Cholera Risks Remains Very High for Travelers

The World Health Organization (WHO) today reported the global cholera situation has deteriorated, with four new countries reporting outbreaks.

In total, 24 countries are reporting cases as of March 20, 2023.

Since the beginning of 2023, cholera outbreaks have spread further in southeast Africa.

And the widespread outbreaks in Malawi and Mozambique remain active.

Additional outbreaks have been reported in Tanzania, South Africa, Zimbabwe, and Zambia since the start of the year.

In the greater Horn of Africa, outbreaks continue in Somalia, Ethiopia, Kenya, and South Sudan.

Cholera is an acute diarrheal infection characterized, in its severe form, by extreme watery diarrhea and potentially fatal dehydration. It is caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. 

The mortality associated with these outbreaks is of particular concern as many countries reported higher case-fatality ratios (CFR).

The average cholera CFR reported globally in 2021 was 1.9% (2.9% in Africa). Preliminary data suggests a similar trend for 2022 and 2023.

The overall capacity to respond to cholera outbreaks continues to be strained due to the global lack of resources, including shortages of the oral cholera vaccine (OCV), says the WHO.

From a prevention perspective, the global surge in cholera cases over the past two years has put unprecedented stress on the OCV supply chain, resulting recently in the decision to temporarily suspend the standard two-dose vaccination regimen in cholera outbreak response campaigns, using a single-dose approach instead.

As of March 22, 2023, this vaccine disruption continues to impact OCV availability in the U.S.

Based on the current situation as presented in External situation report #1, the WHO assesses the risk at the global level as very high.