Cholera Outbreaks

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Last reviewed
November 6, 2023
Content Overview
Cholera is a vaccine preventable disease causing outbreaks in Haiti, Malawi, Africa, and Syria during 2023.

Cholera Outbreaks 2023

The U.S. Centers for Disease Control and Prevention (CDC) has identified an unprecedented global increase in cholera outbreaks in 2022 and 2023. In addition, the World Health Organization (WHO) says the current (7th) cholera epidemic has accelerated in 2023 and is considered to have started in 1961. The WHO has recorded seven cholera pandemics over the past two centuries. The WHO published External Situation Report #8 on November 2, 2023, confirming the WHO African Region remains the most affected region, with 29 countries reporting cholera cases since the beginning of 2023. The WHO continues to assess the risk of global cholera outbreaks as very high.

The CDC, the WHO, the Pan American Health Organization (PAHO), and the European CDC have reported active cholera transmissions in all six WHO regions, including Benin, Cameroon, the Democratic Republic of the CongoEswatini, Ethiopia, KenyaMalawiMozambique, Niger, Nigeria, Somalia, South AfricaSouth Sudan, Tanzania, Uganda, and ZambiaHaitiSyria, and India. Furthermore, data show 472,697 cholera cases were reported to the WHO in 2022, up from 223,370 in 2021. The number of countries reporting cholera cases rose from 35 to 44. The WHO reported the average cholera fatality rate in 2021 was 1.9% (2.9% in Africa).

Cholera in the U.S.

Nearly all cholera cases reported in the U.S. are acquired during international travel. For example, in December 2022, the CDC confirmed (8) travelers infected with cholera arrived from Pakistan, Iraq, and Bangladesh. In addition, the CDC's Clinician Outreach and Communication alert in 2023 identified an unprecedented global increase in cholera infections.

Cholera Africa

The cholera outbreak has affected 18 countries in the WHO African Region as of September 2023. The Republic of Kenya vaccinated about 1.59 million people in eight high-risk counties during a 10-day OCV campaign in early August 2023. Since January 2022, a cumulative number of 223,951 cholera cases has been reported in Africa, including 4,125 deaths, with a case-fatality ratio (CFR) of 1.8%. Cameroon, the Democratic Republic of the Congo, Malawi, Mozambique, and Nigeria account for 83.4% of the cases. The WHO says (Feb. 2023) Malawi has been experiencing a widespread cholera outbreak since March 2022. Malawi had among the highest total cases and the most deaths, 54,841 and 1,684, respectively, as of March 20, 2023. Cholera has been endemic in Malawi since 1998. In Mozambique, the first cholera case in the city of Beira was reported in January 1998, and an outbreak has been growing exponentially since December 2022, according to the WHO.

The Republic of Zimbabwe recently recorded 100 suspected cholera deaths from cholera and more than 5,000 possible cases in August 2023, prompting the government to impose restrictions.

The first cholera cases in this outbreak in South Africa were imported or import-related cases following travel to Malawi. All subsequent cases acquired infection locally and are classified as indigenous cases. As of May 22, 2023, a cholera outbreak has killed at least ten people near Pretoria. As a result, the city of Pretoria urged residents of Hammanskraal and surrounding areas not to drink from the tap. Sudan recently declared a cholera outbreak in Gedaref State, where 16 associated deaths had been reported in 2023.

Cholera Caribbean

In the Dominican Republic, the Ministry of Public Health confirmed 88 cholera cases, 71 of which were imported from Haiti as of late February 2023. Over three years, Haitian national authorities reported confirmed cholera cases in the greater Port-au-Prince area. Since January 2023 and as of August 2023, over 40,000 cholera cases, including 253 deaths, have been reported in Hati. 

Cholera Syria

Since a cholera outbreak was first declared in Syria in September 2022, over 50 thousand suspected cases have been reported in both Idlib and Aleppo governorates. On March 8, 2023, the WHO, UNICEF, the Syria Immunization Group, and the Global Alliance for Vaccines announced a cholera vaccination campaign would focus on northwest Syria. During the campaign, 1.7 million doses of a cholera vaccine will be offered to Syrians above one year of age. The U.S. CDC says (January 31, 2023) that active cholera transmission is widespread in Syria. However, cholera is rare among travelers. 

Cholera Taiwan

The Taiwan Centers for Disease Control and Prevention (TCDC) reported in July 2023 the first locally confirmed case of cholera of 2023. The cumulative number of local cases from 2019 to 2022 is 0, 1, 0, and 2 cases, respectively.

Cholera Vaccines

As of September 2023, various cholera vaccines have been WHO-approved but remain in limited availability.

Cholera Outbreak News 2023

August 4, 2023 - The WHO published a Multi-country cholera outbreak, External Situation Report #5.

March 22, 2023 - World Water Day 2023 is about accelerating change to solve the water and sanitation crisis.

February 24, 2023 - The WHO does not recommend any restrictions on travel and trade to and from Mozambique. 

January 19, 2023 - GAVI reported Malawi secured 2.9 million doses in November 2022.

January 17, 2023 - The Haitian Ministry of Health confirmed that the cholera outbreak has expanded in 2023. As of January 3, 2023, about 20,000 suspected cholera cases had been reported nationwide.

January 13, 2023 - The U.S. CDC published that as of January 3, 2023, less than 20,000 suspected cholera cases had been reported in Haiti.

January 11, 2023 - Malawi's Health Minister Khumbize Kandodo Chiponda confirmed the country had recorded 22,759 cholera cases and 750 deaths since March 2022.

January 6, 2023 - The BMJ reported Jane Feinmann follows the work of the International Federation of Red Cross and Red Crescent Societies in fighting this easily treated, yet rising, worldwide threat.