Cholera, 2020/Cholera, 2020.

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Date: Sept. 17, 2021
From: Weekly Epidemiological Record(Vol. 96, Issue 37)
Publisher: World Health Organization
Document Type: Article
Length: 5,171 words
Lexile Measure: 1870L

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World Health Organization

In 2020, the cholera pandemic coincided with the onset of the SARS-CoV-2 (COVID-19) pandemic. While significantly fewer cholera cases were reported globally during the year, the extent to which COVID-19 impacted worldwide cholera transmission, surveillance and reporting is not yet fully documented. COVID-19 preventive measures, such as more handwashing and hygiene, social distancing and banning of large gatherings, improved general hygiene in health facilities, and even household lockdown are likely to have reduced cholera transmission. The COVID-19 pandemic, however, also affected health-care-seeking and access, resulted in overcrowded health centres, reduced laboratory capacity, left fewer resources for outbreak investigation and burdened local and national disease reporting systems, all of which could have affected cholera detection and case-counting.

Overall, in 2020, 80 countries reported data on cholera to WHO. (1) Of these, 27 countries reported a total of 323 320 cholera cases and 857 deaths, for a case-fatality rate (CFR) of 0.27% (Figure 1, Map 1 and Table 1), while 53 countries reported 0 cases for the year (Table 2). After exclusion of Yemen, which accounted for 85% of cases reported globally to WHO for 2020, 47 608 cases and 742 deaths (CFR, 1.5%) were reported from other countries.

In 2019, 923 037 cholera cases and 1911 cholera deaths were reported globally, for a CFR of 0.2%, including 61 941 cholera cases and 886 cholera deaths outside Yemen (CFR, 1.4%). In 2020, the global number of reported cholera cases was 65% lower than in 2019, due to a 68% decrease in the number reported from Yemen and a 23% decrease in the number reported from all other countries. The global number of reported cholera deaths was 55% lower in 2020 than in 2019, corresponding to 89% fewer cholera deaths reported from Yemen and 16% fewer from all other countries.

Patterns of transmission and outbreaks

Africa

Overall, the numbers in Africa reflected the global decrease in 2020, with 47 256 cases and 741 deaths during the year as compared with 55 087 cases and 872 deaths in 2019. This is the 4th consecutive year that the burden of cholera in Africa has decreased, with the fewest reported cases in 30 years on the continent in 2020 (Figure 2).

The Democratic Republic of the Congo (DRC) reported over 30% decreases in the numbers of cases (19 789) and deaths (354) in 2020 than in the preceding year (30 304 and 514, respectively). The epidemic regions of the country remained relatively quiescent during the year, and the endemic zones of the eastern Great Lakes region saw an overall decrease. DRC has continued to strengthen cholera control in these endemic areas during the past 2 years, with implementation of preventive oral cholera vaccine (OCV) campaigns and improved early detection of and response to new outbreaks. These provinces represent a source of epidemic cholera for the whole country and remain a top priority for national cholera control.

The countries of the Horn of Africa and East Africa showed mixed results of cholera control in...

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