Cholera is an acute, watery diarrheal illness caused by the bacterium Vibrio cholerae. It remains a public health issue in many parts of the world, with millions of cases and around 100,000 deaths annually.1 The environmental niches of V. cholerae include saline coastal waters, rivers, and estuaries, often in association with crustacean zooplankton. Thus far, 210 serogroups of V. cholerae have been described, among which those secreting the cholera toxin can cause outbreaks. Vibrio cholerae serogroup O1 biotype El Tor is the cause of the current pandemic that has been ongoing since the 1960s.1 Major outbreaks are currently ongoing, mainly in sub-Saharan Africa and in Hispaniola.1 Serotype O139, which emerged in the 1990s and spanned most of Asia, is now rarely isolated.1
In August 2018, the Algerian health authorities disclosed a cholera outbreak in the northern part of Algeria, almost 40 years after the last epidemic in the country.2 In early September 2018, more than 200 patients with cholera-like symptoms had been hospitalized, leading to two deaths. Cases were reported in seven wilayas (provinces), and V. cholerae was identified in the city of Blida, in the Bani Azza river that extends to the beach in the Algiers area. Vibrio cholerae O1 biotype El Tor serotype Ogawa was confirmed in 83 cases at the Pasteur Institute in Algiers.2
The most recent information suggests that the outbreak is now over.1 However, the origin of the emergence of this epidemic is unclear. Recent genomic works suggest that, apparently, epidemic clones do not implant themselves in endemic form outside Asian foci.1 Human movement from Asia would have the greatest impact for the spread and persistence of V. cholerae, rather than the reemergence of a local lineage of V. cholerae.1 We report here two cases from Algeria and Tunisia, in which V. cholerae was isolated in the absence of any watery diarrheal symptoms or any known cluster or outbreak of cholera.
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