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The first cholera epidemic to hit Haiti in decades has officially hit the country’s capital, making it just that more dangerous than it was when first reported.

This due to five individuals who left the rural Artibonite region where the disease was first reported to get better help in Port-au-Prince, where many foreign relief workers still remain.

An outbreak of cholera has spread from a rural valley in central Haiti to the nation’s capital, intensifying worries the disease would spread in squalid tarp camps that house hundreds of thousands of earthquake survivors.

The death toll from the epidemic topped 200 Saturday and fears of it propagating in the crowded, earthquake-ravaged Port-au-Prince increased after five cases were detected in the city.

U.N. officials stressed that the five cases, the first confirmed in the capital since the epidemic started, were people who had become infected in the main outbreak zone of Artibonite north of Port-au-Prince and had subsequently traveled to the city where they fell sick.

“They were very quickly diagnosed and isolated,” U.N. humanitarian spokeswoman Imogen Wall told Reuters, citing information from Haitian health authorities. “This is not a new location of infection.”

But prevention measures and surveillance were being increased in Port-au-Prince, with its squalid sprawling slums and about 1.3 million survivors of the Jan. 12 earthquake packed into tent and tarpaulin camps. All are highly vulnerable to a virulent diarrhea disease like cholera.

Health officials are fearful about the outbreak spreading into the capital, where thousands and thousands of people are living in unsanitary conditions in refugee camps.

“It will be very, very dangerous,” said Claude Surena, president of the Haitian Medical Association. “Port-au-Prince already has more than 2.4 million people, and the way they are living is dangerous enough already.”

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