Mayotte, a French overseas territory in the Mozambique channel, faced a meaningful cholera outbreak between March and July 2024. The epidemic, with two peaks in April and June, resulted in 215 confirmed cases and tragically, five deaths, all occurring before patients could reach healthcare facilities.
Dr. Julien Carvelli, a resuscitation doctor who took a year-long position at the Mayotte hospital center (CHM) in November 2023, found himself unexpectedly thrust into the heart of the crisis. Initially hired for a position in the intensive care unit, he soon became co-manager of the cholera unit alongside Dr. Mohamadou Niang, head of the multipurpose medicine unit.
The outbreak began on March 18, 2024, when a suspected cholera case from the Comoros was detected in Mayotte by doctors from Samu Center 15. The rapid spread of the disease was a major concern due to the territory’s challenges with drinking water and the overcrowded “Bangas,” precarious dwellings often inhabited by Comorian migrants.
The ARS of Mayotte, in collaboration with the CHM, swiftly implemented measures to contain the outbreak.A triage tent was set up at the emergency department to identify patients exhibiting symptoms such as vomiting, diarrhea, and dehydration.
Rapid diagnostic tests (trod) were conducted on stool samples or swabs. While sensitive,these tests weren’t highly specific. “We sorted more than twice as many patients who had cholera,” Dr. Carvelli explained. Therefore, every Trod result, whether positive or negative, was confirmed by PCR. The Trod, however, provided crucial initial data within 15 minutes, enabling “field” actions.
These actions involved visiting the homes of suspected patients to administer vaccines and antibiotic prophylaxis to those in close contact, as well as disinfecting the premises.
Confirmed cholera patients were transferred to the cholera unit, established by combining the pediatric and adult short-term hospitalization units. This unit, with 12 rooms and 14 beds, could accommodate up to 20 beds during the peak of the crisis.
Tanguy Cholin, head of the security and health emergencies department of the ARS of Mayotte, outlined the multi-tiered hospitalization plan: “The plan of attack was an armament of specific hospitalization capacities at 4 levels, which went from the CHM only, to the extension to the reference medical centers (CMR). We planned to hospitalize up to 180 peopel, while the usual trend was 20 patients.”
Mobilization of Human Resources
Starting in May, all resources were concentrated at the CHM for streamlined human resource management. The initial team, comprising general medicine doctors and intensivists, was considerably expanded by the health reserve, a French public health organization (SPF) composed of volunteer health professionals who can be deployed during health emergencies.
The ARS was responsible for mobilizing the reserve. “Ther were very close links with the ARS and the CHM on the management of the crisis, at least on a weekly basis, for a very long time,” Cholin stated. Approximately 110 reservists,primarily doctors and nurses,were mobilized for the CHM.
Mayotte, a French island department in the Indian Ocean, has successfully contained a cholera outbreak that began in April 2024. The epidemic, which originated in the Comoros, resulted in 236 reservists being mobilized for field actions, including doctors, nurses, and laboratory technicians.
The majority of the mobilized doctors were general practitioners or emergency physicians, with a limited number of pediatricians. They played a crucial role in treating children suffering from severe dehydration, utilizing established protocols and video training resources available on platforms like YouTube, notably from Dr.Julien Carvelli.
On October 7, 2024, the prefect and the director of Public Health France declared the end of the epidemic. While the last indigenous case was reported on July 8 and the last imported case on july 12, vigilance remains paramount across Mayotte. “because the bacteria continues to circulate in the Comoros, with approximately 70 cases reported in Grande Comore, and because the rainy season is approaching,” explains Dr. carvelli.
As a precautionary measure, the sorting tent was reopened. Tanguy Cholin, a local official, explains that “Maraudes are organized thanks to reservists, mediators, and some 350 volunteers from neighborhood associations.” Their mission is to actively search for suspected cases, particularly symptomatic individuals who may have traveled to the Comoros or Africa. “This is what we call community-based surveillance (CBS), which associates associative mediators with the health actions of the ARS in order to increase the number of local relays,” Cholin adds.The ARS is satisfied with the prevention actions implemented, with vaccination and access to water being the two key pillars.
Vaccination was carried out using a “ring vaccination” strategy, targeting areas around emerging epidemic foci.According to Dr. Carvelli, “It was the most suitable strategy due to the limited availability of doses for the entire population.In addition, it is not clear how long vaccination coverage will last, ranging from a few months to 2-3 years.”
Two oral vaccines were used: Vaxchora (from Bavarian Nordic) and Dukoral (from Valvena). Vaxchora was preferred due to its single-dose governance. Dukoral, administered in two doses, was used in cases of contraindication to Vaxchora (pregnancy or immunosuppression). Protection became effective 7 to 10 days after vaccination. Antibiotic prophylaxis with doxycycline was also given to contact cases.
