Cholera worldwide overview

Monthly update as of 16 September 2022

ECDC monitors cholera outbreaks globally through epidemic intelligence activities in order to identify significant changes in epidemiology and to inform public health authorities. Reports are published on a monthly basis.

Several countries in Africa and Asia have reported cholera outbreaks in 2021 and 2022. Major ongoing outbreaks are being reported from Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia and Nigeria.

Since the last update on 24 August 2022, approximately 39 857 suspected cholera cases, including 114 deaths,
have been reported worldwide.

Countries reporting new cases since the previous update are Afghanistan, the Democratic Republic of the Congo, Iraq, Malawi, Mozambique, Nepal, Philippines, Somalia, South Sudan, Syria, and Zambia.

Countries with most cases
Nigeria, Niger, India and Bangladesh
Few travel-related cases
reported each year in the EU/EEA
Vaccination for travellers at higher risk
is recommended, such as emergency and relief workers

Geographical distribution of new cholera cases reported worldwide, July - September 2022

Geographical distribution of 3-month cholera case notification rate per 100 000 population reported worldwide, July-September 2022
Geographical distribution of new cholera cases reported worldwide, July - September 2022

Americas

No cholera cases have been reported in the Americas in 2022.

Africa

Burkina Faso: Since the last update on 24 August, no new cases have been reported in Burkina Faso. In 2022, and as of 5 July, one suspected cholera case has been reported in the country.

Cameroon: Since the last update on 24 August, no new cases have been reported in Cameroon. In 2022, and as of 3 August, a total of 9 821 suspected cases, including 200 deaths, have been reported in the country.

The Democratic Republic of the Congo (DRC): Since the last update on 24 August, 1 082 suspected cholera cases, including 34 deaths, have been reported in DRC. In 2022, and as of 11 September, a total of 8 667 suspected cholera cases, including 150 deaths (CFR: 1.7%), have been reported in 65 health zones across 12 provinces of the Democratic Republic of Congo. According to WHO's Regional Office for Africa, the most affected provinces are
South Kivu, Haut-Lomami, Tanganyika, and North Kivu.

Kenya: Since the last update on 24 August, no new cases have been reported in Kenya. As of 31 May 2022, a total of 319 cases, including two deaths (CFR 0.6%), have been reported from the country.

Malawi: Since the last update on 24 August, Malawi has reported 1 121 confirmed cholera cases, including 31 deaths. In 2022, and as of 18 August, a total of 2 479 cholera cases and 85 deaths have been reported in 19
districts.

Mozambique: Since the last update on 24 August, 169 new suspected cases have been reported in Mozambique. In 2022, and as of 11 September, a total of 3 470 suspected cholera cases, including 16 confirmed cases and 15
fatalities, have been reported in the country.

Niger: On 1 September 2022, Niger reported 10 suspected cholera cases in the Maradi region. This is the first time Niger reported cholera cases in 2022 and, as of 4 September, a total of 14 suspected cases have been reported, of whom seven tested positive for cholera.

Nigeria: Since the last update on 24 August, 1 087 suspected cases, including 13 deaths, have been reported in Nigeria. In 2022, and as of 31 July, a total of 3 610 cases, including 91 deaths (CFR 2.5%), have been reported from the country’s 31 states. According to the Nigerian Centre for Disease Control, 10 states – Taraba, Cross River, Katsina, Borno, Kano, Ondo, Zamfara, Bayelsa, Bauchi and Adamawa account for 87% of all cumulative cases.

Somalia: Since the last update on 24 August, 3 259 suspected cholera cases, including nine deaths, have been reported in Somalia. In 2022, and as of 18 September, a total of 11 300 suspected cholera cases, including 44 deaths, have been reported.

South Sudan: Since the last update on 24 August, 16 new suspected cases have been reported from South Sudan. In 2022, and as of 7 September, a total of 332 suspected cholera cases, including 60 confirmed cases and one death, have been reported.

Tanzania: Since the last update on 24 August, no new cholera cases have been reported in Tanzania. In 2022, and as of 7 August, a total of 341 cases and six deaths (CFR: 1.8%) have been reported. The outbreak badly affected the country’s Katavi Region and 215 cases, and all six deaths have been reported from this region.

