If the current trend persists, the supply of preventive vaccination will likely continue to be limited
Multiple ongoing emergencies, such as the COVID-19 pandemic, monkeypox, dengue and chikungunya, have strained the health resources of some countries. Representative photo: iStock. A sudden surge in cholera cases accompanied by high mortality rates has been observed in 24 countries this year, noted a World Health Organization (WHO) report on March 22, 2023.
The 24 countries include the Philippines, India, Bangladesh, Pakistan, Afghanistan, Yemen, Somalia, Lebanon, Syria, Dominican Republic, Haiti, Nigeria, Cameroon, Ethiopia, Kenya, South Sudan, Zimbabwe, Zambia, South Africa, Malawi, Mozambique, United Republic of Tanzania, Burundi and the Democratic Republic of Congo.
“Concerning historical transmission patterns and seasonality, it is important to note that large parts of the world are currently in low or interepidemic transmission periods, therefore this number could increase in the months to come,” the report warned.
Read more: WHO warns of ‘worrying surge’ in cholera cases globally
In 2021, 23 countries reported cholera outbreaks in WHO Africa and the Eastern Mediterranean regions. In 2022, 30 countries across five WHO regions reported cholera cases and outbreaks.
If the current trend in cholera outbreaks continues, the supply of preventive vaccination will likely continue to be limited during this period, Gavi, the Vaccine Alliance, said in a press release on May 22. This calls for transparency and equity in vaccine allocation, the statement added.
Nearly 38 million doses of oral cholera vaccine were issued globally between 2010 and 2020. In 2021 and 2022 alone, 10 million more vaccines were needed to cater to the wave of cholera outbreaks. This means that nearly 48 million doses were needed for emergency response, Gavi said.
However, investments from EuBiologics, Gavi, and BMGF and an anticipated new vaccine manufacturer might increase the global supply by 2025.
“Climate change, conflict, and displacement have all contributed to a recent alarming rise in cholera outbreaks, with 30 countries reporting cases or outbreaks in 2022,” the press release said.
Multi-country data of cholera outbreak till March 2023. Case and death numbers are to be viewed with caution due to differences in reporting systems, data availability and accessibility. Source: WHO.
A case in point of natural disasters increasing cholera cases is the present situation in Mozambique. “Health authorities in Mozambique are battling the most severe cholera outbreak in the country in more than 20 years. The number of cases of cholera increased after Cyclone Freddy hit the country in late February,” reported Africanews, a Pan-African multilingual portal.
After the Syria earthquake, 92,649 suspected cholera cases and 101 deaths were reported between 25 August 2022 and 15 February 2023. The disaster increased the risk of waterborne diseases as the health facilities had to limit operations, according to a report by WHO and UNICEF.
“We are witnessing a worrying scenario where conflict and extreme climatic events are worsening the triggers of cholera and increasing its toll on lives,” said Dr Matshidiso Moeti, WHO regional director for Africa, early this year. As of January 29, an estimated 26,000 cases and 660 deaths have been reported in the 10 countries in Africa, the WHO said.
Read more: Cholera resurgence? Several countries record case surge, deaths since October
Several studies have shown a significant correlation between either high or low rainfall and the incidence of cholera cases. Weather conditions such as increasing ambient temperature are key parameters for cholera incidence, noted a study based in Iran.
So, increasing or decreasing the average rainfall could lead to floods and droughts, affecting the concentration of bacteria and human health. Rainfall can also affect nutrient concentrations, salinity and pH of water resources which affect bacterial survival, the study added.
Violence and conflict can also exacerbate a cholera outbreak. For example, from November last year, the ongoing armed conflict in the North Kivu province of the Democratic Republic of Congo (DRC) substantially increased the number of internally displaced people in camps next to Goma, a city in DRC.
“The lack of access to water and sanitation in the camps continues to pose a threat to the control of the outbreak, reversing the trend in decreasing cases in the past weeks,” the WHO’s situation report stated. From January to March 15, 2023, 3,739 cholera cases and nine deaths were reported in the province.
Multiple ongoing emergencies, such as the COVID-19 pandemic, monkeypox, dengue and chikungunya, have strained the health resources of some countries that have to respond to the outbreaks simultaneously.
Some countries reported cases only from sentinel sites and not from remote locations. Also, inadequate laboratories sometimes don’t accurately confirm the cholera bacteria and report acute watery diarrhoea instead, the WHO said.
A total of 177 Kenyans succumbed to cholera since October last year. The Kenyan Ministry of Health revealed that their current cumulative caseload of cholera reached 10,784 over the previous eight months, reported The Star, a Kenyan daily. Nairobi recorded 58 deaths, 17 in Garissa, 20 from Tana River and 16 from Wajir during the same period, the report said.
Similarly, deaths from cholera rose to 15 in the Gauteng province of South Africa, news portal Aljazeera reported on May 24. In another part of South Africa, north of Pretoria, 17 people died from a cholera outbreak in Hammanskraal, a town in the City of Tshwane.
This sudden spike in cholera deaths is attributed to high levels of pollution of the Leeukraal Dam, which is not treatable by the local water treatment network, according to the South African non-profit publication GroundUp. Cholera spreads through water and food contaminated with the bacterium Vibrio cholera, causing an acute diarrheal infection.
While most cases are mild to moderate, about 20 per cent develop severe cases of watery diarrhoea accompanied by extreme dehydration. The ongoing seventh pandemic of cholera started in 1961, after which it became endemic in many parts of the world during those first two decades.
After significantly decreasing in the 1990s, cholera remained prevalent in certain parts of Africa and Asia, with cases continuing to be reported in vulnerable populations without access to healthcare.
Since October 2022, the International Coordinating Group substituted the standard two-dose vaccination regimen for cholera with single-dose vaccines to extend the supply. “Production is currently at maximum capacity, and despite this unprecedented decision, the stockpile remains very low,” the WHO director informed the media in January.
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