WHO Warns of the ‘Unacceptable’ Death Toll in Global Cholera Outbreaks
The WHO assisted Zimbabwe to respond to a cholera outbreak in the country. As part of the response, mobile community centres were set up to detect and treat cases.

Deaths during the cholera outbreaks over the past two years have been “unacceptably high”, according to the World Health Organization (WHO).

“We are looking at outbreaks with unacceptably high case fatality ratios (CFR),” said Philippe Barboza, WHO’s cholera lead and head of the Global Task Force on Cholera Control (GTFCC) secretariat.

“Without any type of treatment or case management, the CFR of cholera can be up to 50%. However, with adequate treatment, the CFR should be below 1%. The 1% is not the target, the 1% is the maximum acceptable CFR,” Barbosa told a WHO meeting on cholera this week.

But in recent outbreaks in Malawi, Zambia, Uganda and Sudan, around 3% of those infected have died, according to WHO statistics.

“This is totally unacceptable. And when I say that, I’m not blaming the country. The size of the outbreaks are so big, that they overwhelmed the national capacity,” said Barbosa.

Cholera is a bacterial disease spread largely in contaminated food and water, and can cause severe acute watery diarrhoea.

However, Barboza added that it was also “totally unacceptable” that, in the 21st century people are still dying “because they are drinking water contaminated with faeces”.

Between 2017 and 2020, significant progress was made to reduce cholera but the pandemic reversed these gains. Climate change and conflict are also driving the recent outbreaks.`

Since the start of 2023, there have been almost 850,000 reported cases, with this year alone already recording 140,000 cases.

The WHO declared cholera a Stage Three health emergency, the most serious level, in early 2023 and this remains the case currently, with 23 countries experiencing outbreaks.

“Around 80% of the patients WHO have symptoms of cholera can be treated have either no or very mild signs or mild to moderate dehydration and can be treated with oral rehydration solution alone,” said Kathryn Alberti, WHO technical offer on cholera.

Although the global surveillance of cholera is poor, a GTFCC review shows that many deaths occur in communities rather than in health facilities.

Barboza and other speakers emphasised the importance of involving the community in outbreak response. During a large cholera outbreak in Malawi following a cyclone that caused widespread flooding, the country’s health ministry set up community outreach centres to provide people with oral rehydration. Community engagement was also seen as essential in encouraging people to seek care.

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