Cholera worldwide overview

Monthly update as of 24 March 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 16 February 2022, approximately 30 629 suspected cholera cases including 39 deaths have been reported worldwide. Countries reporting new cases since the previous update are Afghanistan, Bangladesh, Benin, Cameroon, Democratic Republic of Congo, Ethiopia, India, Malawi, and Nigeria. A list of all countries reporting new cases since our previous update 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, January - March 2022

Geographical distribution of new cholera cases reported worldwide, January - March 2022
Geographical distribution of new cholera cases reported worldwide, January - March 2022

Americas

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

Africa

Benin: Since the last update, six suspected cholera cases have been reported in Benin. In 2022 and since 10 October 2021, a total of 1 622 cases including 20 deaths (CFR 1.2%) have been reported in Benin.

Cameroon: Since the last update, 675 suspected cholera cases have been reported in Cameroon. In 2022 and as of 6 February, a total of 771 suspected cases including three deaths have been reported in the country.

Democratic Republic of Congo: In 2022, and as of 31 January, a total of 2 168 suspected cholera cases including 27 deaths (CFR:1.2%) have been reported in 28 health zones across seven provinces of the Democratic Republic of the Congo. This is an increase of more than 200% compared to the same period in 2021 (604 cases).

Ethiopia: The outbreak of cholera is ongoing in Oromia and Somali regions. The first case was reported on 31 August 2021. In 2022 and as of 31 January, a total of 674 cases including 7 deaths (CFR 1.0%) have been reported in Ethiopia.

Malawi: On 3 March 2022, the Malawian Ministry of Health declared a cholera outbreak after a case was identified in a 53-years old male in Balaka district. The case had onset of symptoms on 25 February 2022 and was tested positive for Cholera on 3 March 2022. So far, no further information is available about any other cases.

Nigeria: Since last update, 287 suspected cholera cases including 12 deaths have been reported in Nigeria. In 2022 and as of 27 February, a total of 701 suspected cases including 19 deaths (CFR 2.7%) have been reported from 12 states and FCTs. Five states - Taraba (242 cases), Cross River (111), Borno (91 cases), Bayelsa (76) and Adamawa (56 cases) account for 82% of all cases. Of the suspected cases, minors under five years of age are the most affected group.

Tanzania: Since the last update, no new cholera cases have been reported in Tanzania. Since December 2021 and as of 31 January 2022, at least 30 suspected cholera cases including four deaths have been reported in Tanzania's southern highlands regions of Rukwa and Kigoma.

Zimbabwe: Since the last update, no new Cholera cases have been reported in Zimbabwe. On 27 January 2022, Zimbabwe reported one cholera case. The last cholera case reported in Zimbabwe was in March 2019.

Asia

Afghanistan: Since the last update, 74 new acute watery diarrhoea (AWD) cases have been reported in Afghanistan. In 2022 and as of 28 February, a total of 74 cases of AWD have been reported.

Bangladesh: Since the last update and as of 17 March 2022, 27 313 AWD cases were reported in Rohingya Refugee Camp in Cox's Bazar, Bangladesh. In 2022 a total of 27 324 suspected cholera cases have been reported from the country. Among these cases, 47 tested positive by means of a cholera rapid diagnostic test or culture test.

India: Since the last Since the last update 100 new cholera cases have been reported in India. In 2022 and as of 9 March, a total of 100 suspected cholera cases have been reported in Gujarat.

Nepal: Since the last update, no new cholera cases have been reported in Nepal. In 2021, a total of 899 suspected cholera cases including seven deaths have been reported.

Philippines: Since the last update, no new cholera cases have been reported in the Philippines. In 2022 and as of 7 February, 491 cholera cases and six fatalities have been reported.

No updates were available on the outbreaks reported in Togo, Uganda, and Mozambique in early 2022.

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.