Reporte Colera 2013 Oms

8/12/2019 Reporte Colera 2013 Oms

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Weekly epidemiological record

Relev pidmiologique hebdomadaire2 AUGUST 2013, 88th YEAR / 2 AOT 2013, 88e ANNENo. 31, 2013, 88, 321336http://www.who.int/wer

2013, 88, 321336 No. 31

Contents

321 Cholera, 2012335 Monthly report on

dracunculiasis cases, JanuaryMay 2013

Sommaire321 Cholra, 2012

335 Rapport mensuel des cas de

dracunculose, janvier-mai2013

Cholera, 2012After several years of steady increase(since 2007), the number of cholera casesreported to WHO, as well as the numberof countries which reported cholera cases,showed an important decrease in 2012.A cumulative total of 245 393 1 cases werereported including 3034 deaths with acase-fatality rate (CFR) of 1.2% ( Table 1 ),

representing a 58% decrease in number ofcases compared with the previous year(Figure 1 ). Cholera cases caused by Vibriocholerae have been reported from all re-gions of the world ( Map 1).

In 2012, a total of 48 countries from allcontinents reported cholera cases to WHO,a 17% decrease in the number of countries

compared with 2011 ( Map 1). From theAfrican continent, 27 countries reportedcases, similar to 2011. From Asia, the num-ber of countries reporting cases decreasedby 3 from the previous year, with a totalof 12 countries in 2012. In the Americas,the number of reporting countriesdecreased from 9 in 2011 to 6 in 2012.Imported cases were reported from theAmericas, Asia, Europe and Oceania(Figure 1, Map 1, Table 1 ).

Of the 30 countries that reported deathsfrom cholera, 23 were from the Africancontinent, accounting for 2042 deaths or67% f h l b l l hil i h A i

Cholra, 2012Aprs plusieurs annes daugmentation rgu-lire (depuis 2007), le nombre de cas de cholranoti s lOMS ainsi que le nombre de paysqui noti ent des cas de cholra ont accus unebaisse importante en 2012. Un total cumul de245 393 cas1 a t noti , dont 3034 dcs, soitun taux de ltalit (TL) de 1,2% ( Tableau 1 ),reprsentant une diminution de 58% du

nombre de cas par rapport lanne prc-dente ( Figure 1 ). Des cas de cholra provoquspar Vibrio cholerae ont t signals danstoutes les rgions du monde ( Carte 1 ).

En 2012, au total 48 pays de tous les continentsont noti des cas de cholra lOMS, soit unebaisse de 17% du nombre de pays par rapport

2011 (Carte 1 ). Sur le continent africain,27 pays ont noti des cas, soit un chiffrecomparable 2011. En Asie, 3 pays de moinsont noti des cas par rapport lanne prc-dente, soit un total de 12 pays en 2012. Dansla Rgion des Amriques, 6 pays en 2012contre 9 en 2011 ont noti des cas. Des casimports ont t signals dans les Amriques,en Asie, en Europe et en Ocanie ( Figure 1 ,Carte 1 , Tableau 1 ).

Sur les 30 pays qui ont noti des dcs parcholra, 23 taient situs sur le continent afri-cain, reprsentant 2042 dcs, ou 67% du total

di l t di l A i l R
http://www.who.int/werhttp://www.who.int/wer


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Table 1 Number of cholera cases and deaths reported to WHO, and case-fatality rate (CFR), 2012Tableau 1 Nombre de cas de cholra et de dcs signals lOMS, et taux de ltalit (TL), 2012

Continent Country Pays

Total no. of cases(including imported

cases/deaths) Nombre total de cas

(incluant casimports et dcs)

No. of imported cases Nombre de cas imports

No. of deaths Nombre de dcs CFR % TL (%)

Africa Afrique

Angola 1215 98 8.1Benin Bnin 625 3 0.5Burkina Faso 143 7 4.9Burundi 214 1 0.5

Cameroon Cameroun 363 5 1.4Central African Republic Rpublique

centrafricaine21

Congo 1 181 37 3.1Cte dIvoire 424 19 4.5Democratic Republic of the Congo

Rpublique Dmocratique du Congo33 661 819 2.4

Ghana 9 548 100 1.1Guinea Guine 7 350 133 1.8

Guinea-Bissau Guine-Bissau 3 068 22 0.7Liberia Libria 219Mali 219 19 8.7Malawi 187 2 1.1Mozambique 647 7 1.1Niger 5 284 110 3.1Nigeria Nigria 597 18 3.0Rwanda 9 0.0Senegal Sngal 1 0.0

Sierra Leone 23 124 299 1.3Somalia Somalie 22 576 200 0.9Togo 61 1 1.6United Republic of Tanzania Rpublique-

Unie de Tanzanie286 4 1.4

Uganda Ouganda 6 326 135 2.1Zambia Zambie 198 2 1.0Zimbabwe 23 1 4.4

Total 117 570 2 042 1.7

Asia Asie

Afghanistan 12 0.0China Chine 77 2 0.0Iran (Islamic Republic of) Iran

(Rpublique islamique d)53 0.0

Iraq 4 693 4 0.1Japan Japon 3 3 0.0


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In 2012, 49% of all reported cases originated from a largeoutbreak which continued to affect Haiti and theDominican Republic, having started at the end ofOctober 2010. A total of 117 570 cases were reported fromAfrica, a 37% decrease compared with 2011 (188 678 cases).In 2012, cases from Africa represented less than half ofthe global total compared with the high 93%98% of allcases worldwide reported from Africa during 20012009.This reduced proportion of African cases is consistentwith the trends observed in 2010 and 2011 and is linkedto the still ongoing outbreak in Hispaniola. Decreasingtrends were also reported from Asia with a total of7367 cases, a decrease of 81% compared with 2011(38 298), or 3% of the global total. From Oceania, theonly reports were imported cases in Australia(Figure 2 ). During 2012, WHO participated in the veri-

