An Overview of Cholera Epidemiology: A Focus on Africa; with a Keen Interest on Nigeria
International Journal of TROPICAL DISEASE & Health,
Cholera is still a problem in the world today. A huge population of deaths due to cholera disease still occur in Sub-Saharan Africa (Nigeria most especially), Asia, the Americas and other developing countries, where approximately 1.7 billion inhabitants are still served by faecally polluted water sources. Approximately, 2.4 billion inhabitants of these areas of the world lack the majorly required sanitary conditions of living. Legros, asserts that, as of 2019, about forty-seven countries of the globe, are still affected by cholera. Raw or undercooked, contaminated seafood, serves as a vehicle for the transmission (especially to non-endemic areas). A Case Fatality Rate of 4.87% was recorded from 34 Local Government Areas of Bauchi, Borno, Kaduna, Kano and Zamfara state in Nigeria by the 34th week, in 2018, while 298 confirmed cases and 38 deaths (CFR 1.5%) were recorded from three Local Government Areas in two States (Adamawa & Borno) by Epidemiological week 41 in 2019. Cholera in some cases is regarded as a “disease of the poor” because the populations most affected are those that cannot afford to provide the basic health facilities for themselves. For example, waste management systems, and good accommodation with toilet facilities (the living and health conditions of the people) are wanting. In 2017, A Global Roadmap to 2030 was launched by the Global Task Force on Cholera Control (GTFCC Ending Cholera) to decrease the death rate due to cholera by 90%. By so doing, the disease can be eradicated from at least half of the 47 cholera-affected countries. The objectives of this roadmap are: to fortify health systems, water, sanitation and hygiene (WASH), and to coordinate different ways by which cholera can be controlled in these countries by 2030 (ensuring early detection and prompt response to contain outbreaks). This review aimed to understand the epidemiology of cholera in Nigeria, Africa and the world at large, to access the level of spread, management and preventive measures so far implemented in the endemic regions.
How to Cite
WHO. Global Health Observatory (GHO) data cholera. Number of Reported Cholera Cases - WHO who.int; 2019.
World Health Statistics 2018: Monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO. 1-86; 2018.
World Health Organization. Cholera fact sheet. Updated January; 2019.
[Accessed October 2019]
Jikal M, Tuan R, Rosmawati A, Mohammad SJ, Kamruddin A. Cholera outbreak by Sea Gypsies in Sabah, Malaysia: A challenge in North Borneo. Intl J Infect Dis. 2019;83:83–85.
WHO. Cholera; 2018.
Institut Pasteur. Cholera: A public health threat that still causes devastating outbreaks. All Reports 2018.01.22 The Research Journal.
Chioma CDN, Uzoma O, Onyiah P, Saheed G, Bashorun A, Nguku P, et al. A cholera outbreak in a rural north central Nigerian community: An unmatched case-control study. BMC Public Health. 2019;19: 112.
Thandavarayan R, Ankur M, François-Xavier W, Bhabatosh D, Amit G, Gopinath BN. Revisiting the global epidemiology of cholera in conjunction with the genomics of Vibrio cholerae. Review Article Front. Public Health; 2019.
Richterman A, Azman AS, Constant G, Ivers LC. The inverse relationship between national food security and annual cholera incidence: A 30-country analysis. BMJ Global Health. 2019;4:e001755.
CDC and Prevention CDC 24/7: Saving Lives, Protecting People TM Cholera - Vibrio cholerae infection.
Ivers LC. Advancing control of cholera in the interest of the most vulnerable in our global society. J Infect Dis. 2018;218(Suppl 3):S135–S136.
(Published Online 2018 Sep 1)
WHO. Seventy-First World Health Assembly Agenda Item 11.2 A71/A/CONF./3 Rev.1 24 1-4 May 2018 Cholera Prevention and Control Draft Resolution Proposed by Brazil, Dominican Republic, Ghana, Haïti, Kenya, Mozambique, Peru, United Republic of Tanzania, United States of America and Zambia; 2018a.
NaTHNaC Factsheets Cholera: TravelHealthPro Cholera epidemiology file/NaTHNaC - Cholera.htm.
