Cholera worldwide overview

Monthly update as of 26 November 2021

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. Major ongoing outbreaks are being reported from Bangladesh, Nigeria and Niger. Haiti reported its last laboratory-confirmed case in February 2019.

Since the last update on 22 October 2021, approximately 26 648 suspected cholera cases, including 346 deaths, have been reported worldwide. Countries reporting most of the new cases since the previous update are Nigeria, Bangladesh, Democratic Republic of the Congo, Mozambique, and Niger. A list of all countries reporting new cases since our previous update on 22 October 2021 can be found below.

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, September - November 2021

Geographical distribution of new cholera cases reported worldwide, September - November 2021
Geographical distribution of cholera cases reported worldwide from September to November 2021

Americas

Haiti: No new cases have been reported since the last update. In 2021, and as of 14 November, no confirmed cholera cases were reported in Haiti.

Dominican Republic: No new cases have been reported since the last update. In 2021, and as of 18 October 2021, no cholera cases were reported in the Dominican Republic.

Africa

Benin: Since the last update, 138 suspected cholera cases, including nine deaths, have been reported in Benin. In 2021, and as of 8 November, a total of 259 cases, including nine deaths (CFR 3.5%), have been reported.

Cameroon: Since the previous CDTR update, 88 suspected cholera cases, including six deaths, have been reported in Cameroon. In 2021, and as of 14 November, a total of 104 suspected cholera cases, including nine deaths, have been reported from various regions of Cameroon.

DR Congo: Since the previous CDTR, the Democratic Republic of the Congo has reported 529 suspected cholera cases, including 12 deaths. In 2021, and as of 17 October, 5 950 suspected cholera cases, including 117 deaths, have been reported from 79 health zones across 15 provinces of the Democratic Republic of the Congo.

Ethiopia: In 2021, and as of 26 September 2021, 561 suspected cholera cases were reported, including 10 suspected deaths.

Kenya: No new cases have been reported since the last update. In 2021, and as of 18 October, 38 cholera cases, including 14 confirmed cases, have been recorded in Kenya.

Mali: Since the last update no new cholera cases have been reported in Mali. In 2021, and as of 31 October, a total of 11 cases, including four deaths, have been reported in Mali's northern region of Gao.

Mozambique: According to WHO's regional office for Africa, a new cholera outbreak was declared in Caia district at the end of September 2021. As of 19 October 2021, a total of 191 suspected cholera cases have been reported in this outbreak. In 2021, and as of 14 November, a total of 5 872 suspected cholera cases, including 35 deaths, have been reported in various provinces of Mozambique.

Niger: Since the previous CDTR, Niger has reported 188 cholera cases, including four deaths. In 2021, and as of 25 October, a total of 5 469 cases, including 159 deaths (CFR 2.9%), have been reported. Seven out of eight regions of the country have reported cases so far. The rainy season is still ongoing, causing floods that might pose a risk to the spread of the outbreak.

Nigeria: Since the previous CDTR, Nigeria has reported 13 980 suspected cholera cases, including 311 deaths. In 2021, and as of 14 November, a total of 102 684 suspected cholera cases, including 3 519 deaths (CFR 3.4%), have been reported from 32 Nigerian states. According to the Nigeria Centre for Disease Control (NCDC), five to 14 years is the most affected age group, showing a similar gender distribution.

Togo: According to the WHO regional office for Africa, a cholera outbreak was declared by Togo¶s health authority on 7 November 2021. As of 9 November, a total of 17 cases, including four deaths (CFR: 23.5%), have been reported in the Lacs district of Togo.

Asia

Afghanistan: According to a UNICEF report, a cholera outbreak has been reported in different parts of Kabul city and surrounding districts. In 2021, and as of 30 September, a total of 900 suspected cholera cases have been reported in Afghanistan.

Bangladesh: Since the previous CDTR update, 10 617 Acute Watery Diarrhoea (AWD) cases were reported in Rohingya Refugee Camp in Cox¶s Bazar, Bangladesh. In 2021, and as of 3 October, a total of 116 340 suspected cholera cases, including two deaths, have been reported. Among these cases, 272 tested positives by means of a cholera rapid diagnostic test or culture test.

India: Since the last update, no new cholera cases have been reported in India. In 2021, and as of 13 October, a total of 1 751 suspected cholera cases, including two deaths, have been reported in different parts of India.

Nepal: Since the last update, no new cholera cases have been reported in Nepal. In 2021, and as of 19 October, 885 cases of cholera, including four deaths, have been reported in Nepal.

No updates were available on the outbreaks reported in Yemen earlier this year.

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 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 travel to assess their personal risk and be informed 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.