Long-Distance Spread of a Highly Drug-Resistant Epidemic Cholera Strain

This correspondence documents the transcontinental spread of a highly drug-resistant seventh-pandemic Vibrio cholerae O1 El Tor (7PET) strain, sublineage AFR13, from South Asia to East Africa and Europe. Initially identified in Zimbabwe (2018–2019), the strain carried an IncC plasmid (pYA00120881) with 14 resistance genes. A related strain in Yemen acquired a distinct IncC plasmid (pCNRVC190243), conferring resistance to azithromycin, ciprofloxacin, and third-generation cephalosporins. By 2022–2024, the AFR13 strain was detected in Lebanon, Kenya, Tanzania, Comoros, and Mayotte, including in European travelers returning from Kenya. Genomic surveillance revealed its presence in recent outbreaks, including 12,120 cases in Kenya and 7335 in Comoros. The authors call for strengthened laboratory capacity and real-time transborder surveillance to monitor the strain’s evolution and prevent further resistance acquisition that could compromise oral cholera treatment.

This correspondence documents the transcontinental spread of a highly drug-resistant seventh-pandemic Vibrio cholerae O1 El Tor (7PET) strain, sublineage AFR13, from South Asia to East Africa and Europe. Initially identified in Zimbabwe (2018–2019), the strain carried an IncC plasmid (pYA00120881) with 14 resistance genes. A related strain in Yemen acquired a distinct IncC plasmid (pCNRVC190243), conferring resistance to azithromycin, ciprofloxacin, and third-generation cephalosporins. By 2022–2024, the AFR13 strain was detected in Lebanon, Kenya, Tanzania, Comoros, and Mayotte, including in European travelers returning from Kenya. Genomic surveillance revealed its presence in recent outbreaks, including 12,120 cases in Kenya and 7335 in Comoros. The authors call for strengthened laboratory capacity and real-time transborder surveillance to monitor the strain’s evolution and prevent further resistance acquisition that could compromise oral cholera treatment.