What we know about the cholera epidemic which killed one person in Mayotte

A three-year-old child died of cholera in the department of Mayotte on Wednesday May 8, announced the Regional Health Agency. This is the first death linked to this disease in France since 1986. Symptoms, vaccines, risk factors… We take stock of the situation.

Where is the epidemic in France?

As of May 6, 58 cases have been identified on the island of Mayotte, a French department located in the Indian Ocean. A vaccination campaign is underway, and more than 4,000 people have been vaccinated to date, according to the Regional Health Agency.

This outbreak comes as a major epidemic is underway in the neighboring archipelago of the Comoros, where there have been 98 deaths and more than 4,900 cases since the start of the year.

We have to go back to 1986 to find traces of an outbreak in France, mainly from cases imported from North Africa, with more than thirty cases and a 10-year-old child dying after a stay in Algeria.

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In mainland France, this disease has become very rare and mainly reported by travelers returning from infected countries or areas: there have been on average zero to two cases per year since the beginning of the 2000s, according to the Ministry of Health.

Where does this disease come from?

Cholera is caused by eating food or water contaminated with bacteria called bacillus. vibrio cholerae or cholera vibrio. This is an acute diarrheal infection.

Three-quarters of infected people express no symptoms. But when it occurs, the disease can be serious in 10 to 20% of cases, with severe diarrhea and vomiting which cause accelerated dehydration.

If left untreated, cholera is one of the most rapidly fatal infectious diseases: death can occur within one to three days. Only rapid treatment by infusion, with the administration of rehydration salts and antibiotics, can prevent death.

Is there a vaccine?

Several oral vaccines have been developed and are recommended by the World Health Organization (WHO) for areas where cholera is endemic and during epidemics. But the multiplication of outbreaks has dangerously limited stocks and forced humanitarian organizations to reduce the number of doses administered during vaccination campaigns.

In April, the WHO gave the green light to the simplified version of a vaccine, produced by the South Korean group EuBiologics, to accelerate production and replenish global stocks of anticholera serums.

Who are the most vulnerable populations?

“There is a strong link between the transmission of cholera and inadequate access to drinking water and sanitation facilities” underlines the WHO. The list of recent cholera outbreaks, in Haiti, Syria and the Democratic Republic of Congo, shows how this disease is a marker of poverty, instability and armed conflicts.

Places at risk of epidemics are typically refugee camps: humanitarian crises with the displacement of populations and difficulties in accessing drinking water considerably increase the risks.

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Climate change is making the situation worse by increasing the intensity and frequency of floods, cyclones and droughts. This disrupts access to drinking water and “creates an ideal environment for the development of cholera”, according to the WHO. Recent example: cases of cholera in Mozambique increased tenfold after the passage of Cyclone Freddy which, at the start of 2023, deprived some of the inhabitants of drinking water.