Chapter 10 Popular Itineraries The Americas & the Caribbean
Nestled between the Caribbean Sea and the Atlantic Ocean, the Republic of Haiti occupies the western third of the island of Hispaniola, with the Dominican Republic on the eastern two-thirds (Map 10-08). Originally inhabited by the native Taíno, Ayiti (“land of high mountains”) was introduced to European influence through periods of Spanish and French colonization from the 15th through 18th centuries. After a successful slave rebellion in 1804, Haiti became the first independent black republic in the Western Hemisphere, the first independent state in the Caribbean, and the second independent state in the Western Hemisphere after the United States.
The “Pearl of the Antilles,” Haiti is home to a vibrant and diverse landscape that includes beaches, waterfalls, caves, and the most mountains of any nation in the Caribbean. Once rich in natural resources and products (sugar, rum, coffee, cotton, wood, and lumber), Haiti was the wealthiest French colony in the Caribbean. Deforestation, poor agricultural practices, and soil erosion have since contributed to considerable environmental degradation, however; it is now the poorest country in the Western Hemisphere.
Although Haiti has suffered from political and economic instability for most of its history, the people of Haiti are known for their resilience, strength, and warm and kind spirit, often leaving travelers to say that they have fallen in love with the country and its people. Because of the mix of indigenous, African, and European influences, Haiti possesses a “mosaic culture” reflected in its art, music, and cuisine. French and Creole are the official languages of the country. French is the principal written and administratively authorized language. It is the medium of instruction in most schools. Most (approximately 90%) of Haiti’s 10.3 million people, however, use Creole as their primary language.
Map 10-08. Haiti destination map
The environmental degradation described above has contributed to Haiti’s poor sanitation and water quality. As a result, multiple public health risks exist for Haitians and for people traveling to Haiti.
Anyone traveling to Haiti should be up-to-date on routine vaccinations, including seasonal influenza and tetanus and diphtheria boosters. Diphtheria is endemic, and the number of reported cases has increased in recent years. Additionally, hepatitis A vaccine and typhoid vaccine are strongly recommended, especially for travelers staying with friends or relatives or visiting smaller cities or rural areas. Providers should also consider administering hepatitis B vaccine.
Rabies affects Haiti more than any other nation in the Americas. Prevention efforts have decreased the number of cases of human rabies transmitted by dogs, but deaths continue to be reported. Rabies vaccination is recommended for travelers anticipating contact with animals.
Active cholera transmission has been reported in Haiti in recent years. Check the destination page at www.cdc.gov/travel for current recommendations.
Yellow fever vaccination is required for people traveling from countries where the disease is endemic.
Vectorborne diseases are common to Haiti and include Plasmodium falciparum malaria, dengue, chikungunya, and Zika. Travelers to Haiti should take measures to protect themselves from mosquito bites (see Chapter 3, Mosquitoes, Ticks & Other Arthropods).
P. falciparum malaria is endemic to Haiti. The incidence of malaria in Haiti is approximately 1,278 per 100,000 people annually. The highest transmission rates are reported to occur after the rainy seasons from March through May and October through November. Instruct travelers to begin malaria prophylaxis before travel (see Chapter 4, Malaria).
DENGUE, CHIKUNGUNYA, AND ZIKA
Dengue is endemic to Haiti, as it is throughout the Caribbean. Cases have been reported among military personnel and US missionaries; 240 cases were reported in 2014 alone. Chikungunya virus transmission was first reported in Haiti in May 2014, and the incidence rate is reported to be 627 per 100,000 population. For more information on these diseases, see Chapter 4.
Zika is a risk in Haiti. Because of the risk of birth defects in infants born to women infected with Zika during pregnancy, women who are pregnant or trying to become pregnant should research the most recent recommendations at www.cdc.gov/zika.
Travelers’ Diarrhea and Food- or Water-Related Diseases
Travelers wanting to experience the local, flavorful cuisine—rice with red beans, plantains, griot (seasoned fried pork), and a variety of fish and shellfish, including conch—should select food and beverages with care (see Chapter 2, Food & Water Precautions). Travelers’ diarrhea is a significant risk; unvaccinated travelers are at additional risk of contracting hepatitis A and typhoid fever (see Chapter 4, Hepatitis A, and Typhoid & Paratyphoid Fever).
The cholera outbreak that followed the earthquake in 2010 caused 700,000 cases of illness and 8,500 deaths. The curve peaked in 2011, with incidence and mortality rates in decline every year since, a consequence of improved access to clean water and sanitation and the work of cholera treatment centers. In 2015, 5 years after the outbreak started, Haiti reported >30,000 cholera cases and about 325 deaths.
