As researchers and policy-makers in Rwanda's health sector, we congratulate Guinea and Haiti on integrating oral cholera vaccination into their regular control efforts during epidemics (see Nature http://doi.org/h2c; 2012). Rwanda has also learned valuable lessons about the costs of inaction from the world's delayed response to cholera outbreaks in post-earthquake Haiti.
Because cholera is endemic in the neighbouring Democratic Republic of Congo, Rwanda's health workers are trained in outbreak detection and management. Immediate action meant that a small cholera outbreak in the Nkamira refugee camp, currently at four times normal capacity, was promptly contained.
Nine patients at the camp presented with severe watery diarrhoea within a few days of each other (29 May to 3 June 2012). These cases were rapidly confirmed as cholera by laboratory testing; all were successfully treated with intravenous solution, oral rehydration salts and ciprofloxacin antibiotic. Patient contacts were traced and monitored, and sanitation campaigns reinforced. No further cases have been reported.
Within 24 hours, preparations were made to procure Shanchol cholera vaccine for all 10,000 camp residents. However, it was not necessary to deploy this vaccine because traditional methods had worked in time.
We support the call for a global stockpile of cholera vaccine and argue for rapid integration of prevention and care at the first signs of a cholera outbreak.