Cholera worldwide overview

Monthly update as of 15 January 2023

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.

Since the last update on 20 December 2022, 74 761 cholera cases, including 745 fatalities, have been reported worldwide. Countries and territories reporting new cases since the previous update are Afghanistan, Bangladesh, Burundi, Cameroon, the Democratic Republic of the Congo, the Dominican Republic, Haiti, Iraq, Kenya, Lebanon, Malawi, Mozambique, Nigeria, the Philippines, Somalia, Syria, and Tanzania.

Countries with most cases
Syria, Malawi, Afghanistan, and Nigeria
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 cholera cases reported worldwide from January 2022 to January 2023

Geographical distribution of cholera cases reported worldwide from January 2022 to January 2023
Geographical distribution of cholera cases reported worldwide from January 2022 to January 2023

Americas

Haiti: Since the last update, 6 808 suspected cholera cases, including 90 fatalities, have been reported in Haiti. In 2023 and as of 12 January, a total of 3 355 suspected cholera cases, including 44 deaths, have been reported in the country. In 2022, there were 20 593 suspected cholera cases including 253 fatalities.

Dominican Republic: An outbreak of cholera has been reported in the Dominican Republic. In 2023, and as of 15 January, a total of eight cholera cases have been reported in the Dominican Republic. Cases have been reported in La Zurza sector in Santo Domingo. The PAHO is providing local support to Dominican health authorities. In 2022, a total of six cholera cases were reported in the country. In October 2022, an imported cholera case from Haiti was detected.

No additional cholera cases have been reported in other regions of the Americas in 2023.

Africa

Burundi: On 1 January 2023, Burundi’s Minister of Public Health declared a cholera outbreak in the Bujumbura, the capital of the country. In 2023, and as of 6 January, 42 suspected cholera cases, including two fatalities, have been reported in Burundi. Four districts have reported cholera cases: Bujumbura North, Cibitoke, Isale, and Bujumbura Centre. In 2022, between 30 and 31 December, 12 confirmed cholera cases were reported.

Cameroon: Since the last update, 1 207 suspected cholera cases including three fatalities have been reported in Cameroon. In 2022 and as of 8 December, a total of 15 003 suspected cases including 298 fatalities have been reported in the country.

The Democratic Republic of the Congo (DRC): Since the last update, 577 suspected cholera cases, including 20 fatalities, have been reported in DRC. In 2022, and as of 27 November, a total of 14 290 suspected cholera cases, including 262 fatalities (CFR: 1.7%), have been reported in 97 health zones across 17 provinces of the Democratic Republic of Congo. According to the World Health Organization (WHO) Regional Office for Africa, the most affected provinces are South Kivu, Haut-Lomami, Tanganyika, and North Kivu.

Kenya: Since the last update, 1 407 suspected cases including 25 fatalities have been reported in Kenya. In 2022, and as of 18 December, a total of 2 959 cases including 55 fatalities (CFR 1.9%) have been reported in the country. The outbreak has affected 12 counties: Nairobi, Kiambu, Nakuru, Uasin Gishu, Kajiado, Murang’a, Machakos, Garissa, Meru, Nyeri, Wajir and Tana River.

Malawi: Since the last update, Malawi has reported 14 806 confirmed cholera cases, including 531 deaths. In 2023, and as of 16 January, a total of 8 010 cholera cases, including 265 fatalities, have been reported in the country. In 2022, a total of 17 448 cholera cases, including 576 fatalities, were reported in Malawi. According to Malawian Ministry of Health, 29 districts have reported cholera cases since the start of the outbreak in March 2022. To date, the outbreak has been controlled in two health districts but is still ongoing in 27 districts. The most affected districts are Mangochi, Biantyre, Lillongwe, Sallma, and Nkhata Bay.

Mozambique: Since the last update, 72 suspected cholera cases including two fatalities have been reported in Mozambique. In 2022 and as of 28 December, a total of 3 930 suspected cholera cases including 21 fatalities (CFR 0.5%) have been reported in the country.

Niger: Since the last update, no new cholera cases have been reported in Niger. In 2022, a total of 72 suspected cases, including one death, have been reported in the country.

Nigeria: Since the last update, 1 540 suspected cases, including 32 fatalities, have been reported in Nigeria. In 2022 and as of 27 November, a total of 20 768 cases, including 498 fatalities (CFR 2.4%), have been reported from 31 Nigerian states. Three states, Borno, Taraba, and Yobe, have reported a combined total of 15 495 suspected cases and 382 fatalities. The most affected age groups are children aged under five years and aged five to 14 years.

Somalia: Since the last update 2 083 suspected cholera cases, including 27 fatalities, have been reported in Somalia. In 2022 and as of 27 November, a total of 13 383 suspected cholera cases, including 71 fatalities, have been reported in the country. The most affected districts are Daynile, Dharknely, Kahda, and Kismayo, with Kismayo being the epicentre of the outbreak.

