“ The cholera vibrio, The bacteria responsible for cholera disease is still actively circulating around the world today. The Bay of Bengal, its historical home, remains a reservoir for this pathogen, » indicates a Science and Future François Xavier Weill, director of the National Reference Center for Vibrios and Cholera at the Pasteur Institute. In 2018, a worrying strain appeared in Yemen. It was resistant to two of the three commonly used antibiotic families. The remaining strains were tetracyclines, antibiotics that inhibit protein synthesis. While the epidemic was contained in Yemen, the multi-resistant strain reappeared a few years later in Lebanon, and then this year in France, on the island of Mayotte. In March, a cholera epidemic broke out there. Drastic measures were put in place to ensure proper sanitary conditions and contain the epidemic, which ended in July. According to Public Health France.
Science and Future This multi-resistant bacterium was first identified in Yemen. How did this strain arrive in Mayotte?
Francois-Xavier Weill : This highly antibiotic-resistant bacterium was first identified in Yemen during a prolonged armed conflict that fueled a major cholera epidemic. The emergence of this highly resistant strain was observed in 2018, two years after the outbreak began. A few years later, it was reported in Lebanon, in an equally complex context where displaced populations and saturated health systems facilitated its spread. Local conditions were ideal for its spread: contaminated water networks or lack of drinking water, insufficient infrastructure, etc.
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In Mayotte, this bacterium proliferated between March and July, in an environment marked by intense human interaction. The emergence of this bacterium is explained in particular by migratory flows from the Comoros and other East African countries affected by health crises. Mayotte is a strategic island in the Indian Ocean, and its healthcare system is under constant pressure. The cases recorded in these different regions illustrate how this bacterium has taken advantage of degraded health contexts to establish itself and spread, particularly in medical facilities where control measures are often insufficient.
“Clean up the environment and ensure the hygiene of residents”
How was the epidemic managed in Mayotte?
The response to this epidemic, contained last July, was based on several key steps. First, it was It is essential to identify cases with the laboratory at the Mayotte hospital center and then to treat the patients by rehydrating them.. It was also necessary to identify the sources of infection and break the chains of transmission by ensuring access to uncontaminated water, the proper functioning of water networks, etc. This is what is called the WASH approach, a set of measures aimed at cleaning up the environment and guaranteeing the hygiene of the inhabitants. Then, an information and training strategy was deployed among health professionals to ensure better prevention and rational use of antibiotics. Since only one class of antibiotic worked, it was a matter of reserving its use for serious cases and not giving it to all the inhabitants as a preventive treatment: essential to avoid the development of resistance against these latter antibiotics. Two types of vaccines were also used.
Can we fear a return of cholera after the passage of Cyclone Chido in Mayotte?
Today, the risk associated with this bacteria is low, as there have been no cases on the island, nor on the islands near Mayotte, for several months. The measures put in place have helped to stem its spread. Even in the event of infrastructure damage due to a cyclone, this bacteria should not reappear except in the case of reimportations followed by dissemination, which seems unlikely given the recent expertise of health personnel, the proper functioning of the laboratory and the current response of the state. Vigilance is still required. The risk now lies in the spread of other pathogens (such as typhoid fever, dysentery, etc.) which could take advantage of this deteriorating health situation.
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“Identifying cases quickly allows us to act before an epidemic gets out of control.”
What are the main risks associated with this multi-resistant strain of cholera?
It should be remembered that antibiotics are only used in addition to rehydration and primarily to reduce the duration of the illness. Digestive losses, which can reach several liters each day (including a large number of bacteria), contribute to the spread of the epidemic. By reducing the duration of patients' symptoms, the transmission of the infection will be reduced. In the short term, this new strain will therefore restrict the treatment of cholera patients to a single class of antibiotic, tetracyclines. Health authorities in countries that are or will be affected by this strain must therefore recommend the correct class of antibiotic, which requires high-quality laboratories. Without this, there is a risk of being less able to control the spread of the infection, resulting in an increase in cases, including more serious cases, particularly in an environment where health structures already lack resources. In the long term, the fear is that this strain will develop resistance to this last class of antibiotics, which is still effective. The use of tetracyclines will therefore be strictly reserved for the treatment of patients and not for large-scale preventive use, which would encourage the selection of resistant strains. We would then no longer have the means to deal with this disease, which spreads rapidly in regions where sanitary conditions are difficult.
This crisis highlights several key points for the future management of similar situations. The first lesson is the importance of an effective surveillance system, including competent laboratories. Identifying cases quickly allows for action before an epidemic spirals out of control. Another priority is to strengthen hygiene protocols in all healthcare facilities, not just during crises. Furthermore, cholera persists in South Asia. It is from this persistent source that the bacteria originate. There is therefore an urgent need to effectively combat cholera in India and Bangladesh if we are to prevent reintroductions into other countries.
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