Zambia: Since the last update on 24 August, one confirmed cholera case has been reported in Zambia. In 2022, and as of 31 July, a total of 160 cholera cases have been reported in the country, of which 12 have been confirmed.

Asia

Afghanistan: Since the last update on 24 August, 31 441 suspected cholera cases, including 18 deaths have been reported in Afghanistan. In 2022, and as of 12 September, a total of 150 278 cases, including 55 deaths, have been reported. According to WHO, the most affected provinces are Kabul, Helman, Kandahar, Baghlan, Jawzjan, and Nangarhar.

Bangladesh: Since the last update on 24 August, no new suspected cholera cases have been reported in Bangladesh. In 2022, and as of 19 September, a total of 519 217 suspected cholera cases, including 29 deaths, have been reported from the country. Among these cases, 461 611 cases, including 29 deaths, have been reported from different parts of the country, and 57 606 cases and no deaths have been reported in Rohingya Refugee Camp in Cox’s Bazar.

India: Since the last update on 24 August, no new suspected cholera cases have been reported in India. In 2022, and as of 29 July, a total of 549 suspected cholera cases and nine deaths have been reported in the country.

Iraq: Since the last update on 24 August, 189 confirmed cholera cases and one death have been reported in Iraq. In 2022, and as of 23 August, 1 008 confirmed cholera cases and five associated fatalities have been reported in the country.

Nepal: Since the last update on 24 August, 24 cholera cases have been reported in Nepal. In 2022, and as of 5 September, 76 cholera cases have been reported in the Kathmandu valley.

Pakistan: Since the last update on 24 August, no new suspected cholera cases have been reported in Pakistan. In 2022, and as of 18 August, a total of 258 139 cholera cases, including 30 deaths, have been reported in the country.

Philippines: Since the last update, 522 new cholera cases have been reported in the Philippines. In 2022, and as of 12 September, 3 030 cholera cases and 20 fatalities have been reported.

Syria: Since the 25 August 2022, several cases of acute watery diarrhoea (AWD) have been reported in different districts of Syria. As of 13 September 2022, a total of 936 AWD cases have been reported, including 53 confirmed cases (Aleppo (22), al-Hasaka (13), Deir Ezzor (10), Lattakia (6), and Damascus (2)), and at least eight fatalities.

No updates were available on previous outbreaks reported in Benin, Ethiopia, Togo, Uganda, and Zimbabwe.

ECDC assessment

Cholera cases continue to be reported in eastern Africa, the Horn of Africa and the Gulf of Aden. Cholera outbreaks have also been reported in the western and southern part of Africa and in some areas of Asia. Despite the high number of cholera outbreaks reported worldwide, few cases are reported each year among returning EU/EEA travellers. The risk of cholera infection in travellers visiting countries with ongoing outbreaks remains low, although sporadic infections among EU/EEA travellers are possible. In 2018, 26 cases were reported in EU/EEA Member States, while 17 and 23 cases were reported in 2017 and 2016, respectively. All cases had a travel history to cholera-affected areas. The risk of further transmission of Vibrio cholerae within the EU/EEA is very low.

According to WHO, vaccination should be considered for travellers at higher risk of infection, such as emergency and relief workers who are likely to be directly exposed. Vaccination is generally not recommended for other travellers.

Travellers who plan to visit cholera-endemic areas should seek advice from travel health clinics ahead of their trip to assess their personal risk and obtain information on precautionary sanitary and hygiene measures to prevent infection. These include drinking bottled water or water treated with chlorine, carefully washing fruit and vegetables with bottled or chlorinated water before consumption, regularly washing hands with soap, eating thoroughly cooked food, and avoiding the consumption of raw seafood products.

Disclaimer: Data presented in this report originate from several sources, both official public health authorities and non-official, such as media. Data completeness depends on the availability of reports from surveillance systems and their accuracy, which varies between countries. All data should be interpreted with caution as there may be areas of under-reporting and figures may not reflect the actual epidemiological situation.