29 Countries Report Cholera Outbreaks in 2023

The multi-country cholera outbreak has recently expanded to reach the 29th country this year, with the African region remaining the most affected, with 16 countries reporting cholera cases.

In the Caribbean, both the Dominican Republic and Haiti have reported cholera outbreaks this year.

In 2023, 603,731 cholera cases and 3,804 deaths have been reported.

According to the World Health Organization (WHO) External Situation Report #8, the global capacity to respond to multiple and simultaneous cholera outbreaks continues to be strained due to a lack of resources, including shortages of oral cholera vaccines (OCV) and cholera supplies.

For these reasons, the WHO continues to assess the risk of a cholera outbreak at a global level as very high.

Currently, there are three WHO pre-qualified OCVs: Dukoral®, Shanchol™, and Euvichol®. 

In August 2023, the U.S. Centers for Disease Control and Prevention published Cholera Vaccine: Recommendations, highlighting CVD 103-HgR (Vaxchora®) for travelers ages 2–64 years.

The vaccine manufacturer reports that Vaxchora reduces the chance of moderate and severe diarrhea in people by 90% ten days after vaccination and by 80% three months after vaccination. It is unknown how long protection lasts beyond 3–6 months after vaccination.

Vaxchora should be taken at least ten days before travel to an area of active cholera transmission.

The U.S. Food and Drug Administration, the European Medicines Agency, and the U.K. NHS recommend OCV for specific conditions in outbreak countries. These agencies do not generally recommend cholera vaccination because most international travelers do not visit cholera outbreaks.

A global shortage of OCVs continues as of November 2023.

According to the WHO, about 50 million doses have been requested since the beginning of 2023, of which about 39% have been approved.

Gavi, the Vaccine Alliance, published a roadmap in May 2023 that outlines actions needed to ensure the supply of OCVs can meet growing international demand.

GAVI's roadmap forecasts that the OCV supply could meet the demand for preventive vaccination by 2026.