Access to drinking water was strengthened through an action plan focused on “high-risk” areas,the most affected and impoverished. This involved rehabilitating existing water ramps, creating new ones, and installing magnetic fountain terminals for residents without access to the water network. As a fecal-oral disease, cholera can only be effectively controlled if the population has sufficient access to clean water.
Dr. Carvelli acknowledges the success of these efforts but highlights a persistent challenge: public support for dialog strategies. “This epidemic mainly circulated in slums. It is very challenging to provide a health solution to a precarious and vulnerable population who have no rights to the territory. It was extremely difficult in terms of communication, the general population is not necessarily in favor of it. However, it is crucial, in terms of public health, to make the general population understand that we must take care of the most precarious and the most vulnerable so that the response can benefit the collective. Yes, cholera is a contagious disease imported from Africa and then to the Comoros. But the geography is like…
The threat of cholera spreading from the Comoros to the French island of Mayotte remains a serious concern, according to health officials. They emphasize that addressing the ongoing cholera outbreak in the Comoros is crucial to preventing its resurgence in Mayotte.
“this, immigration will not stop tomorrow and if the Comoros remain an epidemic center, cholera will return to Mayotte,” a health official stated. “By caring for the sick and through prevention, the collective will benefit, not otherwise.”
The official stressed the importance of continued surveillance and collaborative efforts to combat the disease.
The proximity of the Comoros to Mayotte, coupled with the movement of people between the two locations, creates a heightened risk of transmission.
Health authorities are urging a multifaceted approach that includes providing medical care to those infected, implementing preventative measures such as improved sanitation and access to clean water, and fostering cooperation between the two regions to effectively address the cholera outbreak.
## World Today News Expert Interview: Containing the Cholera Outbreak in Mayotte
**World Today News exclusive interview with Dr. Julien Carvelli, a resuscitation doctor who played a key role in managing the recent cholera outbreak in Mayotte.**
**WTN:** Dr.Carvelli, thank you for joining us. Can you provide some background on the recent cholera outbreak in Mayotte?
**Dr. Carvelli:** Certainly. The outbreak began in March 2024, originating from a suspected case from the Comoros. By July, we’d recorded 215 confirmed cases, tragically resulting in five deaths before patients could reach healthcare facilities.
**WTN:** What were the main challenges in containing the outbreak?
**Dr. Carvelli:** Mayotte faces challenges with access to clean drinking water and overcrowded living conditions, particularly in “Bangas,” precarious dwellings frequently enough inhabited by Comorian migrants. These factors created a fertile ground for cholera transmission.
**WTN:** How did the hospital center and the ARS of Mayotte respond to the crisis?
**Dr. Carvelli:** The response was swift and collaborative.A triage tent was set up to identify symptomatic patients, and rapid diagnostic tests (Trod) were used for initial screening. While not entirely specific, the trod provided crucial early data, enabling rapid field actions like home visits for vaccination and antibiotic prophylaxis.
**WTN:**
You co-managed the cholera unit alongside Dr. Mohamadou Niang. Can you tell us about the unit and its operation?
**Dr. Carvelli:** the cholera unit was established by combining existing short-term hospitalization units. This allowed us a capacity of up to 20 beds during peak periods. The unit was crucial for delivering vital rehydration therapy and managing severe cases.
**WTN:** The mobilization of human resources was crucial. Can you elaborate on this aspect?
**Dr. Carvelli:** Absolutely. Starting in May, all resources were concentrated at the hospital center for efficient management. This included mobilizing the health reserve, a French public health organization composed of volunteer health professionals. Around 110 reservists, primarily doctors and nurses, were deployed to the hospital center, significantly bolstering our capacity.
**WTN:** The epidemic was officially declared over on October 7, 2024. What are the ongoing preventive measures?
**Dr. carvelli:** Vigilance remains paramount.The bacteria still circulates in the Comoros, and the rainy season is approaching. We’ve reopened the triage tent and implemented community-based surveillance (CBS) in collaboration with local mediators and volunteer associations to actively search for suspected cases.
**WTN:** What were the key lessons learnt from this outbreak?
**Dr. Carvelli:** This experience highlighted the importance of a coordinated, multi-sectoral approach, involving public health authorities, healthcare professionals, the community, and international partners. we also learned the vital importance of community engagement and access to clean water and sanitation in preventing future outbreaks.
**WTN:** Thank you,Dr. Carvelli, for sharing your insights.
**This interview provides World Today News readers with valuable details about the recent cholera outbreak in Mayotte, highlighting the challenges faced, the response efforts undertaken, and the ongoing preventive measures in place.**
