World Water Crises—April 4, 2017

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CDC's Emergency Partners newsletter provides updates, resources, and useful tips to subscribers interested in emergency preparedness and CDC's emergency responses.

Don't keep this great resource to yourself! Please share it with your colleagues and networks. If you would like more information on Emergency Preparedness and Response, visit CDC's Emergency Preparedness & Response website.





 See below for emergency preparedness updates, tips, and interesting facts.

Controlling Cholera in Haiti: No Easy Task

Adrienne Lefevre, MPH, CHES

Haiti cholera

When a 7.0 magnitude earthquake struck Haiti in 2010, approximately 230,000 people died and over a million were displaced. Approximately 9 months after the earthquake, the Haitian Ministry of Public Health and Population (MSPP) confirmed cases of cholera for the first time. Since the emergence of cholera, Haiti has reported about 805,000 suspected cases and nearly 9,500 deaths. In 2016 alone, Haiti reported 41,421 suspected cholera cases and 447 cholera deaths.

Cholera is an acute, diarrheal illness caused by the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. A person can get cholera by drinking water or eating food contaminated with the bacteria. The majority of cholera cases are caused by the ingestion of water or food contaminated with the feces of a cholera-infected individual. The infection is often mild or without symptoms but can sometimes be severe, leading to swift dehydration and shock. It can be deadly within hours if not appropriately treated with oral or intravenous (IV) rehydration.

Cholera persists in Haiti primarily because many Haitians lack access to clean water and proper sanitation. Although improvements have been made, such as increases in household water treatment and storage through the availability of liquid chlorine products, the cholera epidemic in Haiti—the largest documented cholera outbreak in recent history—remains ongoing.

Cholera was prevalent in the U.S. in the 1800s for the same reasons it is prevalent now in Haiti. The U.S. eliminated cholera through constructing and improving water and sewage treatment systems. According to David Fitter, MD, country director for the U.S. CDC’s office in Haiti, it will take a multipronged approach to eliminate the risk of cholera in Haiti, including further development of water, sanitation and hygiene infrastructure, and the selective use of oral cholera vaccines. “CDC’s assistance for cholera has focused on surveillance, diagnosis, treatment, and prevention, as well as on building the capacity of DINEPA to improve monitoring systems and increase water treatment and sanitation services.”

Hurricane Matthew, a category 4 storm, hit the country in October 2016, hampering Haiti’s ongoing efforts to control cholera. At least 500 Haitians lost their lives [LA((1] and about 140,000 were displaced[LA((2]

Cholera in Haiti

In response to Hurricane Matthew, CDC’s Haiti and Atlanta offices supported the efforts of MSPP, the National Potable Water and Sanitation Directorate (DINEPA), and other partners to respond to the hurricane. CDC teams helped with several activities:

  • Conducting rapid assessments of damaged water systems and increasing availability of clean water by facilitating distribution of chlorine powder
  • Investigating outbreaks of diarrheal disease
  • Evaluating health facilities in hurricane-affected departments and assisting with continuity of key programs such as HIV and TB treatment
  • Restoring functionality to public health surveillance systems
  • Providing cholera culture training to lab technicians in Les Cayes (Sud Department)

CDC continues to assist MSPP and DINEPA. The CDC Haiti office works with MSPP to support field surveillance and to build laboratory capacity. CDC also continues to deploy experts to Haiti to help with specialized areas of cholera control, such as properly chlorinating community water supplies.

The response to Hurricane Matthew benefited from earlier responses following the earthquake and cholera outbreak in 2010. For example, household water treatment products, such as chlorine tablets, that have been distributed to citizens for years were well accepted and properly used in hurricane-affected areas because Haitians were familiar with these items.

The battle against cholera in Haiti has demonstrated the value of building partnerships before a crisis. CDC Haiti built a strong relationship with MSPP and DINEPA for many years before Hurricane Matthew based on trust and mutual respect. It produced familiarity with each other’s strengths, understanding of each other’s perspectives, and the ability to translate scientific knowledge into effective actions within local communities. This enabled the public health agencies to provide a well-coordinated response.

Restoring infrastructure and access to healthcare services is a crucial part of the long-term cholera response. Many partners worked together to repair damaged community water systems and to repair or reconstruct health facilities and cholera treatment centers. While Haiti continues to struggle with cholera, the combined efforts of MSPP, DINEPA, UNICEF, PAHO/WHO, CDC, USAID, and other organizations are strengthening the country’s capacity to combat cholera and other infectious diseases. Haiti’s improved capacity will help with preparedness and response to future public health threats in the country.  Without the combined efforts by countless partners, the cholera epidemic could have claimed many more lives.

