PARIS — A cholera epidemic has been underway in the Comoros since February 2, 2024, also affecting the neighboring island of Mayotte where 193 cases have been recorded so far (6/18/24) and where 2 deaths have been reported, according to a press release from Public health France (SPF) which takes stock of the situation. Although there have been no new cases of cholera in Koungou since June 6, three active outbreaks have been observed in the commune of Mamoudzou. [1]. On the occasion of a global forum on vaccination on June 20, the French president, for his part, announced that, to deal with the shortage of vaccines, a “cholera vaccine production line could be deployed in Africa” by a South African laboratory whose investments will be supported “priority manner”.
64.9% under 25 years old
During the last week of observation by SPF (12 to 06/18/2024), 27 cases of cholera were reported in Mayotte, bringing to 193 the total number of cases recorded in the department since 03/18/ 2024 (i.e. 188 confirmed and 5 probable cases). Of these, 172 were acquired locally and 21 imported from the Comoros – which has 9,241 reported cases of cholera and 142 deaths since the start of the epidemic – or from countries on the African continent. Note that 17 cases were recorded for the single day of June 18, the day after gatherings on the occasion of a religious festival.
Among the 193 cases recorded in Mayotte, 142 reported symptoms (73.58%), mainly diarrhea (93.7%) and vomiting (67.6%). For symptomatic people, the time between the date of onset of symptoms and hospital treatment was on average 1 day [0-14]and 64.9% were under 25 years old.
Since the start of the epidemic in Mayotte, 14 serious cases have required intensive care and 2 deaths of cases confirmed by PCR have been recorded, which represents a case fatality rate of 1.0%. “A death that occurred on June 18 is under investigation and a fourth death that cannot be attributed to cholera was recorded in a probable case,” indicates SPF. The first strains confirmed by the national reference center are O1 serogroups and Ogawa serotypes and the results of the antibiogram show a strain sensitive to doxycycline, specifies the health agency.
3 active outbreaks in the commune of Mamoudzou
Geographically, almost all cases are now located in the commune of Mamoudzou with three active outbreaks Passamainty (36 cases since 03/18/2024), Tsoundzou 1 (13 cases since 03/18/2024) and a new outbreak identified in Doujani with 12 cases in one week. On the other hand, no new cases of cholera have been observed in Koungou since June 6, 2024, although this location had constituted the first infectious focus on the island with 42% of all cases recorded in Mayotte since the reintroduction. of the disease in the territory.
The risk of local transmission in the short and long term throughout the territory remains relevant, especially since access to drinking water and sanitation in the most precarious neighborhoods is far from satisfactory. .
What about vaccination?
Two types of vaccines are available for Mayotte: Dukoral® (inactivated vaccine ideally requiring 2 doses of Valneva) and Vaxchora® (live attenuated vaccine requiring only one dose of Bavarian Nordic A/S). According to the recommendations of the High Council of Public Health (HCSP), the vaccination strategy in Mayotte is carried out in 3 levels according to epidemiology, combining anticipated vaccination of first and then second line workers and vaccination triggered on a case by case basis in those around them. patients (sometimes in combination with antibiotic prophylaxis), indoors as well as for those highly exposed to the same risks (sharing latrines, water stocks, etc.), with use of the 2 types of vaccines depending on the targets.
However, there is another vaccine recommended for mass vaccination during cholera epidemics: Euvichol-Plus, a simplified and inexpensive version of Euvichol-S, has been approved by the World Health Organization. Faced with the shortage of this vaccine manufactured in South Korea, Emmanuel Macron announced at the Global Forum for Vaccine Innovation and Sovereignty « that a cholera vaccine production line could be deployed in Africa » with the Biovac laboratory as a partner. « France will devote 10 million euros to accelerate the production of this vaccine against cholera in South Africa » he said with « the ambition to send cholera to the past ».
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