Epidemiology
Estimated that there are 1.3 to 4.0 million cases and 21,000 to 143,000 deaths from cholera worldwide each year due to cholera (1). According to the World Health Organization (WHO), in 2022, nearly half a million cases of cholera were reported worldwide, more than double the number of cases reported in 2021 (2)
- in endemic areas
- the incidence of cholera is highest in children
- the incidence tends to decrease with age due to acquired immunity
- in non-endemic areas cholera prevalence is not age dependent - this reflects that most of the population have no immunity to the bacterium (3)
The following environmental factors results in an increase in cholera infection:
- increase in phytoplankton and zooplankton (which V cholerae is often associated with) caused by changes in surface water temperature and terrestrial nutrient discharge
- during floods (compared with non-flood periods)
- in natural disasters such as cyclones and earthquakes (3)
Due to improvements in sanitation, public health and medical knowledge, cholera is now rare in Europe. The last indigenous case of cholera in England and Wales was reported in 1893
- occasional imported cases occur, but the risk of an outbreak is very small in countries with modern sanitation and water supplies, and high standards of food hygiene
- in England, Wales and Northern Ireland 126 laboratory notifications of cholera from 1990 through to 2001 were reported
- of these, 64% were imported from the Indian sub-continent. Cholera due to the classical biotype of V. cholerae was endemic in the Ganges Delta of West Bengal and Bangladesh during the last two centuries and caused epidemics and global pandemics (4)
PHE state (5):
- cases in the UK occur in travellers returning from endemic areas (Africa, Asia, Central and South America, Caribbean)
- an average of 16 cases of cholera caused by Vibrio cholera O1 and O139 have been reported in England and Wales between 2004 and 2012
- no confirmed cases have been reported from Northern Ireland since 2004
Reference:
- World Health Organization. Cholera Fact Sheet. December 2024.
- Larkin H. WHO report: cholera resurgent in 2022 after years of decline. JAMA. 2023 Jan 17;329(3):200.
- Harris JB et al. Cholera. Lancet. 2012;379(9835):2466-76
- UK Health Security Agency. Cholera: the green book, chapter 14. Cholera immunisation information for public health professionals. Published March 2013, last updated August 2024
- PHE (2019).Recommendations for the Public Health Management of Gastrointestinal Infections