Fewer cases, more deaths: WHO reports the worst year for cholera since 1999
What happened
On 29 September 2026, the World Health Organization published its latest figures on cholera, meningitis and plague in its Weekly Epidemiological Record. The cholera numbers are the ones that stand out. In 2025, 47 countries reported 451,499 cholera cases and 7,870 deaths to WHO. That death toll is the highest reported to WHO in a single year since 1999. The unusual part is that deaths rose while reported cases fell. Seven countries accounted for around 90% of all reported cases and deaths: Angola, Bangladesh, the Democratic Republic of the Congo, Nigeria, South Sudan, Sudan and Yemen. The WHO African Region carried the largest burden. Compared with 2024, cases there rose by 34% and deaths rose by 58%. WHO also reported that more than 21% of cholera deaths happened outside a health facility. Among patients who did reach a health facility, the death rate was below 1% globally, although 12 countries were above that 1% mark. Dr Chikwe Ihekweazu, Executive Director of the WHO Health Emergencies Programme, said: 'No one should be dying from cholera today when we have the tools to prevent and treat this disease.' The same report covered meningitis and plague. In the African meningitis belt, 24 of 26 countries reported 21,526 suspected cases and 971 deaths in 2025, a death rate of 4.5% and a 5.9% fall in cases on 2024. For plague, WHO recorded 3,847 suspected cases and 423 deaths across 10 countries between 2019 and 2025, mostly in the Democratic Republic of the Congo and Madagascar.
Why this matters
Cholera is an infection of the gut, caught from water or food contaminated with the bacterium. It can cause such heavy watery diarrhoea that a healthy adult becomes dangerously dehydrated within hours. That speed is the whole story. Cholera is not a mysterious disease with no answer. The main treatment is rehydration: getting fluid and salts back into the body, by mouth for most people and by drip for the sickest. Done promptly, it works for the great majority of patients. So a rising death toll alongside falling reported cases is a warning about systems, not about the bacterium becoming more fearsome. The figure that more than one in five deaths happened outside a health facility points the same way. People are dying before they are treated, or without being counted at all. For readers in the UK, cholera is not a domestic risk. Our water and sewage systems are the reason. The relevance here is travel, and the reminder of how much of our own safety rests on plumbing we never think about.
What the evidence actually says
These are reported figures, and WHO says so. Countries report what they detect and record. When conflict, flooding or a collapsed health service gets in the way, both cases and deaths can be missed. That cuts both ways, and it is why the fall in reported cases should be read carefully. It may mean fewer people fell ill. It may also mean fewer people were reached, tested and logged. WHO's note that one in five deaths occurred outside health facilities supports the second reading, at least in part. The treatment evidence is much firmer. The report shows that where patients reached a health facility, fewer than 1% died. That is a strong signal that the problem is access and speed rather than a lack of effective treatment. On prevention, there is genuine progress to report. WHO says global production of oral cholera vaccine roughly doubled, from about 30 million doses a year in 2022 to about 80 million in 2025, and that the International Coordinating Group approved 71 million doses for affected countries. More vaccine is being made than at any point in the recent past. The meningitis figures also show what vaccination can do over time. Since the meningococcal A conjugate vaccine was introduced in 2010, serogroup A cases have fallen by more than 99% among vaccinated populations, with no confirmed cases since 2017 in the countries that vaccinate. In 2025, Niger became the first country to run a nationwide campaign with the newer five-strain vaccine.
Practical advice
If you are travelling to a country where cholera is circulating, the basics do most of the work. Check the FCDO travel advice for your destination before you book and again before you fly. It covers health risks as well as safety. See a travel health clinic, your GP practice or a pharmacy that offers travel health at least six to eight weeks before you go. Some vaccines need time, and your adviser can tell you whether cholera vaccine is sensible for your trip. Drink water you can trust. Sealed bottled water, or water that has been boiled or properly treated. Avoid ice unless you know it was made from safe water. Be careful with food. Hot food served hot, fruit you peel yourself, and caution with salads washed in tap water. Wash your hands with soap, and carry hand gel for when there is no sink. Pack oral rehydration salts. They are cheap, light and the single most useful thing in a travel kit if you get a bad stomach upset. If you develop heavy watery diarrhoea during or shortly after a trip, start rehydrating straight away and seek medical help quickly. Mention where you have been. Rapid treatment is what makes the difference.
What to know
WHO has reported 451,499 cholera cases and 7,870 deaths across 47 countries in 2025, the highest annual death toll reported since 1999, even though reported cases fell. Seven countries accounted for around 90% of cases and deaths, and the African Region saw cases rise 34% and deaths rise 58% on 2024. More than 21% of deaths happened outside a health facility, while fewer than 1% of patients treated in a facility died. Vaccine supply has roughly doubled since 2022. The message from the figures is uncomfortable but clear: this is a disease we know how to treat, and the deaths are concentrated where treatment does not arrive in time. Sources: World Health Organization, 'WHO reports latest global trends in cholera, meningitis and plague', 29 September 2026, https://www.who.int/news/item/29-09-2026-who-reports-latest-global-trends-in-cholera--meningitis-and-plague; World Health Organization, Weekly Epidemiological Record, WER101-38, 29 September 2026, https://www.who.int/publications/journals/weekly-epidemiological-record/wer101-38; World Health Organization, 'Cholera' fact sheet, https://www.who.int/news-room/fact-sheets/detail/cholera. This article is for general information and does not replace advice from a doctor, pharmacist, health visitor or other qualified healthcare professional.
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