In its latest snapshot of global cholera activity, the World Health Organization (WHO) said 29 countries this year have reported outbreaks, including 16 that are experiencing protracted activity. It said the outbreaks follow a spike in activity in 2021, which followed years of decline.
Much of the recent activity has come from countries in the Americas and Africa, with many of them reporting more cases and higher case-fatality ratios than in previous years.
The WHO said one concern is that 13 outbreaks are occurring in countries that didn't report any cases in 2021. Some hadn't reported cases in many years, while others aren't considered cholera-endemic areas.
Multiple outbreaks against the backdrop of complex humanitarian crises—made worse by climate change—is adding to global response challenges and pose risks of spread to other countries, the WHO said. Also, health officials are faced with limited supplies of cholera vaccine and healthcare systems that are stretched thin by juggling other health crises.
Aside from climate change and humanitarian crises, other drivers include surveillance gaps, supply chain problems, and limited resources, including oral cholera vaccine.
Currently, seven African nations are experiencing outbreaks. In the Middle East, outbreaks are occurring in Syria and Lebanon. In South Asia, Bangladesh is experiencing its largest outbreak since 2000, which is occurring before the monsoon season. Haiti is the hot spot in the Americas, and in the Western Pacific, the Philippines has reported localized outbreaks.
The WHO, which in October put the global risk of further spread of cholera as very high, urged countries to improve access to quick care, improve access to safe drinking water, and step up infection prevention and control in health facilities. It added that the oral cholera vaccine, currently used as a one-dose regimen to stretch supplies, should be used alongside improvements in water and sanitation.