Simply setting up clinics to treat Haitians with cholera is not doing anywhere near enough to tackle the epidemic there, health experts said, calling for intensive vaccination and more use of antibiotics.
Their recommendation, published in The Lancet medical journal, adds to a growing chorus of voices speaking in support of a vaccination program.
Health authorities, including the Pan-American Health Organisation, had argued against vaccination, saying it would be too difficult and expensive.
But Paul Farmer of Harvard Medical School and colleagues at his organisation Partners in Health said current strategies are not working.
Rehydration without antibiotics
"Rehydration alone without any antibiotics, in our view, is not a good idea, even for moderate cases of cholera," Farmer told reporters.
Haiti's health ministry reports that more than 91,000 people have been sickened by cholera since the outbreak began in October, with more than 2,000 deaths. More than 3% of patients are dying - a high death rate for cholera.
Cholera is caused by a water-borne bacteria called Vibrio cholerae. It is transmitted when contaminated human faecal matter gets into water, food or onto someone's hands.
Many people show no symptoms but can pass it along, and cholera can cause extremely severe diarrhoea and vomiting that will kill within hours by dehydrating victims.
Standard treatment is a rehydration fluid containing special sugars and salts but Farmer's team said this is not doing enough in Haiti.
"Sometimes we are seeing them really late, when they are very ill and being carried in. Treatment needs to be much more aggressive," Farmer said.
PAHO, the American division of the World Health Organisation, has opposed vaccination. But earlier on Thursday PAHO's Dr Jon Andrus told NPR that his organisation had discovered more than 1 million doses of oral cholera vaccine stockpiled and was rethinking its stance.
Sanofi Aventis' India-based division Shantha makes a vaccine called Shanchol for about $1 a dose, with up to three doses needed for protection, while Netherlands-based Crucell makes another oral vaccine called Dukoral.
Vaccines should be ramped up
"Both Shanchol and Dukoral are needed here, and production of these vaccines should be ramped up, as cholera experts have argued for the past decade," Farmer's team wrote.
They said workers vaccinated Haitian girls against HPV - with better success than in some US cities. HPV vaccination requires three shots, so Farmer said there is no basis for arguing cholera vaccination is too difficult in Haiti.
Many Haitians suspect that United Nations troops, specifically a team from Nepal, brought cholera to Haiti.
Detailed genetic tests show only that the cholera strain came from South Asia and most closely resembles a strain circulating in Bangladesh.
Harvard experts who published that report are also calling for vaccination in Haiti.
Aid workers from more than 10,000 organisations all over the world have poured into Haiti to help after a devastating January earthquake, which levelled much of the capital and killed 250,000 people.
Adding to the uncertainty in Haiti are the disputed results of last month's election there that have triggered nationwide unrest. (Reuters Health/ December 2010)
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