Table 1 (Continued) Tableau 1 (Suite)

Continent Country Pays

Total no. of cases

(including importedcases/deaths) Nombre total de cas

(incluant casimports et dcs)

No. of imported cases Nombre de cas imports

No. of deaths Nombre de dcs CFR % TL (%)

Americas Amriques

Bahamas 1 1 0.0Cuba 417 3 0.72Dominican Republic Rpublique

dominicaine7 919 68 0.86

Haiti Hati 112 076 894 0.8Mexico Mexique 2 0.0United States of America Etats-UnisdAmrique

18 17 0.0

Total 120 433 18 965 0.8

Oceania Ocanie

Australia Australie 5 5 0.0

Total 5 5 0.0Grand total 245 393 129 3 034 1.2

a Laboratory-con rmed cases only. Uniquement des cas con rms en laboratoire.

En 2012, 49% des cas noti s avaient pour origine une ambeimportante qui a dbut la n octobre 2010 et sest poursuivieen Hati et en Rpublique dominicaine. Au total, 117 570 cas ontt noti s en Afrique, soit une diminution de 37% par rapport 2011 (188 678 cas). En 2012, les cas noti s en Afrique ontreprsent moins de la moiti du total mondial par rapport aupourcentage lev de 93% 98% des cas mondiaux signals parlAfrique entre 2001 et 2009. Cette rduction du pourcentage descas africains correspond aux tendances observes en 2010 et2011 et est lie la ambe qui se poursuit sur lle dHispaniola.Des tendances dcroissantes ont galement t signales enAsie, avec un total de 7367 cas, soit une baisse de 81% parrapport 2011 (38 298), ou 3% du total mondial. En Ocanie,les seules noti cations concernaient des cas imports en Austra-lie (Figure 2 ). En 2012, lOMS a particip la vri cation de38 ambes dans 35 pays, dont 29 en Afrique, 4 dans les


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labeled acute watery diarrhoea occurring in south-eastern and central Asia. The actual numbers of choleracases are known to be much higher than those reported.

Figure 1 Countries/areas reporting cholera and cases reported by year 20002012Figure 1 Pays/Territoires ayant dclars des cas de cholera et nombre de cas dclars par anne 2000-2012

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

No. of cases Nombre de cas

Number of cases Nombre de pays

Countries with local cases Pays signalant des cas autochtones

Countries with imported cases Pays signalant des cas imports

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annuels attribus la diarrhe aqueuse aigu survenant enAsie du Sud-Est et en Asie centrale. On sait que les nombresrels de cas de cholra sont bien suprieurs aux chiffres noti s.


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R E L E V E E P I D E MI O L O

G I Q U E H E B D

O MA D A I R E ,N o

3 1 ,2 A

O T 2

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0 1750 3500875 Kilometers Kilomtres

Map 1 Countries reporting cholera deaths in 2012Carte 1 Pays ayant dclar des dcs dus au cholra en 2012

Imported cholera cases Cas imports de cholra

1293099100900Data not available Donnes non disponibles

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoeveron the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, orconcerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which theremay not yet be full agreement. Les limites et appellations gurant sur cette carte ou les dsignations employes nimpliquent de la

part de lOrganisation mondiale de la Sant aucune prise de position quant au statut juridique des pays, territoires, villes ou zones,ou de leurs autorits, ni quant au trac de leurs frontires ou limites. Les lignes en pointill sur les cartes reprsentent des frontiresapproximatives dont le trac peut ne pas avoir fait lobjet dun accord d nitif.

Source: World Health Organization Source: Organisation mondiale de la santMap : WHO Department of Control of Epidemic Diseases Carte: DpartementOMS de lutte contre les maladies pidmiques

WHO 2013. All rights reserved OMS 2013. Tous droits rservs


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access to improved sources of drinking-water 3 and im-proved sanitation, and by working with communities to

encourage behavioural change to diminish the risks ofinfection. In 2012, a technical working group took animportant step in the direction of coordinated globalcholera management by recommending the creation ofa global oral cholera vaccine (OCV) stockpile for use inemergencies. 4 Oral cholera vaccines have proven to besafe and effective are now considered to be part of acomprehensive and multidisciplinary approach to pre-vention of cholera and response to outbreaks.