Legros D. Global cholera epidemiology: Opportunities to reduce the burden of cholera by 2030. The Journal of Infectious Diseases. 2019;219(3):509.
Charles RC, Ryan ET. Cholera in the 21st century. Curr Opin Infect Dis. 2011;24: 472–477. [PubMed] [CrossRef] [Google Scholar]
Spiegel P, Ratnayake R, Hellman N, Mija Ververs, Ngwa M, Wise PH, et al. Responding to epidemics in large-scale humanitarian crises: A case study of the cholera response in Yemen, 2016–2018. BMJ Global Health. 2019;4:e001709.
DOI: 10.1136/ bmjgh-2019-001709
Martinelli-Filho JE, Lopes RM, Rivera ING, Colwell RR. Are natural reservoirs important for cholera surveillance? The case of an outbreak in a Brazilian estuary. Lett. Appl. Microbiol. 2016;63:183–188. [Google Scholar] [CrossRef] first_page
Gwenzi W, Sanganyado E. Recurrent cholera outbreaks in Sub-Saharan Africa: Moving beyond epidemiology to understand the environmental reservoirs and drivers review. Challenges. 2019;10(1):1.
Okello PE, Bulage L, Riolexus AA, Kadobera D, Kwesiga B, Kajumbula H, Kiyaga C. A cholera outbreak caused by drinking contaminated river water, Bulambuli District, Eastern Uganda, March 2016. BMC Infectious Diseases. 2019;19(1):516.
GlobalTask Force on Cholera Control. Sixth Annual Meeting of the Global Task Force on Cholera Control 3 - 4 June, 2019 – Les Pensières Center for Global Health WHO/WHE/IHM/2019.8.
World Health Organization Emergencies Preparedness, Response: Cholera–Zimbabwe.
(Accessed on 30 November 2018)
Department of Health.
Mukhopadhyay AK, Takeda Y, Nair GB. Cholera outbreaks in the El Tor Biotype Era and the impact of the new El Tor variants. Cholera Outbreaks, Nair, G.B., Taeda, Y. (Eds.). 2014;10:263.
World Health Organization. Cholera Fact Sheet. 2014;107.
Rebaudet S, Sudre B, Faucher B, Piarroux R. Cholera in Coastal Africa: A systematic review of its heterogeneous environmental determinants. J. Infect Dis. 2013; 208(Suppl):S98–S106.
Langa JP, Sema C, De Deus N, Colombo MM, Taviani E. Epidemic waves of cholera in the last two decades in Mozambique. Journal of Infections in Developing Countries. 2015;9(6):635-641.
World Health Organization. Cholera, 2011. Wkly Epidemiology Records. 2012;87:289–304.
Ujah IOA, Nwaokorie F, Adeneye A, Oladele D, Tajudeen B, Sola M, Kehinde A, Ihuora J, Ochoga M, Smith S. A review on perception and myth on causes of cholera infection in endemic areas of Nigeria. Afr J Microbiol Reas. 2015;9(9): 557-564.
Adagbada AO, Adesida SA, Nwaokorie FO, Niemogha MT, Coker AO. Cholera epidemiology in Nigeria: An overview. Pan African Afr Med J. 2012;12:59.
Akyala IA, Shadrack BE, Olufemi A, Adebola O, Nguku P. Investigation of cholera outbreak in an urban North Central Nigerian community. The Akwanga Experience, Pub Health Res. 2014;4(1):7-12.
Quilici ML, Massenet D, Gake B, Bwalki B, Olson DM. Vibrio cholerae O1 variant with reduced susceptibility to ciprofloxacin in Western Africa. Emerg Infect Dis. 2010;16: 1804–1805.
Akoachere J-FTK, Mbuntcha CKP. Water sources as reservoirs of Vibrio cholerae O1 and non-O1 strains in Bepanda, Douala (Cameroon): Relationship between isolation and physico-chemical factors. BMC Infect Dis. 2014;14:421.
Malange EN. The cholera epidemic and barriers to healthy hygiene and sanitation in Cameroon. A Protocol Study: Supervisor: Anna-Karin Hurtig; 2010.
de Magny GC, Thiaw W, Kumar V. Cholera outbreak in Senegal in 2005: Was climate a factor? PLoS One. 2012;7:e44577.
