Current Situation
Since the first disease outbreak news on the global cholera situation was published on 16 December 2022, the global situation has further deteriorated with additional countries reporting cases and outbreaks.
Since mid-2021, the world is facing an acute upsurge of the 7th cholera pandemic characterized by the number, size and concurrence of multiple outbreaks, the spread to areas free of cholera for decades and alarming high mortality rates.
In 2021, 23 countries reported cholera outbreaks, mainly in the WHO Regions of Africa and the Eastern Mediterranean. This trend continued into 2022 as 30 countries across five of the six WHO regions reported cholera cases or outbreaks. Among those, 14 had not reported cholera in 2021, including non-endemic countries (Lebanon and Syria)i,ii or countries that had not reported cases over three years (Haiti and the Dominican Republic), while most of the remaining countries reported higher case numbers and case fatality ratios (CFR) than in previous years.
As of 1 February 2023, at least 18 countries continue to report cholera cases (Table 1 A & B). As according to the seasonality patterns large parts of the world are in currently in low or interepidemic transmission period this number could increase in the months to come.
The mortality associated to those outbreaks is of particular concern as many countries reported higher CFR than in previous years. The average cholera CFR reported globally in 2021 was 1.9% (2.9% in Africa), a significant increase above acceptable (<1%) and the highest recorded in over a decade. Preliminary data suggests similar trend for 2022 and 2023.
The potential drivers of the outbreaks and challenges impacting response activities were highlighted in the last Disease Outbreak News. The simultaneous progression of several cholera outbreaks, compounded in countries facing complex humanitarian crises with fragile health systems and aggravated by climate change, poses challenges to outbreak response and risks further spreading to other countries.
The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including the oral cholera vaccine, as well as overstretched public health and medical personnel, who are dealing with multiple disease outbreaks at the same time.
Based on the current situation, including the increasing number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO assesses the risk at the global level as very high.
