Rising cholera outbreaks: Afghanistan and Bangladesh top the list in Asia

The report says the number of reported cholera cases increased by 13% and deaths by 71% in 2023 compared to 2022

Conflict, climate change, limited investment in development and population displacement due to emerging and re-emerging risks all contributed to the rise in the number of cholera outbreaks, the World Health Organization (WHO) says in its global cholera statistics for 2023.

Released on Wednesday evening, the report says the number of reported cholera cases increased by 13% and deaths by 71% in 2023 compared to 2022. Over 4000 people died last year from a disease that is preventable and easily treatable.

In 2023, very large outbreaks, greater than 10 000 suspected and confirmed cases per country, were reported by nine countries on three continents. In Asia, Afghanistan and Bangladesh topped the list.

Afghanistan reported (222 249) 87% of the cases and 79% of the deaths (101) in the region , all classified as suspected cases.

The number of cases reported by Bangladesh increased substantially between 2022 (1191) and 2023 (23 369 cases). “The increase may be attributed to increased surveillance and reporting and not to a new or worsening outbreak. The enhanced reporting will contribute to the implementation of Bangladesh’s cholera control programmes,” the report said.

India fared better, with only 649 cases, and no reported deaths.

Cholera is an acute intestinal infection spread through contaminated food and water. Communities with limited access to sanitation are most affected.

Across the world, in 2023, the 7th cholera pandemic continued to surge, with 535 321 cases reported to the WHO, up from 472 697 in 2022.

Cholera cases were reported from 45 countries, territories and areas, an increase from 44 in 2022 and 35 in 2021. The geographical pattern of outbreaks evolved further, with a 32% reduction in the number of cases reported in countries in the Middle East and Asia and a 125% increase in cases in Africa.

“This trend reflects a lack of long-term development investment, particularly in water, sanitation and hygiene (WASH). Cholera outbreaks indicate that the sustainable development goals for WASH are not on track to meet the 2030 objectives, despite the United Nations General Assembly’s recognition in 2010 that access to safe drinking-water and sanitation is a fundamental human right,” WHO said.

Because of the limited availability of oral cholera vaccine (OCV), the International Coordinating Group (ICG), which manages the OCV emergency stockpile, took the unprecedented decision in October 2022 to temporarily suspend the standard 2-dose vaccination regimen in cholera outbreak response campaigns and instead use a single-dose approach, which was accepted by the Strategic Advisory Group of Experts on Immunization (SAGE).

The change in strategy, which continued throughout 2023 and into 2024, enabled the available vaccines to protect more people and responses to more cholera outbreaks amid the ongoing supply shortfall. “Evidence on the duration of protection is limited, but the 1-dose strategy has proven effective in responding to outbreaks. The ICG continues to monitor global epidemiological trends and the OCV stockpile status and will review its decision regularly,” WHO adds.