Mayotte has been facing a cholera epidemic since March, with 65 cases reported this Friday. Is this epidemic “contained”, as Minister of Health Frédéric Valletoux says? Is there a risk of expansion to mainland France?
The government wants to be reassuring. While the cholera epidemic in Mayotte left one dead, the Minister responsible for Health, Frédéric Valletoux, affirmed Thursday that this “surge” was “contained”. “There is no explosion, but that does not mean that it will stop overnight,” the minister told the press, on the sidelines of a visit to the island’s university hospital.
This acute digestive poisoning infection has so far affected 65 people in Mayotte, according to figures given by the minister on RTL this Friday. It caused the first death on the island on Wednesday, a three-year-old girl, according to the Regional Health Authority. It began in March with imported cases, most of them people coming from neighboring Comoros where an epidemic has been raging since the start of the year and where many migrants from the Democratic Republic of Congo transit to Mayotte.
A risk of explosion in Mayotte?
There is “for the moment only one outbreak”, the Kirson district in Koungou, he declared Frédéric Valletoux on RTL, while noting a “slow rise in the level of people affected”. The epidemic “is under control” and “circumscribed”, thanks to “intervention by health services on vaccination, care and support for those affected”, specified the Minister Delegate.
The health monitoring data on cholera “are unfortunately published at an irregular pace by the ARS of Mayotte, which prevents us from verifying the validity of the minister’s remarks”, notes epidemiologist Antoine to BFMTV.com. Flahault. “It is clear, however, that cholera is an infectious disease that we know how to control. But this requires resources and strong political will, both in terms of vaccination and water sanitation on the island and surrounding areas” , adds the author of Tell me! Better health at any age (Robert Laffont).
Vaccines, water distribution…
In Mayotte, more than 3,700 people have been vaccinated so far in the Kirson district alone, said Fédéric Valletoux Friday. “We have stocks. There are around 7,000 vaccines on the island today. 6,000 vaccines are arriving next week. We still have possible doses and in larger volumes for the start of summer “.
Furthermore, while cholera is transmitted in particular via water contaminated by the bacteria, “the State will continue to distribute water as much as necessary” and “water ramps have been installed in certain neighborhoods”, assured the delegate minister.
An epidemic that will be “difficult” to “curb”
But the island faces many difficulties, in terms of the health system for example. Mayotte only has one hospital and the teams “suffer because they have been permanently subjected to extremely tense rhythms for a long time”, recognized Minister Frédéric Valletoux.
Furthermore, most of the cases reported in Mayotte are imported from the Comoros, “with which Mayotte has legal or illegal multi-day exchanges”, underlines Antoine Flahault. “This very poor country bordering the French department of Mayotte does not have the means, alone, to vaccinate its entire population nor, above all, to carry out the water sanitation work which would make it possible to sustainably resolve this nagging health crisis,” continues the professor of public health at the University of Geneva.
Questioned Thursday on RTL, Benjamin Davido, infectious disease specialist at Garches hospital (Hauts-de-Seine), stressed that “to close the tap valve, we would have to, in quotes, also tackle what is happening to the Comoros”. The current epidemic will be “very difficult” to “curb, and we risk ending up with a very rapid increase in cases, perhaps even several more deaths which will occur”, he warned.
What risk for the metropolis?
Could the epidemic arrive in mainland France? 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 Public Health France.
We have to go back to 1986 to find traces of an outbreak in mainland 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. The Global Cholera Control Task Force, which brings together NGOs, academic institutes and UN agencies, emphasizes that while “cholera was eradicated in developed countries decades ago, it continues to affect many disproportionately affects the poorest and most vulnerable communities.
Also, epidemiologist Antoine Flahault is categorical: despite the current episode in Mayotte, “there is no risk that cholera will spread in an epidemic manner in mainland France or even in Reunion”. In mainland France, “all the health control that revolves around (cholera, Editor’s note), whether it be PCR, diagnostic and isolation methods, means that these cases are quickly identified, isolated, controlled, treated,” infectious disease specialist Benjamin Davido also told RTL.
This minimal risk also has to do with the mode of transmission of cholera, mainly linked to the absorption of contaminated water or food. “The cholera bacillus has no animal reservoir, it survives in the environment (a bit like the poliomyelitis virus), we have an effective vaccine and we have been able to eliminate the risk of a cholera epidemic from all rich countries through water sanitation”, explains Antoine Flahault.
And to plead: “isn’t it time to get rid of cholera once and for all, when this disease still causes several million cases per year and several tens of thousands of totally preventable deaths around the world?”
