Concern about Haiti’s cholera outbreak is spreading to the United States as Florida health officials late last week told doctors in South Florida to watch for signs that the disease is creeping north.

State health officials on Nov. 2issued an epidemiology advisory warning doctors that people traveling from Haiti may exhibit cholera symptoms. The advisory noted that most of the state’s estimated 241,000 Haitian-born residents live in the Miami-Dade County region, Broward, Palm Beach and Orange counties.

“As a result, we can expect that some travelers returning from Haiti may become symptomatic with cholera en route to or shortly after arrival in Florida,” according to the advisory.

According to the MedTV website*, Cholera can spread rapidly through inadequately treated sewage and drinking water. It is reported “Cholera is not likely to be transmitted directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.”

Haiti continues to be plagued by the cholera epidemic in the wake of the conditions following the Jan. 12 earthquake. With the death toll over 650, doctors have now set up cholera centers throughout the capital of Port-au-Prince.

The city is more vulnerable than ever for the spread of the waterborne virus. Close to one million Haitians are living in tent cities which have marginal sanitation levels, while facing competing demands for cooking, washing and personal hygiene. Doctors are preparing for the worst.

“Before this, Port-au-Prince for the most part, was a large urban slum with very poor water and sanitation conditions,” Dr. Jon Andrus of the Pan American Health Organization, an arm of the World Health Organization, told Voice of America News. “This is ripe for the rapid spread of cholera. We expect transmission to be extensive.”

As long as the infrastructure in the country remains in its fragile state, the disease will be a threat. Doctors are expressing frustration that they’re not able to treat an otherwise treatable disease, because of the current conditions in the Haiti.

“If we were in hygienic conditions, maybe we would be able to say we were in control of the situation,” Dr. Juliet Olivier, a Haitian physician with Doctors Without Borders, told the AP. “The disease is easy to treat, but the patients take a long time before coming to see a doctor.”