Cholera is a severe diarrheal disease that can be fatal within hours if not treated.
Quick access to
treatment is crucial.
Researchers estimate that there are 1.3 to 4.0 million cases and 21 000 to 143 000 deaths from cholera
worldwide each year (1).
Most people with cholera have no or mild symptoms and can be treated with oral rehydration solution.
Severe cases need intravenous fluids, oral rehydration solution and antibiotics.
Population’s access to safe water, basic sanitation and hygiene (WASH) is essential to prevent cholera.
The oral cholera vaccine (OCV) can help prevent and control cholera.
Overview
Cholera is an acute diarrheal infection caused by consuming food or water contaminated with the
bacterium Vibrio cholerae. It is a global public health threat and indicates inequity and lack of social and
economic development. Access to safe water, basic sanitation and hygiene is essential to prevent
cholera and other waterborne diseases.
Most people with cholera have mild or moderate diarrhoea and can be treated with oral rehydration
solution (ORS). However, the disease can progress rapidly, so starting treatment quickly is vital to save
lives. Patients with severe disease need intravenous fluids, ORS and antibiotics.
Countries need strong epidemiological and laboratory surveillance to swiftly detect and monitor
outbreaks and guide responses.
Symptoms
Cholera can cause severe acute watery diarrhoea, which can be fatal within hours if untreated. Most
people infected with V. cholerae do not develop symptoms but can spread the bacteria through their
faeces for 1–10 days. Symptoms appear 12 hours to 5 days after infection (2).
Most people with the disease have mild or moderate symptoms. A minority of patients develop severe
acute watery diarrhoea and life-threatening dehydration.
History
Cholera has been known for many centuries. The first pandemic, or global epidemic, was recorded in the
19th century. Since then, six pandemics have killed millions of people worldwide. The current (seventh)
pandemic started in south Asia in 1961 and continues to affect populations globally.
Vibrio cholerae strains
Only two serogroups, O1 and O139, cause cholera outbreaks. V. cholerae O1 has caused all recent
outbreaks. V. cholerae O139 caused outbreaks in Asia in the past but has recently only been identified in
sporadic cases. There is no difference in the illness caused by the two serogroups.
Epidemiology, risk factors and disease burden
Cholera outbreaks occur regularly in some countries. In others, they are less frequent, and it may be
years between outbreaks. Cholera is linked to limited access to safe water, basic sanitation facilities and
poor hygiene practices. This may be due to conflict, population displacement, climate events like
cyclones, floods or drought, and lack of investment in maintaining and improving WASH services and
infrastructure.
The number of cholera cases reported to WHO has continued to rise in recent years. In 2023, 535 321
cases and 4007 deaths were reported to WHO from 45 countries (3). The discrepancy between these
figures and the numbers estimated by researchers is likely due to limited surveillance systems and cases
not being recorded out of fear of repercussions for trade and tourism.
Prevention and control
Preventing and controlling cholera involves a combination of strengthening surveillance, improving
water, sanitation and hygiene, increasing risk communication and community engagement, improving
access to quality treatment and implementing oral cholera vaccine campaigns.
Surveillance
Cholera surveillance should be part of an integrated disease surveillance system. This includes timely
reporting, data analysis, interpretation and sharing of information from local to global levels. Rapid
diagnostic tests (RDTs) are useful for early detection of probable cholera outbreaks, but confirmation
requires laboratory testing by culture, seroagglutination or polymerase chain reaction (PCR).
Countries at risk or affected by cholera should strengthen their surveillance systems according to the
revised Global Taskforce on Cholera Control (GTFCC) recommendations to quickly detect and respond to
outbreaks.
