Global cholera threat continues to escalate with surges in parts of Africa

Ethiopian child with cholera

UNICEF Ethiopia/2023/Nahom Tesfaye/Flickr cc

Preliminary data for 2023 points to a concerning rise in cholera cases and deaths in multiple world regions, a trend that continues into 2024 with surges in Zambia and Zimbabwe, the World Health Organization (WHO) said this week in its latest update.

Though the group is still gathering and analyzing 2023 data, it said 30 countries across five WHO regions reported cholera cases, including nine countries that recorded more than 10,000 cases. The situation remains a grade 3 emergency, the WHO's highest internal emergency level, keeping the global risk as "very high."

In the first month of 2024, countries reported 40,900 cases and 775 deaths.

Africa the hardest-hit region

In Africa, 17 countries reported outbreaks in 2023, with the highest numbers from the Democratic Republic of the Congo, Malawi, and Mozambique. Cholera was especially deadly in Malawi, which reported 26% of the world's cholera deaths last year. Also, Ethiopia, Zimbabwe, and Kenya grappled with significant outbreaks.

Meanwhile, in the Eastern Mediterranean region, eight countries reported outbreaks, with high numbers reported from Afghanistan and Syria. The WHO added that high numbers from those two countries are partly due to a broader case definition, which includes any sickness or death from acute watery diarrhea. The broader definition is useful in conflict situations when diagnostic capability is limited but can fold in other gastrointestinal illnesses.

In the Americas, Hatiti battled a severe outbreak, and in South East Asia, a few countries, including India, Bangladesh, and the Philippines, reported smaller events.

No let-up in new-year momentum

So far this year, nearly 41,000 cases have been reported, 775 of them fatal, from 17 countries in four regions.

Africa remains the worst-affected region. The WHO said especially striking are surges in Zambia, where more than 12,000 new cases, 467 of them fatal, have been reported and in Zimbabwe, where more than 6,700 cases and 156 deaths have been reported.

"The sustained number of countries reporting cases into January 2024 underscores the ongoing challenges posed by cholera and the critical need for persistent public health initiatives," the WHO said, emphasizing that the countries need stronger water and sanitation systems, better awareness of cholera transmission in risk groups, enhanced surveillance, and support for case management.

Vaccine shortages still a response obstacle

Ongoing shortages of oral cholera vaccine are still critical, the WHO said. In 2023, 14 countries requested 76 million doses, but only 38 million doses were available—half the amount needed.

The global stockpile is waiting for replenishment, and all production up to March 8 will be allocated to requests that have already been approved. The WHO said the vaccine shortage, along with geographic cholera expansion and number of outbreaks, is part of what keeps the emergency at the grade 3 level.

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