Mugoya I, Kariuki S, Galgalo T, Njuguna C, Omollo J, Njoroge J, et al. Rapid spread of Vibrio cholerae O1 throughout Kenya, 2005. The Am Soc Trop Med Hyg. 2008;78(3):527-533.
Njeru M, Ahmed AM, Ng'ang'a Z, Goutam C, Gururaja PP, Thandavarayan R, Hamadi IB, Kariuki SM, Oundo J. Phenotypic and genetic characterization of Vibrio Cholerae O1 isolated from various Regions of Kenya between 2007 and 2010. Pan Afri Med J. 2014;19:8.
Suleiman MS, Nityananda C, Sharda PA, Masahiro A, Atsushi H, Yoshio I, et al Prevalence of Vibrio cholerae O1 El Tor variant in a cholera-endemic zone of Kenya. J Med Microbiol. 2014;63:415–420.
Ankur M, Dong WK, Thomson CTR, Je HL, Kariuki S, Croucher NJ, et al. Evidence for several waves of global transmission in the seventh cholera pandemic. Nature. 2011;477:462–465.
Morof D, Cookson ST, Laver S, Chirundu D, Desai S, Mathenge P, et al. Community mortality from cholera: Urban and rural Districts in Zimbabwe. Am J. Trop Med Hyg. 2013;88(4):645-650.
Marin MA, Thompson CC, Freitas FS, Fonseca EL, Aboderin AO, Zailani SB, Quartey NKE, Iruka NO, Vicente ACP. Cholera outbreaks in Nigeria are associated with multidrug resistant a typical El Tor and Non-O1/Non-O139 Vibrio cholera. Plos Neglect Trop Dis. 2013;7(2):e2049.
LaRocque R, Harris JB. Cholera: Clinical features, diagnosis, treatment and prevention. Literature Review Current Through: Oct 2019. ©2019 UpToDate, Inc.
European Centre for Disease Prevention and Control (ECDC). Communicable Disease Threats Report Week 12, 18-24 March. 2018;1-14.
European Centre for Disease Prevention and Control. An Agency of the European Union Cholera worldwide overview Page Last Updated 14 Jun; 2019.
Schreiber M, Beaubien J. Cholera 101: Why this ancient disease is making headlines in 2019 April 2, 201910:25 AM ET Goats and Soda Stories of Life in a Changing World.
Ed Pilkington. Ed Pilkington Reports. The Independent; 2019.
Pan American Health Organization / World Health Organization. Epidemiological Update: Cholera. 6 August 2018, Washington, D.C. PAHO/WHO. 2018 Pan American Health Organization; 2018.
WHO. Weekly Epidemiological Bulletins.
Data published by the Dominican Republic Ministry of Public Health, General Directorate of Epidemiology.
Global Task Force on Cholera control (World Health Organization Ending Cholera)—A Global Roadmap to 2030.
Hussain AM, Lafta RK. Trend of cholera in Iraq in the time of unrest. Mustansiriya Med J. 2019;18:1-4.
Wellcome Trust Sanger Institute. Mystery of Yemen cholera epidemic solved: The most likely source of the cholera epidemic in Yemen has been discovered by scientists. ScienceDaily; 2019.
Camacho A, Malika B, Reema A, Abdulhakeem A, Munna AMN, Xavier de R, et al. Cholera epidemic in Yemen, 2016–18: An analysis of surveillance data. The Lancet Global Health. 2018;6(6): Pe680-e690.
Justin L, Sean MM, Francisco JL, Heather SM, Rebecca G, Myriam H. Mapping the burden of cholera in Sub-Saharan Africa and implications for control: An analysis of data across geographical scales. Lancet. 2018;391(10133):1908–1915.
World Health Organization. Cholera, Number of Reported Cases (Data by Country); 2016.
UN Children's Fund 10 Sep 2018: Lake Chad Basin Cholera Outbreak Update -10 September 2018 (Week 35).
Brecht I, Hendrickx D, Miwanda B, van der Sande MAB, Mossoko M, Vochten H, et al. Recurrent cholera outbreaks, Democratic Republic of the Congo, 2008–2017 CDCP. 2019;25:5.
