Occupied by the Russian army, the city of Mariupol in southeastern Ukraine has been cut off from the world since mid-May. In a press release published on Friday June 10, the British Ministry of Defense says that there is a risk of a major cholera epidemic. The medical services are “most likely on the verge of collapse”, according to English intelligence. Isolated cases “have been reported since May”, says the press release, which recalls that resurgences of the epidemic have taken place in the country as in 1995.
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However, this statement should be taken with caution. The World Health Organization (WHO) tells us that it has not received any notification of suspected or confirmed cases in the country. The NGO Doctors Without Borders (MSF), present in kyiv, Odessa, Mykolaiv and in cities in the East, also supports it: no case has been confirmed.
The WHO nevertheless remains on alert: it considers that there is a “high risk” of a cholera epidemic, due to a lack of access to drinking water, inadequate sanitary facilities, poor hygiene and population gatherings, underlines the institution in a report of April 29.
“The importation of cholera into Ukraine seems highly unlikely to me”
Cholera is transmitted by swallowing water or food contaminated with the cholera vibrio, a bacterium. In the intestine, vibrios secrete cholera toxin, “mainly responsible for the significant dehydration that characterizes the infection”, details the Institut Pasteur. Symptoms are manifested by violent diarrhea and vomiting, without fever. It can be fatal if not treated quickly.
Resurgences of the epidemic did indeed take place in 2011 in Mariupol with 33 cases, quotes the WHO, or also in 1995 with a few hundred cases. “But at that time, many people were coming and going to the south of the country, points out Renaud Piarroux, head of service at Pitié-Salpêtrière (APHP) and specialist in epidemics. Today, the importation of cholera into Ukraine seems highly unlikely to me. For the disease to spread, it has to happen. In a destroyed city where people can neither enter nor leave, I do not see what flow of immigrants would bring cholera. »
This is also what Claire Nicolet, MSF operations manager for Ukraine, says: “There is no confirmation that the cholera vibrio has arrived in the country. That doesn’t mean it can’t happen, but it would have to be imported somehow. »
In its report, the WHO hypothesizes that the cholera vibrio is already there. In 2017, it was detected in surface water in Mykolaiv, water likely to be drunk in the event of a supply disruption. This fear of the spread of cholera was raised recently in this city in the south of the country, located between Odessa and Kherson. “But there is no cholera problem in Mykolaiv,” assures MSF’s head of operations in Ukraine.
Other diarrheal diseases
Cholera foci are currently located in South Asia, sub-Saharan Africa and Yemen. Russia is not known as one. “Over the past two decades, it has been shown that the cholera pathogen is very specific,” explains Renaud Piarroux. We find cholera vibrios even in France, in the Rance estuary for example, but these are not the ones that cause cholera. The vibrio must be able to produce the cholera toxin. All the epidemics that could be studied, from the total sequencing of the DNA of the bacteria, were the consequence of the importation of cholera, in particular from Asia. »
The sanitary conditions on site open the door to other diarrheal diseases. “The major problem in obtaining confirmation or taking charge of these illnesses, adds Claire Nicolet of MSF, is access to the city. “Medical equipment with cholera detection kits has been sent preventively to the country, mentions the WHO. “Getting to Mariupol is difficult, but we are looking for opportunities through partners on the ground,” said a spokesperson for the institution.