The response to a cholera outbreak must focus on limiting mortality and reducing the spread of the disease. It should be comprehensive and multisectoral, including epidemiology, case management, wat
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er, sanitation and hygiene, logistics, community engagement and risk communication. All efforts must be well coordinated to ensure a rapid and effective response across sectors.
This document provides a framework for detecting and monitoring cholera outbreaks and organizing the response. It also includes a short section linking outbreak response to both preparedness and long-term prevention activities.
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Operational Guidelines for the national and district health workers & planners.
These new approaches include use of selective chemotherapy, Rapid Diagnostic Tests (RDTs), Zinc for treatment of cholera in children and complementary use of OCV
Document available in English, French, Russian, Spanish, Portuguese and Swahili. For other languages check also: http://www.who.int/cholera/publications/OutbreakAssessment/en/
Cholera is a transmissible diarrhoeal infection caused by Vibrio cholerae. Endemic and/or epidemic in over 40 countries (mainly in Africa and Asia), cholera continues to be a major global public hea
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lth issue.
The World Health Organization (WHO) estimates that the number of cases reported worldwide represents in reality only 5 to 10% of actual cases.
This guide is intended for medical and non-medical staff responding to a cholera outbreak. It attempts to provide concrete answers to the questions and problems faced by staff, based on the recommendations of reference organisations, such as WHO and UNICEF, as well as Médecins Sans Frontières’ experience in the field.
It is divided into 8 chapters. Chapter 1, Cholera overview, outlines the epidemiological and clinical features of cholera. Chapter 2, Outbreak investigation, explains the method and stages of a field investigation, from the alert to implementation of initial activities. Chapter 3, Cholera control measures, details measures and tools to prevent and/or control cholera transmission and mortality in populations affected, or at risk of being affected, by an epidemic (curative care, prevention means and health promotion activities). Chapter 4, Strategies for epidemic response, addresses the roll-out strategies of the measures described in Chapter 3 which depend on context (e.g. urban, rural, endemic, non-endemic setting, etc.), resources and particular constraints. Chapter 5, Cholera case management, details the different stages of cholera treatment, from diagnosis through to cure.
Chapter 6, Setting up cholera treatment facilities, focuses on the installation of treatment facilities that vary in size and complexity according to operational requirements (treatment centres and units and oral rehydration points). Chapter 7, Organisation of cholera treatment facilities, describes the organisation of these specialized facilities in terms of human resources, supply, water, hygiene and sanitation, etc. Chapter 8, Monitoring and evaluation, presents the key data to be collected and analysed during an epidemic to facilitate a tailored response and evaluate its quality and effectiveness.
The guide includes various practical tools in the appendices to facilitate activities (e.g. water quality tests, job descriptions, documents, etc.). Moreover, the toolbox also contains additional tools in editable formats (individual patient file, cholera case register, pictograms).
Despite all efforts, it is possible that certain errors may have been overlooked in this guide. Please inform the authors of any errors detected.
To ensure that this guide continues to evolve while remaining adapted to field realities, please send any comments or suggestions.
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Cholera which disproportionally impacts poor countries and the most vulnerable continues to affect at least 47 countries across the globe, resulting in an estimated 1.3 – 4 million cases, and 21,000 - 143,000 deaths per year worldwide. In Ethiopia
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, despite major improvements seen in the increasing access to healthcare, clean water, and improvement in maternal and child health, the country continues to be significantly affected by cholera outbreaks. From 2015 – 2021 for example, several outbreaks of cholera have occurred in multiple parts of the country resulting in over 105,000 cases and thousands of deaths. Some of the risk factors associated with cholera in Ethiopia include inadequate access to clean water, practice of open defecation, poor household and environmental sanitation, unhygienic latrine and weak sanitation practise among communities.
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The report offers 20 top recommendations for getting ahead of future outbreaks in Yemen and similarly complex humanitarian settings.
In 2015, Yemen was declared a Level 3 emergency by the UN, kicking into gear the highest level of humanitarian support. A massive
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cholera outbreak followed, leading to 1 million suspected cases in 2 waves from September 2016-July 2018.
“We largely know ‘what to do’ to control cholera, but context-specific practices on ‘how to do it’ in order to surmount challenges to coordination, logistics, insecurity, access and politics remain needed,” the report states.
While the response improved between the 2 waves, there were gaps. For one, Yemen’s history of cholera should have triggered a heavy focus on pre-planning for an epidemic, such as stockpiling supplies and doubling down on community-based surveillance, the report fou
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Practical guide for doctors, nurses,laboratory technicians, medical auxiliaries,water and sanitation specialists and logisticians
To better adapt current case management practices and address excess mortality in otherwise treatable
cases will require better knowledge of the demographic characteristics of the patients and comorbidities
which can make severe dehydration harder to tolerate physiologically. With this in mind, a
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scoping review
was undertaken, to explore the literature and summarise the existing evidence on cholera mortality and
reported risk factors.
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This review of the IFRC support to the Sierra Leone Red Cross Society response to the 2012 cholera outbreak provides ideas and concepts to promote a more coherent and evidence based rationale on how
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to make more effective use of IFRC global assets to stop, control, mitigate and respond to cholera epidemics. No fit and healthy person should die from cholera – that should be the indicator of success.
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Cholera is a diarrhoeal disease that is usually contracted when drinking water contaminated with Vibrio cholerae bacteria. The fight against this disease requires a multidisciplinary approach that combines a water, hygiene and sanitation (WaSH) resp
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onse with a monitoring system, improved water supply and quality, sanitation and hygiene, and a health response with the treatment of the disease itself.
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Since the last situation report on the multi-country outbreak of cholera was published on 1 June 2023 (covering data reported until 15 of May), no new country reported a
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cholera outbreak. In total, 24 countries have reported cases since the beginning of 2023. The WHO African Region remains the most affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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CORE Group has developed a module to improve preparedness for and response of communities in countries at risk of a cholera epidemic. The module consists of four lesson plans with accompanying flipcharts, intended to be delivered through community h
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ealth workers. The lessons target mothers and caregivers of children under age five, a group that is at particular risk of death if infected. The module shares information about symptoms and risks; what families can do to prevent infection; how, when, and where to seek care; and what actions to take in the aftermath of an outbreak.
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BMC Health Services Research (2019) 19:458 https://doi.org/10.1186/s12913-019-4315-7
Since the last situation report on the multi-country outbreak of cholera was published on 6 July 2023 (covering data reported until 15 of June), and as of 15 July 2023, one new
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outbreak of cholera was reported from India on 15 May 2023. In total, 25 countries have reported cases since the beginning of 2023. The WHO African Region remains the most affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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