In Mayotte, where the cholera epidemic is intensifying, the majority of cases have been recorded in a precarious neighborhood in the commune of Koungou. As of May 13, nearly 4,500 contact cases had been vaccinated.
Public Health France is publishing this Friday, May 17, the latest figures for the cholera epidemic currently raging in Mayotte. The epidemic, ongoing since February 2024 in the neighboring Comoros, has spread to the French archipelago with a first case declared on March 18. As of May 15, 85 cases had been reported, including 68 indigenous cases and 17 imported from the Comoros or the African continent. A first death, that of a 3-year-old child, was recorded. Seven patients had to be admitted to intensive care.
Risk of transmission throughout the territory
While the majority of cases have so far been confined to the commune of Koungou, a new outbreak was reported on May 14 in the commune of Mtzangamouji. According to Public Health France, the situation in the Comoros and Koungou, “expose Mayotte to a risk of local transmission throughout the territory, particularly in other precarious neighborhoods.”
As a reminder, cholera is an acute digestive poisoning infection due to the ingestion of water or food contaminated by bacilli. Vibrio cholerae toxigenic serogroups O1 and O139 (cholera vibrios). It is the sanitation and collective hygiene measures that have enabled the disappearance of cholera in France, outside Guyana and Mayotte.
Trace the chains of transmission
In the archipelago, populations have been facing a water crisis for months and access to drinking and running water is extremely difficult. In Koungou, some residents consume river water and many of them are faced with poor sanitation – lack of wastewater disposal, sharing latrines – which are the main risks of spreading the disease.
Public Health France is conducting surveys among infected people and those around them in order to trace the chain of transmission and prevent new ones. Stocks of vaccines were sent from mainland France to Mayotte, where as of May 13, 4,456 contact cases were vaccinated.
Epidemic classified as highest emergency level by WHO
The situation in Mayotte is not isolated. On April 23, the World Health Organization estimated that the cholera outbreak had worsened significantly worldwide. From January 2023“based on the number of epidemics and their geographic expansion, as well as the shortage of vaccines and other resources”the WHO had classified the resurgence of cholera in category 3, the highest level of emergency.
“According to WHO, 473,000 cases were reported in 2022, twice as many as a year ago. Preliminary data indicates that more than 700,000 cases were reported in 2023,” reported the United Nations in April. The situation is expected to get even worse in 2024. “From January 1 to April 28, 2024, a cumulative total of 145,900 cholera cases and 1,766 deaths were reported in 24 countries across five WHO regions, with the African Region recording the highest figures.” In April, 23 countries reported cholera epidemics. Among the causes of this outbreak, the WHO points to the effects of climate change; frequent droughts and floods in East and Central African countries.
A shortage of vaccines
Another difficulty is that cholera vaccines, produced only according to need, are in critical shortage.. “Since January 2023, requests for VCO (oral cholera vaccine, editor’s note) have increased significantly, with 82 million doses requested by 15 countries, almost double the 46 million doses produced during this period,” notes the WHO. The stock, completely exhausted in March, numbered 3.2 million doses as of May 6.
Currently, the two oral vaccines available against cholera are only produced by the South Korean laboratory EuBiologicals. A third, from the same laboratory, simpler to manufacture and less expensive, was prequalified at the end of April by the WHO. Despite these efforts on vaccines, for the WHO, “clean water, sanitation and hygiene are the only long-term, sustainable solutions to end the cholera epidemic and prevent further epidemics.”