Cholera does remain a persistent public health threat (see Chapter 4, Cholera). Use of oral cholera vaccine has been implemented as part of a complementary set of ongoing treatment and control measures that include improved diarrheal disease surveillance and enhanced laboratory culture capacity. Urge all travelers to adhere to food and water precautions, and—depending on their planned itinerary—to consider cholera vaccine. See the Haiti destination page at www.cdc.gov/travel for current recommendations.
Leptospirosis is transmitted to humans who come into contact with the urine or tissues of an infected animal or with water or soil tainted by the urine of an infected animal (see Chapter 4, Leptospirosis). Travelers are advised to avoid freshwater (such as streams or lakes) that may be contaminated with animal urine. The incidence of leptospirosis is highest during the rainy season; because of recurring natural disasters like tropical storms and flooding, Haiti appears to be at greater risk for this disease than other places in the Caribbean (where it is endemic). Many cases have been reported since the 2010 earthquake.
PHYSICAL CONCERNS FOR THE TRAVELER
Motor Vehicle Safety
Motor vehicle injuries are the most common cause of death for healthy Americans traveling abroad (see Chapter 8, Road & Traffic Safety). The risk of death from road injuries in Haiti is high; the 2013 rate was 945 per 100,000 population, compared with an average rate of 721 for the region as a whole. Road conditions in Haiti differ significantly from those in the United States: roads and lanes are generally unmarked, speed limits are seldom posted or adhered to, right-of-way is not widely observed, and a variety of people and objects may appear on roads (such as carts, animals, and vendors). Roads may be unpaved or have large potholes. And, although the main roads have been cleared of rubble from the 2010 earthquake, debris still remains in some places.
Traffic is usually chaotic and congested in urban areas. Vibrantly painted tap taps are open-air vehicles (buses or pick-up trucks), mechanically unsound and often overloaded with passengers. A common form of public transportation for Haitians, tap taps are not recommended for visitors because of safety concerns (crashes, robberies, or kidnappings). Remind travelers to stay alert when walking, to choose safe vehicles, and to observe safety practices when operating vehicles. Travelers should fasten seat belts when riding in cars and wear a helmet when riding bicycles or motorbikes.
The crime rate in Haiti is high, particularly in the capital of Port-au-Prince, presenting persistent safety concerns for travelers. Although much of the violent crime is perpetrated by Haitians on Haitians, American citizens have also been victims (see Chapter 3, Safety & Security Overseas). Travelers arriving on flights from the United States have been targeted for robbery and attack.
During Carnival, crime, disorderly conduct, and general congestion increase. Advise travelers to maintain awareness of their surroundings and recommend that they avoid nighttime travel, keep valuables well hidden (not left behind in parked vehicles), and lock closed all doors and windows.
Civil unrest also poses a safety concern for visitors to Haiti. Frequent and sometimes spontaneous protests occur in Port-au-Prince. Demonstrations—which travelers should avoid, when possible—can turn violent. The US State Department’s Smart Traveler Enrollment Program (https://step.state.gov/step/) sends enrolled travelers information about safety conditions at their destination and provides direct embassy contact in case of man-made emergencies (political unrest and demonstrations, rioting, terrorist activity) as well as natural disasters.
Natural disasters common to Haiti include tropical storms, floods, hurricanes, and earthquakes. Haiti has two rainy seasons; the first runs from April to June and the second from October through November. Hurricane season lasts from June through November. In 2008, Haiti experienced a series of 4 hurricanes and tropical storms within 2 months.
In January 2010, Haiti experienced a 7.0 magnitude earthquake that killed more than 220,000 people and displaced 1.5 million from their homes. Multiple powerful aftershocks added to the widespread devastation and destruction, significantly weakening the health, emergency response, and safety infrastructure of the nation, which remains largely underdeveloped.
Hurricane Matthew, the first category 4 hurricane to hit the island since 1964, struck Haiti in October 2016. The storm took 546 lives and displaced more than 120,000. Strong winds and heavy rain caused flash floods, mudslides, river floods, crop and vegetation loss, and destruction of homes and businesses. One year later, rain and flooding from Hurricane Irma compounded the losses to Haiti’s agricultural sector. These combined disasters have further weakened an already fragile infrastructure.
Lacreisha Ejike-King is an employee of the US Food and Drug Administration (FDA); views expressed in this chapter are those of the authors and do not necessarily reflect the official policy or position of the FDA.
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