Overview Cholera Elimination in Hispaniola

A catastrophic confluence of factors contributed to the rapid spread of cholera in Haiti following its introduction in late 2010. The outbreak is now the largest in modern his-tory to affect a single country1; cases from Haiti comprised nearly half of the cholera cases reported worldwide in 2012.2 Although cases of cholera related to this outbreak have occurred in the Dominican Republic, the United States,3 and possibly in Cuba and other countries,4,5 spread in these other countries has been nil or limited. The factors responsible for rapid spread in Haiti include: long-standing water and sanitary inadequacies in Haiti; the further disruptions to water and sani-tary systems imposed by the earthquake; above average rainfall; high water and ambient temperatures; and insufficient capacity of the government infrastructure to respond to the crisis. In 2008, before the earthquake, 63 % of Haitians had access to improved sources of drinking water, and only 17 % of the population had access to improved sanitation.6 To addres