Cholera Outbreaks Continuing Into 2023

The World Health Organization (WHO) recently confirmed that over 29 countries reported cholera cases or outbreaks in 2022.

As of late November 2022, sixteen countries have reported protracted outbreaks.

Of the countries that have reported cholera outbreaks in 2022, many are experiencing natural disasters such as cyclones (Mozambique, Malawi), flooding (Pakistan, Nigeria), and drought (countries in the Horn of Africa). 

Cholera is an acute, watery diarrheal illness that can be severe and rapidly become fatal without proper treatment, says the WHO.

Many countries reported higher case numbers and case fatality ratio (CFR) than previous years.

The average cholera CFR reported globally in 2021 was 1.9% (2.9% in Africa), the highest recorded in over a decade.

Unfortunately, cholera vaccine shortages have exasperated this adverse situation.

The global stockpile of Oral Cholera Vaccine (OCV) is currently insufficient to meet all requests for two doses of preventive vaccination.

As a result, in October 2022, the International Coordinating Group and WHO decided to temporarily limit all reactive OCV vaccination campaigns to one dose.

While using a single dose will protect more people in the short term, this strategy has limitations, as it's unclear how long immunity will last.

Since vaccine manufacturers are producing at their maximum current capacity (2.5 million/month), there is no short-term solution to increase production.

To solve the long-term problem, there needs to be an increase in global vaccine production.

The WHO does not recommend travel or trade restrictions based on the currently available information.

However, as cholera outbreaks can also affect border areas, the WHO encourages Member States to ensure cooperation and regular information sharing so that any spread across the border is quickly assessed and contained.

Currently, there are three WHO-prequalified OCVs: Dukoral®, ShanChol™, and Euvichol®. 

Currently, the U.S. CDC recommends cholera vaccination when visiting outbreak areas.

Healthcare providers can use these CDC guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.

Additional cholera vaccine information is posted at Vax-Before-Travel.com/Cholera.