George G, Rotich J, Kigen H, Catherine K, Waweru B, Boru W, et al. MMWR Morb Mortal Wkly Rep. 2016;65(3):68-9. [Notes from the Field: Ongoing Cholera Outbreak - Kenya, 2014-2016]
Bulletin: Cholera and AWD Outbreaks in Eastern and Southern Africa, Regional Update for 2019 - as of 17 May; 2019.
WHO Cholera – Republic of the Sudan UN News October 31; 2019.
WHO and UNICEF in campaign to protect 1.6 million in Sudan from cholera. The Guardian UN News October 31; 2019.
UN Children's Fund Published on 17 May 2019 Reliefweb Update Report. Available:https://reliefweb.int›report›mozambique›bulletin-cholera-and-awd-out
Bwire G, Munier A, Ouedraogo I, Heyerdahl L, Komakech H, Kagirita A, et al. Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015. PLoS Negl Trop Dis. 2017;11(3):e0005407.
Nyambe S, Brunkard JM, Nathan K, Mazyanga LM, Kunda GM, Raymond H, et al. US Department of Health and Human Services/Centers for Disease Control and Prevention. Cholera Epidemic — Lusaka, Zambia, October 2017–May 2018 MMWR. 2018;67(19):556-559.
Regional Updates (Cholera Bulletin).htm Latest Issue, as of 15 June; 2019.
WHO AFRO Outbreaks and Other Emergencies, Week 39: 22 - 28 September 2018 (Data as reported by 17:00; 28 September 2018) Report from World Health Organization.
(Published on 28 Sep 2018)
OHCA West and Central Africa: Weekly Regional Humanitarian Snapshot (9–15 October 2018).
WHO AFRO Outbreaks and Other Emergencies, Week 42: 13 - 19 October 2018 (Data as reported by 17:00; 19 October 2018) Report from World Health Organization.
(Published on 19 Oct 2018)
WHO AFRO Outbreaks and Other Emergencies, Week 4: 18 - 25 January 2019; Data as reported by 17:00; 25 January 2019 Report from World Health Organization.
(Published on 25 Jan 2019)
WHO AFRO Outbreaks and Other Emergencies, Week 17: 22 - 28 April 2019; Data as reported by 17:00; 28 April 2019. Report from World Health Organization.
(Published on 28 Apr 2019)
WHO AFRO Outbreaks and Other Emergencies, Week 39: 23 - 29 September 2019 Data as reported by: 17:00; 29 September 2019.
Unicef Cholera Epidemiology and Response Factsheet Nigeria Cholera Overview.
OCHA; Nigeria – North-East Flash Update No. 2 – Cholera Outbreak 9 September; 2018.
Cholera Outbreak in Nigeria: NCDC Situation Report (21 June 2018).
Nigeria Centre for Disease Control, Weekly Epidemiological Report Main Highlight of the week. Evaluating the 2018 Cerebrospinal Meningitis Response in Nigeria.
Ballah AD, Cecilia BA, Salihu AK, Ibrahim K. Low case fatality during 2017 cholera outbreak in Borno State, North Eastern Nigeria. Ann Afr Med. 2018;17(4):203-209.
Nigeria Centre for Disease Control Weekly Epidemiological Report Main Highlight of the Week Prevention of Cholera Outbreaks I: Issue: Volume 7 No. 25 7th July; 2017.
World Health Organization. Diarrhoeal disease. WHO fact sheet. Updated May; 2017. Available:http://www.who.int/mediacentre/factsheets/fs330/en/
(Accessed 20 August 2018)
Nigerian Center for Disease Control Situation Report. Cholera Outbreak In Nigeria No15 Epi-Week: 35, 3rd September; 2018.
Nigerian Center for Disease Control Situation Report. Cholera Outbreak In Nigeria No 16 Epi-Week: 3, 10th September; 2018.
Nigeria Centre for Disease Control Protecting the health of Nigerians Weekly Epidemiological Report October Week 41.
Nigeria Centre for Disease Control Protecting the health of Nigerians Weekly Epidemiological Report December Week 51.
Weekly Epidemiological Report Issue: Volume 8 No. 31 17th August 2018. National Preparedness and Response to Acute Water Diarrhoea/ Cholera Guidelines.
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