In 2011, the 64th World Health Assembly adopted reso-lution WHA 64.15 recognizing the re-emergence ofcholera as a signi cant public health burden and callingfor the implementation of an integrated and compre-h i h t h l t l hi h i l d

Figure 2 Cholera cases reported to WHO by year and by continent 19892012 Figure 2 Cas de cholra dclars lOMS par anne et par continent 1989-2012

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1989 1990 19 91 1992 1993 1994 1995 199 6 1997 1998 1 999 2000 2001 2002 2003 2 0 04 2005 2006 2007 2008 20 09 2010 2011 2012

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Oceania OcanieAmericas AmriquesAsia AsieAfrica Afrique

sources deau potable 3 et des installations dassainissementamliores, et en travaillant avec les communauts pour encou-

rager les changements de comportement a n de diminuer lesrisques dinfection. En 2012, un groupe de travail technique afait un pas important dans le sens dune gestion coordonneau niveau mondial de la lutte contre le cholra en recomman-dant la cration dun stock mondial de vaccin anticholriqueoral (VCO) utiliser dans les situations durgence.4 Les vaccinsanticholriques oraux se sont avrs srs et ef caces et sontdsormais considrs comme faisant partie dune approchecomplte et multidisciplinaire pour prvenir le cholra et faireface aux ambes.

En 2011, la Soixante-Quatrime Assemble mondiale de la Santa adopt la rsolution WHA64.15 reconnaissant que le cholraavait fait sa rapparition en tant que problme de sant publiqueimportant et appelant la mise en uvre dune approche int-

l b l d l l tt t l h l i tili t


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(Table 1 ). Compared with 2011, the number of casesreported from Africa decreased by 37%, to a level similarto that reported in 2005 ( Figure 2). Five countries fromWest Africa (Ghana, Guinea, Guinea-Bissau, Niger andSierra Leone) accounted for 48 974 cases or 42% of casesreported from the continent ( Map 1).

When compared to 2011, the number of cases reportedfrom Central Africa and the Horn of Africa showed animportant decrease. In 2012, decreasing trends were alsocon rmed in East and Southern Africa.

Overall an important decrease in cases reported from

the Horn of Africa was observed, but 22 576 cases (in-cluding 200 deaths) were reported from Somalia.

The declining trends observed in recent years amongthe countries along the East African coast were con-

rmed during 2012, resulting in a 40% decrease in thetotal number of cases reported for that area in 2012.

In southern Africa the number of reported cases

continued to decline, reaching the lowest levels everreported during the current millennium.

In the Great Lakes region the number of reported casesincreased by 71% compared with 2011, mainly becauseof large outbreaks affecting the Democratic Republic ofthe Congo (33 661 cases including 819 deaths) andUganda (6326 cases including 135 deaths). Cases contin-ued to be reported along the Congo River affecting

5 provinces of the Democratic Republic of the Congoas well as in the eastern part of the country where chol-era is endemic, with cases reported from Ituri, Northand South Kivu, Katanga and Maniema provinces. InUganda, cholera epidemics were reported in the MountElgon area (Eastern region) and in the districts sur-rounding Lake Albert (Western region).

In Central Africa, an important decrease in reported

cases was observed, and the countries bordering the LakeChad Basin, Cameroon, Chad and Nigeria accounted fora 98% decrease in reported cases compared to 2011.

In West Africa reported cases increased by 171% witha total of 50 066 cases compared with 18 412 in 2011.An important outbreak in Guinea and Sierra Leone ac-

2011, le nombre de cas noti s par lAfrique a diminu de37%, tombant un niveau comparable celui noti en 2005(Figure 2 ). Cinq pays dAfrique de lOuest (Ghana, Guine,Guine-Bissau, Niger et Sierra Leone) ont totalis 48 974 cas, soit42% du nombre de cas noti s par le continent (Carte 1 ).

Par rapport 2011, le nombre de cas noti s par lAfriquecentrale et la Corne de lAfrique fait apparatre une baisseimportante. En 2012, la tendance la baisse a galement tcon rme en Afrique australe et orientale.

Dans lensemble, une baisse importante du nombre de cas noti-

s par la Corne de lAfrique a t observe, mais 22 576 cas(dont 200 mortels) ont t noti s par la Somalie.

La tendance la baisse observe ces dernires annes dans lespays situs le long de la cte orientale de lAfrique sest con r-me en 2012, avec une diminution de 40% du nombre total decas noti s pour cette rgion en 2012.

En Afrique australe, le nombre de cas noti s a continu bais-

ser, atteignant les niveaux les plus bas jamais signals depuisle dbut du millnaire.

Dans la rgion des Grands Lacs, le nombre de cas noti s aaugment de 71% par rapport 2011, principalement en raisondimportantes ambes survenues en Rpublique dmocratiquedu Congo (33 661 cas, dont 819 mortels) et en Ouganda (6326 cas,dont 135 mortels). Des cas ont continu tre noti s le longdu euve Congo dans 5 provinces de la Rpublique dmocra-

tique du Congo ainsi que dans la partie orientale du pays ole cholra svit ltat endmique, des cas tant noti s par lesprovinces dIturi, de Kivu nord et sud, de Katanga et deManiema. En Ouganda, des pidmies de cholra ont t signa-les dans la zone du Mont Elgon (rgion est) et dans les districtsentourant le Lac Albert (rgion ouest).

En Afrique centrale, on a observ une importante diminutiondu nombre de cas noti s et les pays riverains du Bassin duLac Tchad, le Cameroun, le Nigria et le Tchad ont reprsent98% de la baisse des cas noti s par rapport 2011.