A CDC blog on this can be found here for more information on cholera in Haiti.


Use CDC's Clear Communication Corner and CERC Corner tips to improve the clarity of your public health messages.

Clear Communication Corner

Q&A with Marcy Friedman, Emergency Risk Communication Branch 

plain language header

Why do you believe health literacy is such a big problem in the U.S.? 

MF: We have a very complex health system here in the United States. Research shows that today’s health information often isn’t usable by most Americans. This is a very large public health issue. The National Action Plan to Improve Health Literacy says that nearly 9 out of 10 adults have a hard time using the everyday health information they might encounter. They might be confused by documents in healthcare facilities, instructions on prescriptions, and articles they read in the media. According to the national plan, if people cannot understand health information, they are more likely to

  • skip important medical tests,
  • end up in the emergency room more often,
  • have difficulty managing chronic diseases such as diabetes or high blood pressure,
  • find it hard to search for and use health information,
  • find it hard to adopt healthy behaviors,
  • not act on important health alerts, and
  • often have worse health outcomes at higher costs. 

Health organizations can take steps to make sure information, products, and services are understandable so people can make healthy decisions for themselves and their families.

What communication techniques do you use to appeal to those with limited health literacy?

MF: I have found that having so many resources readily available is helpful—I spend a lot of time on CDC’s Plain Language Materials and Resources webpage and it really makes my job a lot easier! The site has plain language resources that include

Keeping the reader in mind as you write can help you make the best decisions about content organization, word choice, and presentation. Remember, the goal when writing clearly is to create material that readers understand the first time.

What tips would you give to our Emergency Partners to improve their plain language techniques?

MF: I would suggest they look at CDC’s plain language materials and resources. These tools can help communicators increase their plain language skills and become more aware of communication mistakes that can confuse some readers. The federal plain language website can also give ideas on ways to write more clearly. Clear writing is important because it helps readers truly understand our messages, which improves their health literacy.

I would take that idea further, and suggest that communicators create plain language and health literacy programs for their organizations, something the federal government has already done. The National Action Plan to Improve Health Literacy was developed by the Office of Disease Prevention and Health Promotion (ODPHP) at the U.S. Department of Health and Human Services. It describes what is required to create and sustain a health literate Nation. At CDC, we used the national plan as a guide to create CDC’s Health Literacy Action Plan. CDC’s emergency communication partners can develop their own plans, using both the national plan and CDC’s plan as blueprints.

To help get our partners started, CDC has created a webpage to walk them through the planning process. To keep their plan current, they can sign up for the Institute of Healthcare Advancement's health literacy listserv to keep track of new developments in the field.


Why Work with Social Media in a Crisis?

Social media can support message sharing in public health emergencies that are—like technology—quick and constantly evolving. Using social media channels with more traditional communication channels can help your organization spread urgent public health messages farther and faster.

Social media can

  • Reach people where they are.

Social media may be able to reach wider populations. People in rural areas or cities, diverse communities, and specific audiences might all have access to the same social media platform.   

  • Build relationships with the public.

Social media can help you address concerns, gather feedback, answer questions, and engage in dialogue. Social media may also reveal common myths and misconceptions, allowing you to address these in your messaging. Answering the questions people post in a public forum can humanize your organization, improving your trust and credibility with audiences.

  • Help disseminate information in real-time.

People often get their news from social media first. Your organization can use social media to send messages to the masses fast. Linking to photos, new sites, and information resources can draw attention to the facts.

Once you’ve created messages that can help protect the public’s health in an emergency, you’ll need to communicate them. Social media, in addition to other channels, can help your organization respond to any emergency more efficiently.

For more resources and information on CERC, please see Crisis and Emergency Risk Communication, 2014 Edition or Crisis and Emergency Risk Communication Pandemic Influenza, 2007.

Have you used CERC in your work? To share your CERC stories, e-mail Your stories may appear in future CERC Corners.


See below for some of CDC themes, events, and series that occurred during the month of March.

