Florida's health department is asking doctors statewide to be prepared for possible cholera cases here as Haiti grapples with the dual calamities of Tropical Storm Tomas and a waterborne outbreak that has sickened 4,649 and killed 305 on the island.

Florida has more than 240,000 Haitian-born residents, the state said.

Nearly half of the United States' Haitian-born population lives in Florida, the agency said. About 41,000 live in Palm Beach County. Broward County has 63,000 Haitian residents and Miami-Dade has 73,000.

Since last January's earthquake, travel between Florida and Haiti has increased.
It can take anywhere from five hours to five days after exposure for a person to develop the symptoms of cholera: severe diarrhea and vomiting.

"We can expect that some travelers returning from Haiti may become symptomatic with cholera en route to, or shortly after arrival in Florida," the letter warns.

Cholera is rare in the United States and places with adequate sanitation systems. The disease is spread through unclean water contaminated with fecal material. Prompt treatment with rehydration solution is the treatment. Sometimes antibiotics are given as well.

The Florida Department of Health asked doctors to phone in reports of watery diarrhea in people with recent Haiti travel, and to collect swabs and send them to a state laboratory in Miami, Jacksonville or Tampa.

In Haiti, the approach of the tropical storm was stretching already lean food, water and medical supplies, and making treatment efforts even more complicated.

"This storm could not have come at a more difficult time. Although we have made some extensive preparations and prepositioned stocks across the country, some crucial supplies have been badly depleted by ongoing needs, particularly the response to the ongoing cholera epidemic", Nigel Fisher, UN Humanitarian Coordinator in Haiti, told Haiti Libre.

The cholera strain circulating in Haiti is an Asian one, not a Central American one, the National Public Health Laboratory in Haiti and the U.S. Centers for Disease Control and Prevention in Atlanta said on Monday.

Haiti has not reported cholera in 60 years.

Reuters reported widespread speculation that U.N. peacekeepers from Nepal brought cholera into the nation. There are nearly 12,000 peacekeepers stationed in Haiti since the earthquakes.

"Although these results indicate that the strain is non-Haitian, cholera strains may move between different areas due to global travel and trade," said Minister of Health Dr. Alex Larsen. "Therefore, we will never know the exact origin of the strain that is causing the epidemic in Haiti."