En Afrique de lOuest, le nombre de cas noti s a augmentde 171%, avec un total de 50 066 cas contre 18 412 en 2011. Une

ambe importante survenue en Guine et en Sierra Leone a


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0 50 10025 Kilometers Kilomtres

Map 2 Areas affected by cholera outbreaks in 2012, in Guinea, Guinea-Bissau and Sierra LeoneCarte 2 Zones touches par des fambes de cholera en 2012, en Guine, Guine-Bissau et Sierra Leone

Cumulative attack rate/1000 hab Taux datteinte cumul pour 1000 habitants

0.11.61.74.2

4.38.0

Guinea-Bissau Guine-Bissau

Guinea Guine

Sierra Leone

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WorldHealth Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers orboundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Les limites et appellations gurantsur cette carte ou les dsignations employes nimpliquent de la part de lOrganisation mondiale de la Sant aucune prise de position quant au statut

juridique des pays, territoires, villes ou zones, ou de leurs autorits, ni quant au trac de leurs frontires ou limites. Les lignes en pointill sur les cartesreprsentent des frontires approximatives dont le trac peut ne pas avoir fait lobjet dun accord d nitif.

Source: World Health Organization Source: Organisation mondiale de la santMap : WHO Department of Control of Epidemic Diseases Carte: Dpartement OMS de lutte contre les maladies pidmiques

WHO 2013. All rights reserved OMS 2013. Tous droits rservs

districts along the Niger River on the border with Mali.The CFRs were high for Burkina Faso (4.9%), CtedIvoire (4.5%) and Mali (8.7%).

The AmericasThe large outbreak that started in Haiti in October 2010has continued throughout 2011 and 2012 but in2012, the number of reported cases decreased by 67%compared with 2011 and the number of deaths de-creased by 69% (112 076 cases including 894 deaths CFR

ont t levs au Burkina Faso (4,9%), en Cte dIvoire (4,5%)et au Mali (8,7%).

AmriquesLimportante ambe qui a dmarr en Hati en octobre 2010sest poursuivie tout au long de 2011 et de 2012, mais en 2012, lenombre de cas noti s a baiss de 67% par rapport 2011 etle nombre de dcs a baiss de 69% (112 076 cas, dont894 mortels TL 0 8%) Dans lensemble le TL global a chut


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quake in January 2010. The outbreak spread to theDominican Republic: in 2012, the Dominican Republicreported a total of 7919 cases including 68 deaths (CFR,0.9%) from 32 provinces. These gures represent a 62%decrease in reported cases and a decrease of 80% inreported deaths compared to the previous year.

Cuba reported a cholera outbreak that started in Julyand lasted until the end of August 2012. A total of417 cases, including 3 deaths were recorded in Manza-nillo, a municipality of Granma Province. A few isolatedcases with travel history to Manzanillo were recordedin Santiago de Cuba, Guantanamo and La Havana. Mostcases occurred in adults and all were infected withVibrio cholerae toxigenic serogroup O1, serotype Ogawa,biotype El Tor. This was the rst cholera outbreak inCuba since the mid-19th century.

Cases of autochthonous transmission of V. cholerae O1have been reported in Mexico (2) and the United States(1). The United States also reported 17 imported cases.Additionally, an imported case was reported by theBahamas (1).

With the introduction of V. cholerae into the Caribbean,it is important that countries in the Americas continueto ensure strengthened cholera surveillance to detectcases early, allowing timely triggering of controlmeasures.

AsiaDuring 2012, a total of 7367 cases including 27 deathswere reported by 12 countries (CFR, 0.4%). This repre-sents a decrease of 81% in reported cases compared to2011. (Figure 2, Table 1 ); Asia accounted for 3% of theglobal total. An important outbreak was reported in Iraqwith 4693 cases including 4 deaths (CFR 0.1%). The northof the country had experienced its second cholera out-break within 5 years. The rst detected case occurred atthe end of September 2012 in Suliemanya and Kirkukgovernorates with the majority of the cases registered inSuliemanya. The Philippines were also affected by animportant outbreak with 1864 cases including 14 deaths(CFR 0.8%) in all 11 municipalities of Catanduanes prov-ince between January and June 2012. Cases were reported

7919 cas, dont 68 mortels (TL 0,9%) dans 32 provinces. Ceschiffres reprsentent une diminution de 62% des cas noti s etune diminution de 80% des dcs noti s par rapport lanneprcdente.

Cuba a signal une pidmie de cholra qui a commenc en juillet et a dur jusqu la n aot 2012. Au total, 417 cas, dont3 mortels, ont t enregistrs Manzanillo, une municipalit dela Province de Granma. Quelques cas isols prsentant des ant-cdents de dplacements Manzanillo ont t enregistrs Santiago de Cuba, Guantanamo et La Havane. La plupart descas sont survenus chez des adultes et tous taient infects parVibrio cholerae , srogroupe O1 toxigne, srotype Ogawa,biotype El Tor. Il sagissait de la premire ambe de cholra Cuba depuis le milieu du XIXe sicle.

Des cas de transmission autochtone de V. cholerae O1 ont tsignals au Mexique (2) et aux tats-Unis (1). Les tats-Unisont galement signal 17 cas imports. De plus, un cas importa t noti par les Bahamas (1).

Avec lintroduction de V. cholerae dans les Carabes, il estimportant que les pays des Amriques continuent assurer unesurveillance renforce du cholra a n de dtecter prcocementles cas, et de permettre la mise en place rapide de mesures delutte.

