Outbreak of multi-drug resistant Vibrio cholerae Ogawa Serotype in Ibb, Yemen (2018–2024): The OVCO-IY study

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OBJECTIVE: This study aims to investigate the epidemiological trends, antibiotic resistance patterns, and demographic and clinical characteristics of Vibrio cholerae infections in Ibb, Yemen, during the conflict years 2018-2024. By analyzing demographic characteristics, antimicrobial susceptibility profiles, and spatial-temporal trends, our objective is to provide insights into cholera dynamics in a conflict-affected region, with a focus on the predominant O1 Ogawa serotype. STUDY DESIGN AND SETTING: This retrospective observational study analyzed clinical, demographic, and laboratory data from 1663 patients with suspected cholera or other enteric infections treated at healthcare centers in Ibb, Yemen, between 2018 and 2024. We describe key trends in infections and patterns of antibiotic resistance, providing a data-driven quantitative understanding of cholera dynamics in the context of prolonged conflict. Statistical analyses included calculation of attack rates, descriptive statistics, group comparisons, trend tests for ordinal data, and visualization of resistance patterns using R software. RESULTS: Of the 1663 patients with clinical symptoms of cholera, 584 (35.1%) were confirmed by laboratory testing to have Vibrio cholerae O1. The predominant strain was Ogawa, with a significantly higher prevalence in females (63.7%) and among individuals aged 19-35 years. All 16 antibiotics evaluated against Vibrio cholerae O1 isolates demonstrated either resistance or susceptibility. The number of cases tested varied across antibiotics. Among those with resistance, ampicillin and co-trimoxazole were tested in the largest proportion of cases, accounting for 65.4% and 67.3%, respectively. For susceptible antibiotics, Ciprofloxacin and Chloramphenicol had the highest testing coverage, with 68.2% and 60.4% of cases tested, respectively. Temporal trends showed a high proportion of cholera cases in 2018 (49.6%) and a peak in 2019 (52.2%), followed by a decline in 2020 (2%) and no cases from 2021 to 2023, with a resurgence in 2024 (23.1%). CONCLUSION: Cholera remains a severe public health threat in Yemen, intensified by the ongoing war and a prolonged humanitarian crisis that have devastated water, sanitation, and healthcare infrastructure. This study highlights the urgent need for targeted interventions, including oral cholera vaccination, improved sanitation systems, strengthened disease surveillance, and rational antibiotic use policies to curb resistance development and reduce the disease burden in conflict-affected settings.

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