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What to Know About the Cholera Outbreaks in Southern Africa

Updated: Mar 8

A virulent cholera outbreak caused by the vibrio cholerae bacteria has gripped multiple nations across southern Africa since early 2022.

The disease, which produces severe diarrhea and vomiting leading to rapid dehydration, has infected over 188,000 people and claimed more than 4,100 lives in seven countries so far, according to the United Nation’s OCHA from a report by Aljazeera. Mild cholera cases can be treated with oral rehydration, but around 10% of cases can be fatal within 24 hours without proper medical care.

Key Takeaways

Zambia, Malawi, and Zimbabwe have been hit hardest, with Zambia experiencing its worst cholera epidemic on record and Malawi reporting its largest outbreak ever.

  • Poor sanitation, lack of access to clean water, and unchecked population movement across borders are major drivers fueling the spread of cholera in the region.

  • Recent cyclones and flooding, exacerbated by climate change, have worsened the outbreaks by displacing people, damaging water and sanitation infrastructure, and contaminating water sources.

Travelers to areas affected by the cholera outbreaks are strongly advised to get vaccinated against cholera, such as at travel health clinics like Away Clinic.

Regional Toll Continues Rising

While Zambia only confirmed its first cholera cases in October 2023, the outbreak has exploded with over 18,800 infections and 658 deaths so far - the country's worst cholera epidemic on record.

Malawi has been ravaged as well, reporting nearly 59,000 cases since early 2022 in its largest outbreak ever. In Zimbabwe, over 21,000 cases make this the nation's second-deadliest cholera event.

Cholera Hotspots Across the Region

Other southern African nations severely impacted include Mozambique, Tanzania, South Africa and the Democratic Republic of Congo (DRC). The DRC has seen the highest regional toll at 71,000 cholera cases, while South Africa has the lowest number of infections at just over 1,000. 

After remaining around 2,000 cases per month throughout 2023, regional cholera transmission appears to have peaked in January 2024 at over 3,400 cases, signaling the outbreak may be intensifying.

What Worsened the Outbreaks in Africa?

Poor sanitation and lack of access to clean water sources are major drivers fueling cholera's spread across southern Africa.

More than half the population in many regional rural communities lack access to basic sanitation facilities like toilets. Inadequate sewage systems and wastewater treatment mean drinking water supplies are vulnerable to contamination with cholera-causing bacteria.

Unchecked population movement across porous borders has also allowed the outbreak strain originating from South Asia to proliferate between countries.

Heightened Cholera Risk due to Typhoon or Rainy Season

While the full impact of recent Cyclone Freddy in March 2023 is still unfolding, experts warn the displacement of people to crowded evacuation camps and disruption of water and sanitation infrastructure will likely lead to a surge in cholera cases across the region.

Malawi's protracted outbreak was exacerbated by flooding from Cyclones Ana and Gombe in 2022, which damaged WaSH (Water, Sanitation, and Health) facilities and cut off access to safe water for many. In the cyclones' aftermath, cases spiked in districts like Machinga and Mangochi.

Freddy's devastation across southern Malawi has been even more catastrophic, destroying numerous hospitals and sanitation systems. This raises the risk of water source contamination and accelerated cholera transmission in impacted areas already grappling with an outbreak.

Cholera Response Ramping Up Across Southern Africa

Ministries of Health across southern Africa have mobilized comprehensive cholera response efforts in coordination with the World Health Organization, UNICEF and other global partners. 

Key interventions include establishing cholera treatment centers, distributing oral rehydration salts and IV fluids, conducting oral cholera vaccination campaigns, and intensifying water quality monitoring and decontamination.

Community outreach and public information campaigns are also critical for promoting cholera preventive measures and behaviors like proper handwashing, safe water handling and food preparation practices, and rapid care-seeking for diarrheal illnesses.

Outbreaks in Africa a Recurring Public Health Battle

While cholera has been eliminated in most of the developed world through water and sanitation infrastructure advances, the bacteria still sickens millions globally each year. Africa experiences a disproportionate cholera burden, with outbreaks flaring up regularly in regions plagued by gaps in safely managed drinking water, sanitation, and hygiene access.

This latest southern Africa cholera outbreak serves as a sobering reminder that inequitable progress in securing these basic services perpetuates vulnerability to extremely preventable yet potentially deadly diseases like cholera. Long-term investments in climate-resilient WaSH systems are essential for comprehensively addressing cholera's root causes.

Traveling to Southern Africa? Get Cholera Vaccine

In the meantime, continued emergency cholera response efforts from national governments with global support remain critical for saving lives and preventing wider spread across the region and continent.

Travelers to Africa and other areas affected by active cholera outbreaks are highly advised to get cholera vaccines, which can be obtained at Away Clinic  in Chandler, Phoenix and Scottsdale, Arizona.


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