AsieEn 2012, un total de 7367 cas, dont 27 mortels, ont t noti spar 12 pays (TL, 0,4%). Cela reprsente une diminution de 81%du nombre de cas noti s par rapport 2011 (Figure 2 , Tableau 1 );lAsie reprsentait 3% du total mondial. Une ambe importantea t signale en Iraq avec 4693 cas, dont 4 mortels (TL 0,1%).Le nord du pays a connu sa deuxime pidmie de cholra en5 ans. Les premiers cas sont survenus n septembre 2012 dansles gouvernorats de Suliemanya et de Kirkuk, la majorit des castant enregistrs Suliemanya. Les Philippines ont galement ttouches par une ambe importante avec 1864 cas, dont14 mortels (TL 0,8%) dans les 11 municipalits de la province deCatanduanes, entre janvier et juin 2012. Des cas ont t noti spar lAghanistan (12), la Chine (75, et 2 cas imports en RAS deHong Kong), lIran (53), le Japon (3 cas imports), le Myanmar


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EuropeImported cholera cases were reported from 2 Europeancountries: 1 in the Russian Federation and 17 in theUnited Kingdom; 24 countries reported zero cases.

OceaniaAustralia reported 5 imported cases.

SurveillanceUnder the International Health Regulations (2005) no-ti cation of all cases of cholera is no longer mandatory.However public health events involving cholera mustalways be assessed against the criteria provided in theregulations to determine whether there is a need forof cial noti cation. The move away from mandatorynoti cation linked to automatic publication should en-courage improved surveillance and information-sharingto prevent and contain cholera epidemics in a timelymanner. Local capacities for improving diagnosis, andfor collecting, compiling and analysing data, need to bestrengthened so that vulnerable populations living in

high-risk areas may be identi ed in order to bene t fromcomprehensive control activities. Cholera surveillanceshould be part of an integrated disease surveillance sys-tem that includes feedback at the local level and infor-mation-sharing at the global level. Use of the WHOstandard case de nition will allow a more precise esti-mation of the burden of cholera and thus facilitate moresustained support.

International travel and tradeExperience shows that quarantine and embargoes onthe movement of people and goods are unnecessary andineffective in controlling the spread of cholera. Importrestrictions on food produced under good manufactur-ing practices, based solely on the fact that cholera isepidemic or endemic in a country, are not justi ed.

Countries neighbouring cholera-affected areas are en-couraged to strengthen their own disease surveillanceand national preparedness to rapidly detect andrespond to outbreaks should cholera spread across bor-ders. Information should be provided to travellers andthe community about the potential risks of cholera, its

EuropeDes cas de cholra imports ont t noti s par 2 pays euro-pens: 1 en Fdration de Russie et 17 au Royaume-Uni; 24 paysnont noti aucun cas.

OcanieLAustralie a noti 5 cas imports.

SurveillanceDans le cadre du Rglement sanitaire international (2005), lanoti cation of cielle de tous les cas de cholra nest plus obli-gatoire, mais les vnements de sant publique impliquant lecholra doivent toujours tre valus selon les critres prvuspar le Rglement pour dterminer la ncessit dune dclara-tion of cielle. Le fait de ne plus avoir de noti cation obligatoiredclenchant une publication automatique devrait aider lam-lioration tant de la surveillance que des changes dinforma-tions pour prvenir et juguler rapidement les pidmies decholra. Il faut renforcer les capacits locales pour amliorer lediagnostic, la collecte, la compilation et lanalyse des donnes,de faon pouvoir recenser les populations vulnrables vivant

dans des zones haut risque et les faire bn cier dactivitsde lutte compltes. La surveillance du cholra devrait fairepartie dun systme intgr de surveillance de la maladieprvoyant le retour dinformations au niveau local et deschanges lchelle mondiale. Lapplication de la d nition decas standardise de lOMS permettra de faire une estimationplus prcise de la charge du cholra et donc de fournir un appuiplus soutenu.

Voyages et changes commerciaux internationauxLexprience a montr que les quarantaines et les embargosentravant la circulation des personnes et des biens sont desmesures inutiles et inef caces pour endiguer la propagation ducholra. Les restrictions limportation de denres produitesen respectant les bonnes pratiques de fabrication fondes surle seul fait que le cholra est pidmique ou endmique dansun pays ne se justi ent pas.

Les pays limitrophes de zones touches par le cholra sont invi-ts renforcer leur propre systme de surveillance et leurprparation nationale pour dtecter rapidement les ambes ety rpondre si le cholra venait se propager au-del des fron-tires. Il convient dinformer les voyageurs et les communautsdes risques potentiels, des symptmes, des prcautions


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WHO does not advise a requirement for prophylacticadministration of antibiotics, or proof of their admin-istration, for travellers coming from or going to a coun-try affected by cholera.

Variation in strainsV. cholerae O139, which emerged in the Bay of Bengalin 1992, has so far been con ned to South-East Asia.During 2012, only China reported occurrence of casesdue to O139 strains. Among the 69 laboratory-con rmedcases in China, 52 were O139 serogroup. Laboratorycon rmation in Sierra Leone and Guinea resulted in the

isolation of V. cholerae O1 serotype Ogawa, while sero-type Inaba was preponderant in the East part of theDemocratic Republic of the Congo.

Countries are encouraged to test for both serogroupsO1 and O139 when diagnosing V. cholerae infection.

Recently newly evolved strains have been reported fromseveral parts of the world. These variant El Tor strainsexpress the toxin produced by classical strains, and ap-pear to be more virulent. These strains were rst iden-ti ed in Bangladesh and have since been reported fromseveral African countries, from Asia and from Hispan-iola; they cause more severe episodes of cholera andare associated with higher CFRs. 6

Multidrug-resistance has emerged in recent years inBangladesh. Strains have been isolated from patientshospitalized in Dhaka; these patients had longer hospi-tal stays, presented with excess purging and requiredmore intravenous uids.

