storms which creates an ideal breeding environment for mosquitoes. However, there are no major signs of an outbreak. The timing in the decline of Haiti’s reported Zika infections coincides with a three month-old strike that has resulted in a collapse of public hospitals and has left patients in remote areas with virtually no access to healthcare services.
Brazil and Colombia together have over 200,000 reported Zika infections, however, this is not the case in Haiti. Cantave Henry Gateau is the medical director of a Port-au-Prince government hospital which has not been affected by the strike. He said that physicians at the hospital have not reported a single case of Zika infection. However, there has been five reported Guillain-Barré cases, the first he has seen in his fifteen years at the hospital.
Experts warn that Haiti’s low infection numbers are not indicative of the nation becoming a Zika-free zone, or that the rates of infection are decreasing. As many as 80 percent of people infected with the Zika virus are asymptomatic. Others may experience mild symptoms including fever, joint pain, rash, and red eyes which may last from a few days to a week. In a nation like Haiti, these symptoms are not enough to prompt most people to seek medical care. “Most Haitians who get a fever don’t go to the doctor. They drink tea,” said Joseph Donald Francois, national coordinator for cholera and Zika at Haiti’s Public Health Ministry.
Louise Ivers, an infectious disease specialist with the Boston-based non-profit organization Partners in Health and who also directs the Mirebalais teaching hospital outside of Port-au-Prince notes “it’s hard to know if no information means the absence of disease, or if it means there’s just no information.” To date, ten pregnant women have been diagnosed with Zika virus in the hospital, yet all have given birth without complications.
Christophe Milien, an obstetrician-gynecologist in the maternity ward, which delivers approximately 300 infants a month said “Zika is here…. we can’t say Zika isn’t a problem, because there are so many factors that stop women from coming to the hospital.” Only 36 percent of Haitian expectant mothers deliver their infants in a healthcare facility. The remainder delivers at home.