Cholera is an infection that is transmitted exclusively via the digestive tract, through contaminated water or food, or after direct contact with a patient (including one who has recently died of the infection), and can be rapidly fatal through dehydration in the most severe forms.

Against the backdrop of an epidemic in the Comoros archipelago and the recent occurrence of cases on the island of Mayotte, the High Council for Public Health (HCSP) is issuing recommendations for vaccinations and safe funeral operations, taking into account local constraints, in order to control the risk of an epidemic in Mayotte.

• Prevention is primarily based on access to drinking water, hygiene measures and sanitation, but can also benefit from vaccination. Beside mondial stocks reserved for managing large-scale epidemics, two types of vaccine are available for Mayotte: Dukoral® (an inactivated vaccine ideally requiring 2 doses) and Vaxchora® (a live attenuated vaccine requiring just one dose).

The HCSP recommends a three-stage vaccination strategy, depending on the epidemiology, combining early vaccination of first-line and then second-line healthcare workers and case-by-case vaccination of patients’ families and relatives, within the home or for those highly exposed to the same risks (sharing latrines, water supplies, etc.). Such strategy uses the 2 types of vaccine depending on the targets.

• The HCSP also stresses the importance of working with the public to develop safe funeral practices, based on international recommendations and requiring strict compliance with hygiene and safety measures, in order to avoid the high risk of infection spreading during preparation of the body, burial, gatherings around the deceased and shared meals. The regulatory requirement for a gas scrubber should be kept in perspective, given the ways in which cholera is transmitted, while the rapid use of a watertight body bag is crucial. Chlorine solutions, in different dilutions depending on the use (washing hands, linen, surfaces or preparing the body), make it possible to reduce the risk.