Molecular epidemiology, continuous monitoring ofantimicrobial susceptibility, and strain-tracking areimportant tools for obtaining data to guide the adapta-tion of policies for cholera control at national and

global levels.

Update: oral cholera vaccines

Background

Oral cholera vaccines have been developed and provedt b f i g i d ff ti O l 2 f th

LOMS ne recommande pas dexiger ladministration prophylac-tique dantibiotiques, ou lattestation de cette prophylaxie, pourles voyageurs en provenance ou destination dun pays touchpar le cholra.

Variations dans les souchesV. cholerae O139, qui est apparue dans le Golfe du Bengale en1992, a jusquici t con ne lAsie du Sud-Est. En 2012, seulela Chine a rapport la survenue de cas dus des souches O139.Sur les 69 cas con rms en laboratoire en Chine, 52 apparte-naient au srogroupe O139. La con rmation en laboratoire enSierra Leone et en Guine sest traduite par lisolement de

V. cholerae O1 srotype Ogawa, tandis que le srotype Inabatait prpondrant dans la partie orientale de la Rpubliquedmocratique du Congo.

Les pays sont encourags rechercher la fois les srogroupesO1 et O139 lors du diagnostic de linfection V. cholerae .

Des souches dvolution rcente ont t signales dernirementdans diffrentes parties du monde. Ces souches variantes El Torexpriment la toxine produite par les souches classiques maisparaissent plus virulentes. Elles ont dabord t identi es auBangladesh et ont depuis t signales dans plusieurs paysdAfrique, en Asie et sur lle dHispaniola; elles sont associes des pisodes plus svres de cholra et des taux de ltalitplus levs. 6

Une polypharmacorsistance est apparue ces dernires annesau Bangladesh. Des souches ont t isoles chez des patientshospitaliss Dhaka; ces patients ont t hospitaliss plus long-temps et ont prsent des pertes hydriques plus profuses obli-geant augmenter le volume des solutions perfuses en intra-veineuse.

Lpidmiologie molculaire, la surveillance continue de lasensibilit aux antimicrobiens et le traage des souches sontdes outils importants pour obtenir des donnes et guiderladaptation des politiques de lutte anticholrique aux niveaux

national et mondial.

Le point: vaccins anticholriques oraux

Gnralits

Des vaccins anticholriques oraux ont t mis au point et sesont avrs srs immunognes et ef caces Seuls 2 dentre eux


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endemic countries, particularly in Asia, because it isa bivalent O1 and O139 vaccine, and has no recombi-nant B subunit (so not requiring dilution in buffersolution). Both are prequali ed by WHO and may there-fore be purchased by United Nations agencies.

WHO has never recommended the use of the parenteralcholera vaccine because of its limited protective ef cacy(45% for 3 months) and its unsuitability for publichealth purposes. The previously licensed oral live at-tenuated single-dose vaccine (CVD 103-HgR) is cur-rently not being produced. However, efforts are beingmade to resume its production.

Whole-cell killed + recombinant B subunit vaccine(Dukoral)

The whole-cell recombinant B subunit (WC/rBS) vaccine(Crucell, Sweden) consists of killed whole-cellV. chol-erae O1 with puri ed recombinant B subunit of choleratoxoid; each dose must be diluted in 150 ml of bicarbon-ate buffer. It is administered to adults and children aged>6 years in 2 doses; it is also administered to childrenaged >2 years and 6 ans en 2 doses; il est gale-ment administr aux enfants gs de >2 ans et


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(Shantha Biotechnics, Hyderabad, India). Shanchol wasgranted WHO prequali cation in September 2011. Theimmunization schedule is 2 doses given at an interval of2 weeks; there is no need for a booster dose.

Shanchol has provided longer term protection in chil-dren aged


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Editorial noteAlthough the number of cholera cases reported world-wide decreased during 2012, the Hispaniola Island andseveral African countries continue being affected bysevere epidemics. This, and the fact that the choleradeath toll remains unacceptably high, shows clearly thatthis disease remains a signi cant unresolved publichealth problem.

Signi cant progress has been made by WHO and itspartners by establishing a 2 million doses stockpile ofOCV to respond to cholera epidemics, and collaborativework is ongoing to de ne a robust monitoring andevaluation framework that will provide countries andpartners with standard tools and protocols for assessingvaccine use.

However, effective prevention and control of cholerarequires renewed efforts towards the integration of mul-tidisciplinary approaches, combining the use of newand traditional interventions and tools. To this end,

WHO has initiated a consultation of key stakeholders,in close collaboration with the Task Force for GlobalHealth, with the objective of re-de ning the goal, struc-ture and membership of the Global Cholera Task Forcefor Cholera Control, so as to reinforce global coordina-tion of control initiatives and ensure that the needs ofcountries at high risk are better prioritized and effec-tively addressed.

Note de la rdactionBien que le nombre de cas de cholra noti s dans le mondeait diminu en 2012, lle dHispaniola et plusieurs paysdAfrique continuent dtre victimes dpidmies graves. Cela,alli au fait que la mortalit due la maladie reste encore beau-coup trop leve, montre clairement que le cholra demeure unproblme de sant publique important et non rsolu.

