Cholera in Haiti: please do not forget zinc.

We commend Louise Ivers and colleagues (Dec 18, p 2048) for their thoughts around advocating for complementary public health inter ventions that could slow the cholera epidemic in Haiti. We are also particularly grateful to Partners In Health for the synergistic, helpful, and timely support provided to our medical action during the onset of the outbreak in the Artibonite region. Ivers and colleagues highlight the enormous potential benefi ts (shorter duration of illness, decreased volume of diarrhoea, and decreased duration of pathogen shedding) associated with the proper use of antibiotics. We concur, but would like to suggest the further need to add the systematic use of zinc for all paediatric patients (those younger than 15 years). Supplementation with zinc in children with cholera has been shown to present an additional benefi t over antimicrobial treatment by reducing the duration of diarrhoea and overall stool output. This eff ect can contribute substantially to decreased severity and a reduced overall burden of the disease. The US Centers for Disease Control and Prevention support the use of zinc for the paediatric population. Moreover, zinc has been proven to be eff ective in enhancing the T-cell and B-cell-driven sero conversion to vibriocidal antibodies in children given the oral inactivated cholera vaccine. This aspect is particularly crucial if we want to improve vaccine eff ectiveness and achieve, in the years to come, a meaningful preventive protection rate, aimed at saving thousands of lives.