Retain
- A global resurgence of cholera has been observed since 2022, particularly affecting Africa and recently Mayotte.
- Prevention is based on access to drinking water and improving hygiene conditions.
- Two vaccines are available in France for travelers 2 years old and more going to endemic regions.
Since 2022, cholera knows a worrying resurgence. This acute, strictly human diarrheal infection is one of the fastest fatal infectious diseases if not treated in time.
It is an epidemic sometimes forgotten, but very real
According to the World Health Organization (WHO), every year, cholera affects between 1.4 to 4.4 million people around the world, causing between 21,000 and 143,000 deaths. These figures are undoubtedly underestimated due to the persistent sub-declaration. Africa is the most affected continent. Conflicts, humanitarian and climatic crises as well as limited access to drinking water constitute favorable conditions to the emergence of these epidemics.
In 2024, an outbreak occurred at Mayotte with 221 cases, including 5 deaths, after an epidemic occurred in the Comoros archipelago. The epidemic could be stopped in particular thanks to vaccinationbut this territory remains under surveillance due to the regional context and climatic events.
In 2025, the resurgence Cases continue with 25 African countries that reported epidemic outbreaks.
From the infectious agent to the clinic, cholera is defined by its severity and the urgency of its treatment
Cholera is caused by the bacteria Vibrio choleraeessentially the O1 serogroups (and more rarely o139), producers of cholerate toxin. Man is both a tank and a vector, via the factories of water and food. Propagation is strongly favored by the precarious conditions of hygiene and sanitation.
The cholera vibrion is very mobile and resistant, capable of surviving in poor water environments (for example, the Ganges delta, a major endemic home). The incubation varies from a few hours to 5 days. Asymptomatic portage contributes to the cross -border distribution of the strains.
In 80 % of cases, the infection is asymptomatic or moderate. However, between 10 to 20 % of patients develop a severe form with professional diarrhea, vomiting without fever, as well as massive dehydration of up to 15 l/d of water losses.
Without fast management, the patient can die in 24 to 72 hours by cardiovascular collapse. The populations most at risk are children, the elderly or immunocompromised.
What is the management?
- The diagnosis is based on the identification of V. cholerae in the stool, via culture or PCR.
The National Reference Center Vibrions and Cholera of the Pasteur Institute is empowered to confirm the cases.
- The treatment is based above all on rehydration.
It is done by oral or parenteral according to severity. The answer is generally rapid, with clinical improvement in a few hours and healing in a few days.
Antibiotic therapy, reserved for severe forms, is faced with increasing antimicrobial resistance, making strains sensitivity test essential.
- Health control and vaccination are the 2 key measures to prevent cholera.
Access to drinking water and the improvement of hygiene conditions are the most effective preventive measures.
During epidemics, reactive vaccination is set up with anticholeric oral vaccines (VCO).
Two oral vaccines are available in France, directed against Vibrio cholerae Serogroup O1 and intended for adults and children aged 2 and over in regions where the disease is endemic/epidemic.
- Dukoral (Inactivated recombinant vaccine): Primovaccination comprising 2 doses in adults and children aged 6 and over and 3 doses in children from 2 to 6 years old, with an interval of one week between each dose (J0, J7 +/- J14); It must be completed at least a week before the exhibition.
- Voxor (Live attenuated vaccine): A single dose to administer at least 10 days before exposure.
In order to obtain continuous protection against cholera, a dose of recall of the Dukoral vaccine is administered:
- within 2 years after the first -time adults and children aged 6 and over;
- within 6 months after the first -time children aged 2 to 6.
In the absence of a recall, the primaryvaccination is renewed.
The Vaxchora vaccine was used during the epidemic outbreak in Mayotte.
In addition, 2 inactivated vaccines, EUVICHOL ET EUVICHOL-S, Part of the world stock coordinated by the WHO, active against O1 and O139 strains, can be deployed in epidemics around the world.
No vaccination strategy allows sustainable immunity to date.