Des progrs non ngligeables ont t faits par lOMS et sespartenaires avec la cration dun stock de 2 millions de dosesde VCO pour pouvoir ragir en cas dpidmie de cholra, etune action collective se poursuit a n de d nir un cadre desuivi et dvaluation solide qui fournisse aux pays et aux parte-naires des outils et des protocoles standards pour lvaluationde lutilisation du vaccin.

Toutefois, une lutte ef cace contre le cholra exige des effortsrenouvels en faveur de lintgration dapproches multidiscipli-naires, en combinant lutilisation des outils et interventionsclassiques et des nouveaux. cette n, lOMS a entam une

consultation des principales parties prenantes, en troite colla-boration avec le Groupe spcial pour la sant mondiale, lobjec-tif tant de redfinir le but, la structure et la compositiondu Groupe spcial mondial de lutte contre le cholra, defaon renforcer la coordination mondiale des initiatives delutte et faire en sorte que les besoins des pays haut risquesoient mieux pris en compte et quil y soit rpondu de faonefficace.

How to obtain the WER through the Internet

(1) WHO WWWSERVER : Use WWW navigation software toconnect to the WER pages at the followingaddress:http://www.who.int/wer /

(2) An e-mail subscription service exists which provides by

Comment accder au REH sur Internet?

1) Par le serveur Web de lOMS: A laide de votre logiciel de navigation WWW, connectez-vous la page daccueil du REH ladresse suivante: http://www.who.int/ wer/

2) Il existe galement un service dabonnement permettant de rece-


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Guidelines Marches suivreCholera outbreak: assessing the outbreak response and improving preparedness.Flambes de cholera: Evaluation des mesures mises en uvre en cas de

ambe et amlioration de la prparation WHO/CDS/CPE/ZFK/2004.4http://www.who.int/cholera/publications/OutbreakAssessment/en/index.html (English, French, Russian, Spanish, Portuguese and Swahili)First steps for managing an outbreak of acute diarrhoea Premires tapes de la prise en charge dune ambe de diarrhe aigu.WHO/CDS/CSR/NCS/2003.7 Rev.2http://www.who.int/cholera/publications/ rststeps/en/index.html (English,French, Arabic, Russian, Spanish, Portuguese and Swahili)Acute diarrhoeal diseases in complex emergencies: critical steps

Les maladies diarrhiques aigus dans les situations durgence complexes:mesures essentielles WHO/CDS/CPE/ZFK/2004.6 Rev.1http://www.who.int/cholera/publications/criticalsteps/en/index.html(English, English, French, Arabic, Russian, Spanish, Portuguese and Swahili)

Laboratory LaboratoirePAHO/WHO Expert Consultation on Pharmacological Measures for Prevention of Cholera Introduction in Nonendemic Areas , 2011PAHO/HSD/IR/A/00112Laboratory methods for the diagnosis of epidemic dysentery and cholera , 1999Mthodes de laboratoire pour le diagnostic de la dysenterie pidmique etdu cholra , 1999http://www.who.int/topics/cholera/publications/WHO_CDS_CSR_EDC_99_8_EN/en/index.html

Other diarrhoeal diseases Autres maladies diarrhiquesGuidelines for the control of shigellosis, including epidemics due to Shigelladysenteriae type 1. ISBN: 9241592330http://www.who.int/topics/cholera/publications/shigellosis/en/index.htmlAntibiotics in the management of shigellosis Traitement de la shigellosepar les antibiotiquesWeekly Epidemiological Record Relev pidmiologique hebdomadaire ,2004, 79:355356http://www.who.int/wer/2004/en/wer7939.pdf Background document: the diagnosis, treatment, and prevention of typhoidfever http://whqlibdoc.who.int/hq/2003/WHO_V&B_03.07.pdf

Vaccines VaccinsWHO Technical Working Group on creation of an oral cholera vaccine stockpile Meeting report Geneva, 2627 April 2012 http://apps.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdf Oral cholera vaccines in mass immunization campaigns, guidance for planning and use

http://whqlibdoc.who.int/publications/2010/9789241500432_eng.pdf Cholera vaccines: WHO position paper Vaccins anticholriques: notedinformation de lOMSWeekly Epidemiological Record Relev pidmiologique hebdomadaire ,2010, 85:117128http://www.who.int/werOral cholera vaccine use in complex emergencies: What next? Report of aWHO meeting. Cairo, Egypt, 1416 December 2005.

WHO cholera information sources on the web Sources dinformation OMS lectroniques sur le cholra

Use of the two-dose oral cholera vaccine in the context of a major naturaldisaster. Aceh Province, Indonesia, 2005 WHO/CDS/NTD/IDM/2006.1http://www.who.int/topics/cholera/publications/

nal_tsunami.pdf Typhoid vaccines: WHO position paper Vaccins antityphodiques: notedinformation de lOMSWeekly Epidemiological Record Relev pidmiologique hebdomadaire ,2000, 75:257264http://www.who.int/docstore/wer/pdf/2000/wer7532.pdf

Training material Documents de formationEpidemic diarrhoeal disease preparedness and response Training and

practice (Participants manual) , 1998Prparation et rponse aux pidmies de maladies diarrhiques Formation et pratique (Manuel du participant) , 1998http://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_3Rev_1/en/index.html

