Written By: Team Pharmacally
Reviewed By: Dr. Seema Satbhai, BAMS, MPH, PhD-Public Health
Cholera is severe and an acute diarrheal infection caused by ingestion of food or water contaminated with bacterium Vibrio cholerae, remains one of the most persistent public health challenges in the world. Cholera can kill person within hours if left untreated, however with immediate rehydration therapy and proper care, most patients recover fully. Despite being both preventable and treatable, cholera continues to spread, particularly in regions where access to clean water, sanitation, and health care is limited.
On 5 September 2025, World Health Organization (WHO) has released Cholera Report 2024 which provided a detailed analysis of how the seventh cholera pandemic spread-out last year. The numbers shows that, not only is the disease still spreading, but alongside death toll has risen at an alarming rate.
Global Situation in 2024
In 2024, a total of 560,823 cholera cases and 6,028 deaths were reported to WHO from 60 countries. This marked a rise from 45 countries in 2023. While the number of cases increased by 5%, the number of deaths sprung by 50%, leading to an overall case fatality rate (CFR) of 1.1%.
In 2024, the distribution of cholera cases showed that Africa stayed a major contributor of the disease accounting for about 46% of the global burden. However Asia and the Middle East together stand on 52% of the total cases. Within Asia, the disease was broadly concentrated in Bangladesh and Myanmar with largest reported numbers. Most other Asian countries recorded only small or imported cases, making their contribution negligible. In the Middle East, the major contributor was Yemen, which alone accounted for nine out of ten cases in the region and the vast majority of related deaths. This pattern highlights that while cholera continues to be rooted across Africa but significant and concentrated outbreaks in South Asia and the Middle East, particularly in Yemen, are affecting the global spread of the disease.
This shows that cholera continues to thrive in regions where health systems are unstable and access to clean water and sanitation remains inadequate.
Where Cholera Hit Hardest
Twelve countries each recorded more than 10,000 cases in 2024. These included:
Bangladesh, Comoros, Democratic Republic of Congo (DRC), Ethiopia, Nigeria, Somalia
South Sudan, Sudan, Tanzania, Yemen, Zambia, Zimbabwe
This list is increased by three countries more as compared to 2023 list, showing that transmission is expanding. For Comoros, this was the first outbreak in more than 15 years, underlining the unpredictable nature of the disease’s spread.
On the more positive side, Malawi reported fewer than 1,000 cases in 2024 which is way lesser than a devastating epidemic cases found in 2022. This suggests that Malawi’s outbreak is declining.
The Toll of Deaths
The report shows a sharp rise in deaths. Many of these deaths happened in the community, before people could reach hospitals. In countries that separated hospital and community data, the fatality rate in hospitals was 0.8%, which is within the target. However, the large number of deaths at home increased the overall national fatality rates.
This gap highlights two realities:
Health care systems remain fragile in many affected countries.
Delays in treatment are deadly, since cholera can cause rapid dehydration and shock.
Why Cholera is Spreading
Several forces combined to worsen the global cholera situation in 2024
Conflict and population displacement disrupted health systems in places such as Sudan and South Sudan.
Climate change and extreme weather events fueled outbreaks in southern Africa.
Urban growth and poor sanitation continue to expose millions to unsafe water.
Gaps in long-term water, sanitation, and hygiene (WASH) infrastructure leave communities vulnerable.
Vaccines and Control Measures
Since 2022, WHO and its partners have used a single-dose oral cholera vaccine (OCV) strategy instead of the usual two-dose schedule. This was a temporary measure to stretch limited supplies. Though it offers shorter protection, it has proven effective in outbreak control.
In 2024, a new oral cholera vaccine called Euvichol-S® was introduced. It entered the global supply later in the year and helped to keep the emergency stockpile above 5 million doses in early 2025. This was an important step for ensuring rapid response during outbreaks
Regional Highlights
Africa: Reported 258,442 cases and 4,976 deaths (CFR 1.9%). Sudan (53,001 cases) and South Sudan (20,132) recorded their highest numbers this century. Zambia and Zimbabwe also saw their worst outbreaks in over a decade.
Asia and Middle East: 292,386 cases and 920 deaths. Yemen alone accounted for 89% of cases and 96% of deaths in the region. Myanmar, too, had its largest outbreak in two decades.
Americas: 9,957 cases and 131 deaths, with Haiti contributing almost all of these numbers. Though case counts dropped from 2023, weak surveillance due to civil unrest makes trends hard to interpret.
Europe and Oceania: Only imported cases were reported, showing how international travel can spread the infection, even in regions with strong sanitation systems.
Children at Risk
Children under five years old made up 20% of all cholera cases worldwide (114,447 cases). In some countries, the proportion was even higher, but this may be because other diarrheal diseases were sometimes counted as cholera where lab testing was not routine.
The Way Forward
Cholera is both preventable and treatable, yet it continues to cause unnecessary suffering and deaths. The Global Roadmap to End Cholera by 2030 aims to reduce deaths by 90%. Achieving this goal will require:
- Expanding access to safe water and sanitation.
- Ensuring timely treatment at the community level.
- Strengthening laboratory testing and surveillance.
- Sustaining vaccine supply and rapid deployment during outbreaks.
Conclusion
The WHO’s 2024 report reminds us that cholera is far from a disease of the past. It remains a serious threat wherever poverty, conflict, and poor sanitation intersect. The rise in deaths despite available tools shows that the fight against cholera is as much about equity and access as it is about medicine and vaccines. Ending cholera will depend on long-term investments in health systems and infrastructure, along with action during outbreaks.
Reference
Global Situation Report for Cholera, 2024, Weekly epidemiological record, World Health Organization, 5 September 2025, 100th year No. 36, 2025, 100, 347–364