South Sudan: Since the last update, no new suspected cholera cases have been reported in South Sudan. In 2022 and as of 20 November, a total of 424 suspected cholera cases, including one fatality, have been reported in the country.

Tanzania: Since the last update, 18 new suspected cholera cases, including one fatality, have been reported in Tanzania. All new cases have been reported in Babati District Council. In 2022 and as of 17 November, a total of 359 cases and seven fatalities (CFR: 1.9%) have been reported in the country.

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

Asia

Afghanistan: Since the last update, 12 053 suspected cholera cases, including two fatalities have been reported in Afghanistan. In 2023, and as of 7 January, a total of 2 940 suspected cholera cases have been reported. According to WHO, approximately 55.4% of all reported cases were children below 5 years of age. In 2022, a total of 242 562 suspected cholera cases including 87 deaths have been reported.

Bangladesh: Since the last update, 1 873 suspected cholera cases have been reported in Rohingya Refugee Camp in Bangladesh. In 2022, a total of 603 511 suspected cholera cases including 29 fatalities have been reported from the country. Among these cases, 461 611 cases including 29 deaths have been reported from different parts of the country between January and April this year. The remaining 141 900 cases have been reported in the Rohingya Refugee Camps in Cox’s Bazar between January and December 2022.

Iraq: Since the last update, 30 new suspected cholera cases have been reported in Iraq. In 2023, and as of 8 January, 13 suspected cholera cases have been reported in Iraq. Most of the cases were reported in the northern Kurdistan region. In 2022, a total of 1 025 confirmed cholera cases and five associated fatalities have been reported in the country.

Lebanon: Since the last update, 801 confirmed cholera cases have been reported from Lebanon. In 2023, and as of 15 January 2023, 319 confirmed cholera cases have been reported in the country. So far cases have been reported from all eight governorates (Akkar, Baalbeck-Hermel, Beirut, Bekaa, Mount Lebanon, North Lebanon, Nabatiyeh, and South Lebanon). In 2022, a total of 5 810 confirmed cholera cases and 23 associated fatalities were reported in the country. This is the first cholera outbreak in the country since 1993.

Nepal: Since the last update, no cholera cases have been reported in Nepal. In 2022, and as of 9 September, 76 cholera cases have been reported in the Kathmandu valley.

Pakistan: Since the last update, no new cholera cases have been reported in Pakistan. In 2022, and as of 15 August, a total of 258 139 cholera cases, including 30 deaths, have been reported in the country.

Philippines: Since the last update, 266 suspected cholera cases and seven associated fatalities have been reported in the Philippines. In 2022, and as of 10 December, 6 126 cholera cases and 74 associated fatalities have been reported in the country.

Syria: Since the last update, 31 152 suspected cholera cases, including three fatalities, have been reported in Syria. In 2023, and as of 7 January, a total of 24 682 suspected cholera cases and three associated fatalities have been reported in Syria. The most affected governorates are Idleb, Deir-ez-Zor, Aleppo, and Ar-Raqqa. In 2022, a total of 52 879 suspected cholera cases, including 97 fatalities, have been reported in the country.

Taiwan: Since the last update, no new cholera cases have been reported in Taiwan. In 2022, Taiwan reported its first domestic cholera case. The case most likely contracted the disease from seafood, which she prepared and ate at home. According to media reporting, the case was hospitalised with symptoms and fully recovered after a few days.

No updates were available on previous outbreaks reported in India.

ECDC assessment

Cholera cases continue to be reported in western Africa and south-east Asia over the past months. Cholera outbreaks have also been notified in the eastern and southern parts of Africa as well as in some parts of the Middle East. Despite the number of cholera outbreaks reported worldwide, few cases are reported each year among returning EU/EEA travellers. In this context, the risk of cholera infection in travellers visiting these countries remains low, even though sporadic importation of cases in the EU/EEA remains possible. In 2021, two cases were reported in EU/EEA Member States, while three and 26 cases were reported in 2020 and 2019 respectively. All cases had travel history to cholera-affected areas. According to the WHO, vaccination should be considered for travellers at higher risk, such as emergency and relief workers who are likely to be directly exposed to cholera.

Vaccination is generally not recommended for other travellers. Travellers to cholera-endemic areas should seek advice from travel health clinics to assess their personal risk and apply precautionary sanitary and hygiene measures to prevent infection. These can include drinking bottled water or water treated with chlorine, carefully washing fruits 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.

Actions

ECDC continues to monitor cholera outbreaks globally through its epidemic intelligence activities in order to identify significant changes in epidemiology, and to facilitate updates to public health authorities. Reports are published on a monthly basis. The worldwide overview of cholera outbreaks is available on ECDC's website.

Disclaimer: Data presented in this report originate from several sources, both official public health authorities and non-official, such as the 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.