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Truth in the time of cholera

The United Nations understandably doesn't want its peacekeepers to be blamed for the cholera that has struck Haiti. Anger has mounted with the death toll, now pushing 1200, and in the past 48 hours there have been demonstrations and riots against UN troops, which are hampering efforts to treat the sick.

What could the UN have done to prevent this? I think it could have done the tests required to show whether its troops were or were not the source of the cholera - and released the results. When you're facing people who mistrust you, give them the facts. Doing otherwise can make mistrust worse.

What should have been tested, right at the start, were faecal samples from a Nepalese UN contingent in the town of Mirebalais. There were reasons - timing, geography, the strain of cholera involved - to fear they might have brought it in.

Vincenzo Pugliese, spokesman for MINUSTAH, the UN Mission in Haiti, insisted to me via email last weekend that tests were not necessary as the troops had no symptoms of cholera.

Yet many people infected with cholera do not develop symptoms - but they can shed bacteria and infect waterways for two weeks. The Nepalese arrived one to two weeks before the Haitian outbreak began.

Pugliese phoned me this week. He agreed that people without symptoms can carry cholera. "But without symptoms it is pointless to test, because even if they have the bacteria, you will never detect it."

That's not what the World Health Organisation or what the research says. The cholera experts I spoke to also disagree. In its 1999 lab manual on cholera, the US Centres for Disease Control and Prevention gives a recipe (page 41) for culturing cholera bacteria from "suspected asymptomatic infections".

It's not high-tech: you grow the sample for a few hours in an old-fashioned, commonly available bacterial medium which favours cholera over other bacteria. Then you grow the results in culture dishes.

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