Epidemic diarrhoeal disease preparedness and response Training and practice (Facilitators guide) , 1998Prparation et rponse aux pidmies de maladies diarrhiques Formation et pratique (Guide du modrateur) , 1998http://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_4Rev_1/en/index.html

Videos VidosOral cholera vaccines: a mass vaccination campaign, Zanzibar, United

Republic of Tanzania, 2009 (12mn, English and French)http://www.who.int/cholera/technical/prevention/vaccines/en/index.html

Protecting ourselves and our communities from cholera, 2000 Le Cholra,comment nous en protger et protger notre communaut , 2000 (41 mn)

Fact sheets Aides mmoireCholera Cholra http://www.who.int/mediacentre/factsheets/fs107/en/index.html

Internet only Internet seulementWHO position paper on Oral Rehydration Salts to reduce mortality from cholera http://www.who.int/cholera/technical/en/index.html

WHO statement relating to international travel and trade to and from countries experiencing outbreaks of cholera http://www.who.int/cholera/technical/prevention/choleratravelandtradeadvice231110.pdf

Frequently asked questions and information for travelers http://www.who.int/cholera/technical/FaqTravelersNov2010.pdf Disease outbreak news index cholera (updated regularly mis jourrgulirement)http://www.who.int/csr/don/archive/disease/cholera/en/index.html

Global data Donnes gnrales

Cholera 2011 Cholra 2011Weekly Epidemiological Record Relev pidmiologique hebdomadaire ,2011, 87(31-32):289-304http://www.who.int/cholera/statistics/en/index.html (see issue No. 31 ofeach year voir n 31 de chaque anne)

Global atlas of infectious diseases - http://globalatlas.who.int/

Global Health Observatory -http://www.who.int/gho/epidemic_diseases/cholera/en/index html
http://www.who.int/cholera/publications/OutbreakAssessment/en/index.htmlhttp://www.who.int/cholera/publications/firststeps/en/index.htmlhttp://www.who.int/cholera/publications/criticalsteps/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_CDS_CSR_EDC_99_8_EN/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_CDS_CSR_EDC_99_8_EN/en/index.htmlhttp://www.who.int/topics/cholera/publications/shigellosis/en/index.htmlhttp://www.who.int/wer/2004/en/wer7939.pdfhttp://apps.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdfhttp://apps.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdfhttp://whqlibdoc.who.int/publications/2010/9789241500432_eng.pdfhttp://www.who.int/werhttp://www.who.int/topics/cholera/publications/final_tsunami.pdfhttp://www.who.int/topics/cholera/publications/final_tsunami.pdfhttp://www.who.int/docstore/wer/pdf/2000/wer7532.pdfhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_3Rev_1/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_3Rev_1/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_4Rev_1/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_4Rev_1/en/index.htmlhttp://www.who.int/cholera/technical/prevention/vaccines/en/index.htmlhttp://www.who.int/mediacentre/factsheets/fs107/en/index.htmlhttp://www.who.int/cholera/technical/en/index.htmlhttp://www.who.int/cholera/technical/prevention/choleratravelandtradeadvice231110.pdfhttp://www.who.int/cholera/technical/prevention/choleratravelandtradeadvice231110.pdfhttp://www.who.int/cholera/technical/FaqTravelersNov2010.pdfhttp://www.who.int/csr/don/archive/disease/cholera/en/index.htmlhttp://www.who.int/cholera/statistics/en/index.htmlhttp://globalatlas.who.int/http://www.who.int/gho/epidemic_diseases/cholera/en/index.htmlhttp://www.who.int/gho/epidemic_diseases/cholera/en/index.htmlhttp://www.who.int/gho/epidemic_diseases/cholera/en/index.htmlhttp://www.who.int/gho/epidemic_diseases/cholera/en/index.htmlhttp://globalatlas.who.int/http://www.who.int/cholera/statistics/en/index.htmlhttp://www.who.int/csr/don/archive/disease/cholera/en/index.htmlhttp://www.who.int/cholera/technical/FaqTravelersNov2010.pdfhttp://www.who.int/cholera/technical/prevention/choleratravelandtradeadvice231110.pdfhttp://www.who.int/cholera/technical/prevention/choleratravelandtradeadvice231110.pdfhttp://www.who.int/cholera/technical/en/index.htmlhttp://www.who.int/mediacentre/factsheets/fs107/en/index.htmlhttp://www.who.int/cholera/technical/prevention/vaccines/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_4Rev_1/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_4Rev_1/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_3Rev_1/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_EMC_DIS_97_3Rev_1/en/index.htmlhttp://www.who.int/docstore/wer/pdf/2000/wer7532.pdfhttp://www.who.int/topics/cholera/publications/final_tsunami.pdfhttp://www.who.int/topics/cholera/publications/final_tsunami.pdfhttp://www.who.int/werhttp://whqlibdoc.who.int/publications/2010/9789241500432_eng.pdfhttp://apps.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdfhttp://apps.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdfhttp://www.who.int/wer/2004/en/wer7939.pdfhttp://www.who.int/topics/cholera/publications/shigellosis/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_CDS_CSR_EDC_99_8_EN/en/index.htmlhttp://www.who.int/topics/cholera/publications/WHO_CDS_CSR_EDC_99_8_EN/en/index.htmlhttp://www.who.int/cholera/publications/criticalsteps/en/index.htmlhttp://www.who.int/cholera/publications/firststeps/en/index.htmlhttp://www.who.int/cholera/publications/OutbreakAssessment/en/index.html


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