Cholera worldwide overview

Monthly update as of 23 January 2024

As of 23 January, 50 440 new cholera cases, including 483 new deaths, had been reported worldwide in December 2023. 

The five countries reporting most cases are Afghanistan (12 425), Syria (11 200), Zimbabwe (6 902), Sudan (5 742), and Mozambique (4 257). 

The five countries reporting most new deaths are Sudan (146), Zimbabwe (127), Zambia (95), Ethiopia (69), and Congo (14). 

In addition, 184 272 new cases were reported or collected retrospectively from before 30 November 2023. New cases have been reported from Afghanistan, Dominican Republic, Burundi, Cameroon, Congo, Democratic Republic of the Congo, Ethiopia, Kenya, Malawi, Mozambique, Somalia, Sudan, Syria, Togo, Zambia and Zimbabwe. 

In 2023, 957 050 cholera cases, including 5 518 deaths, were reported worldwide. In comparison, in 2022, 1 261 347 cholera cases, including 2 342 deaths, were reported worldwide.

Countries with most cases
Sudan, Zimbabwe, Zambia, Ethiopia, and Congo
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 October to December 2023

Geographical distribution of cholera cases reported worldwide from October to December 2023
Geographical distribution of cholera cases reported worldwide

Asia: 

Afghanistan: Since 25 November 2023 and as of 30 December 2023, 12 425 new cases, including eight new deaths have been reported. Since 1 January 2023 and as of 30 December 2023, 222 230 cases, including 101 deaths have been reported. In comparison, in 2022 and as of 31 December 2022, 242 562 cases, including 87 deaths were reported. 

Syria: Since 25 November 2023 and as of 23 December 2023, 11 200 new cases have been reported. Since 1 January 2023 and as of 23 December 2023, 294 930 cases, including 952 deaths have been reported. In comparison, in 2022 and as of 31 December 2022, 52 879 cases, including 97 deaths were reported. 

Africa: 

Burundi: Since 28 October 2023 and as of 9 December 2023, 116 new cases have been reported. Since 1 January 2023 and as of 9 December 2023, 1 343 cases, including nine deaths, have been reported. In comparison, in 2022 and as of 31 December 2022, 12 cases were reported. 

Cameroon: Since 26 November 2023 and as of 31 December 2023, 70 new cases, including one new death has been reported. Since 1 January 2023 and as of 31 December 2023, 21 269 cases, including 508 deaths have been reported. In comparison, in 2022 and as of 29 December 2022, 15 108 cases, including 302 deaths, were reported. 

Congo: Since 28 October 2023 and as of 31 December 2023, 631 new cases, including five new deaths have been reported. Since 1 January 2023 and as of 31 December 2023, 724 cases, including 14 deaths, have been reported. In comparison, in 2022 and as of 31 December 2022, no cases were reported. 

Democratic Republic of the Congo: Since 26 November 2023 and as of 31 December 2023, 859 new cases, including two new deaths, have been reported. Since 1 January 2023 and as of 31 December 2023, 40 497 cases, including 344 deaths, have been reported. In comparison, in 2022 and as of 30 December 2022, 17 135 cases, including 285 deaths, were reported.

Ethiopia: Since 26 November 2023 and as of 31 December 2023, 3 318 new cases, including 69 new deaths have been reported. Since 1 January 2023 and as of 31 December 2023, 29 869 cases, including 426 deaths have been reported. In comparison, in 2022 and as of 29 December 2022, 1 141 cases, including 27 deaths, were reported. 

Kenya: Since 26 November 2023 and as of 19 December 2023, 120 new cases, including three new deaths have been reported. Since 1 January 2023 and as of 19 December 2023, 8 937 cases, including 148 deaths, have been reported. In comparison, in 2022 and as of 18 December 2022, 2 959 cases, including 55 deaths, were reported. 

Malawi: Since 26 November 2023 and as of 31 December 2023, nine new cases, including one new death have been reported. Since 1 January 2023 and as of 31 December 2023, 43 015 cases, including 1 262 deaths, have been reported. In comparison, in 2022 and as of 31 December 2022, 17 448 cases, including 576 deaths, were reported. 

Mozambique: Since 26 November 2023 and as of 31 December 2023, 4 257 new cases, including 14 new deaths, have been reported. Since 1 January 2023 and as of 31 December 2023, 41 248 cases, including 164 deaths, have been reported. In comparison, in 2022 and as of 28 December 2022, 3 930 cases, including 21 deaths, were reported. 

Somalia: Since 26 November 2023 and as of 31 December 2023, 2 750 new cases, including three new deaths have been reported. Since 1 January 2023 and as of 31 December 2023, 18 304 cases, including 46 deaths, have been reported. In comparison, in 2022 and as of 31 December 2022, 15 653 cases, including 88 deaths, were reported. 

Sudan: Since 26 November 2023 and as of 31 December 2023, 5 742 new cases, including 146 new deaths, have been reported. Since 1 January 2023 and as of 31 December 2023, 8 267 cases, including 224 deaths, have been reported. In comparison, in 2022 and as of 31 December 2022, no cases were reported. 

Togo: Since 22 December 2021 and as of 19 December 2023, one new case has been reported. Since 1 January 2023 and as of 19 December 2023, one case has been reported. In comparison, in 2022 and as of 31 December 2022, no cases were reported. 

Zambia: Since 26 November 2023 and as of 31 December 2023, 2 035 new cases, including 95 new deaths, have been reported. Since 1 January 2023 and as of 31 December 2023, 3 757 cases, including 128 deaths, have been reported. Due to the rapid spread of the disease and the increase in reported cases this is likely to be one of the worst cholera outbreaks in the recent history of the country. Close to 52% of all cases are reported in children under 15 years of age. Zambian health authorities are conducting vaccination campaigns along with additional disease control measures. In comparison, in 2022 and as of 31 July 2022, 160 cases were reported.

Zimbabwe: Since 26 November 2023 and as of 31 December 2023, 6 902 new cases, including 127 new deaths, have been reported. Since 1 January 2023 and as of 31 December 2023, 15 137 cases, including 333 deaths, have been reported. In comparison, in 2022 and as of 18 July 2022, 135 cases were reported. 

America:

Dominican Republic: Since 15 June 2023 and as of 15 December 2023, 12 new cases have been reported. Since 1 January 2023 and as of 15 December 2023, 111 cases have been reported. In comparison, in 2022 and as of 17 December 2022, six cases were reported.

ECDC assessment

Cholera cases have continued to be reported on the African continent and in South East Asia in recent months. Cholera outbreaks have also been reported in parts of the Middle East and in two countries in the Americas. Despite the number of cholera outbreaks reported worldwide, few cases are reported each year among travellers returning to the EU/EEA. 

In this context, the risk of cholera infection in travellers visiting these countries remains low, even though sporadic importation of cases to the EU/EEA remains possible. 

In 2022, 29 cases were reported by nine EU/EEA countries, while two were reported in 2021 and none in 2020. In 2019, 25 cases were reported in EU/EEA countries. All cases had a travel history to cholera-affected areas. 

According to the World Health Organization (WHO), vaccination should be considered for travellers at higher risk, such as emergency and relief workers who are likely to be directly exposed. 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. Such measures can 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 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 provide timely 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.