World Water Day 2017

world water day

Reducing Wastewater

Each year, World Water Day is celebrated on March 22. The theme for this year, wastewater, centers around the water many underdeveloped countries are not able to manage due to limited resources, technology, and space. Sewage, storm water, or other unused water in a community are considered wastewater. In many underdeveloped countries, this wastewater isn't treated before going into rivers or oceans, increasing the chance of getting people sick.

Every day, people, animals, and plants depend on water for their survival. Water is necessary for growing food, cooking, drinking, and cleaning. Many industries rely on water, and according to UN Water, about half of workers around the world have jobs related to water.

world water day

CDC's Global Water, Sanitation, and Hygiene (WASH) Expertise

CDC's Global WASH group works with other U.S. government agencies, foreign ministries of health, non-governmental organizations, the United Nations, private companies, and various international agencies. The partnerships help to improve global access to healthy and safe water, proper sanitation, and hygiene. For more information about CDC’s water-related public health efforts in the United States, visit CDC’s Drinking Water, Water, Sanitation, and Hygiene-Related Emergency, and Healthy Swimming websites.

Click the image (right) or here to learn more about World Water Day.


See below for highlights on other responses CDC has supported.

Flint Deployment Spotlight

Kellee Waters

Name: Kellee Waters

Deployment Site: Flint, Michigan

What is your current role at CDC?

KW: "I’m a Senior Health Communication Specialist with the Emergency Risk Communication Branch."

When, where, and how long did you deploy for the Flint Water Crisis?

KW: "I went to Flint in February 2016 for 2 weeks."

What were your responsibilities during your deployment and what type of work did you support?

KW: "In Flint, several different federal agencies—including EPA, FEMA, and HHS—came together to form a Unified Command Group. My main responsibility was to act as CDC’s communication liaison to the Flint response’s Public and External Affairs Task Force (PEATF), working to develop and disseminate public health messages that were consistent across all involved agencies."

Describe your deployment experience in one word. Include a brief explanation.

KW: "Awe-inspiring.

Of course, I was impressed by my counterparts from state, local, and other federal agencies, but I was truly touched by how much engagement we saw in the community. Community-based and faith-based organizations acted strongly as their own advocates; they came to town hall meetings and invited us to attend community events; and they traveled door-to-door to share messages and assistance with their neighbors. It was incredibly moving to see people so willing to work together for the greater good."

What surprised you the most about deploying and working on the response?

KW: "The weather.

When I landed, the temperature was 4-below. Two days later, the high was in the mid-50s. Two days after that, it snowed 12 inches."

What was the most challenging part of your deployment?

KW: "Creating consistent public health messages.

With so many experts working together, it took a great deal of coordination to ensure that public health messages accurately captured environmental and clinical information as well."

What best practices or lessons learned did you gain from your deployment?

KW: "The importance of active listening.

Community members were very willing to express their concerns, ask questions, and tell us what information they needed and how they wanted to receive it. Their input definitely shaped PEATF’s coordinated communication efforts, and—I like to hope—made our public health advice easier to understand and follow."



See below and visit CDC's Zika website for the most current updates and information about Zika virus.



Pregnant Women: How to protect yourself

 CDC recommends special precautions for pregnant women.


Do Not Travel to an Area with Risk of Zika

  • All areas with risk of Zika (i.e., with documented or likely Zika virus transmission) have this travel recommendation: pregnant women should not travel to these areas.

What To Do If You Live In or Travel to an Area with Risk of Zika

If you live in or must travel to one of these areas, talk to your doctor or other healthcare provider first and strictly follow steps to prevent mosquito bites and practice safe sex.

During travel or while living in an area with risk of Zika

After travel

  • Talk to a doctor or other healthcare provider after travel to an area with risk of Zika.
  • If you develop a fever with a rash, joint pain, or red eyes, talk to your doctor immediately and tell him or her about your travel.
  • Take steps to prevent mosquito bites for 3 weeks after returning.
  • Take steps to prevent passing Zika through sex by using condoms from start to finish every time you have sex (oral, vaginal, or anal) or by not having sex.

Click the image (above) or here to learn more about what pregnant women should do to protect themselves from Zika.





Pregnant women or families who would like to speak to someone about a possible Zika virus infection or diagnosis during pregnancy and potential risks to the baby can contact MotherToBaby, a service of the nonprofit Organization of Teratology Information Specialists (OTIS). MotherToBaby is not affiliated with CDC.

MotherToBaby experts are available during business hours to answer questions in English or Spanish by phone or talk about Zika:



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