Cholera is an acute watery diarrhoeal disease caused by infection with Vibrio cholerae O1 or O139 bacteria. The bacterium produces a toxin that causes massive fluid secretion into the intestinal lumen — leading to profuse "rice-water" diarrhoea, rapid dehydration and, without treatment, death within hours. Most infected people (approximately 80%) have mild or no symptoms; about 20% develop acute watery diarrhoea; and around 1% develop severe cholera requiring hospitalisation.

How is cholera transmitted?

Cholera spreads through ingestion of water or food contaminated with Vibrio cholerae — from faeces of an infected person. Common sources: water from contaminated rivers, wells or municipal systems; food washed with contaminated water; raw shellfish from contaminated coastal water. Person-to-person transmission is rare. Outbreaks occur rapidly when WASH systems collapse — as in conflict, floods or disasters.

How is cholera treated?

Treatment is primarily oral rehydration therapy (ORT) — prompt replacement of fluid and electrolytes prevents the vast majority of cholera deaths. ORT is sufficient for mild-moderate cases. Severe cholera with severe dehydration or vomiting requires intravenous fluid resuscitation (Ringer's lactate) followed by ORT. Antibiotics (doxycycline, single dose) are recommended for severe cholera to shorten duration. Zinc supplementation is recommended for children.

What is the oral cholera vaccine?

Two oral killed whole-cell cholera vaccines are WHO-prequalified: Shanchol and Euvichol. They provide 65-80% protection against cholera for 3-5 years and are safe including in pregnancy. Two doses given 2 weeks apart provide maximum protection; a single-dose strategy achieves approximately 40% protection and is used in mass outbreak response when time is critical. OCV is a bridge intervention — not a substitute for WASH improvements.

Why is cholera resurging?

After declining in the 2010s, cholera surged dramatically from 2022. Key drivers: ongoing conflicts (Yemen, DRC, Sudan) destroying water infrastructure and displacing populations; climate change-linked flooding contaminating water supplies; political instability; and interrupted WASH investment. The 2010 Haiti earthquake demonstrated how cholera can devastate a population without prior endemic exposure. WHO declared a global cholera emergency in 2022 as cases reached a 10-year high.

Which countries are most affected?

Cholera is endemic in the "cholera hotspots" — countries with persistently poor WASH infrastructure: Yemen, DRC, Haiti, Bangladesh, India, Ethiopia, Somalia, Mozambique, Niger, Nigeria and others. The 47 countries in the GTFCC Ending Cholera roadmap account for the vast majority of global burden. Conflict-affected and fragile states are disproportionately affected.

How does climate change affect cholera?

V. cholerae thrives in warm, brackish coastal water — and climate change is expanding these conditions. Flooding contaminates drinking water with faecal matter. Drought concentrates Vibrio in surface water. El Niño events correlate with cholera outbreaks in endemic regions. Climate change is projected to increase cholera risk in tropical regions and push it into new areas — including Southern Africa and parts of the Middle East.

What is the GTFCC Ending Cholera roadmap?

The Global Task Force on Cholera Control (GTFCC) Ending Cholera roadmap (2017) targets a 90% reduction in cholera deaths and elimination of cholera as a public health threat in 20 countries by 2030. It coordinates: WASH improvement in hotspot areas; strategic OCV vaccination; surveillance and early warning; and case management capacity. Progress monitoring shows that achieving the target requires a 10-fold acceleration of current efforts.

Can cholera be eliminated?

Sustained elimination requires: reliable access to safe water and adequate sanitation for affected populations — which means sustained political commitment and investment over decades. Countries with excellent WASH infrastructure have no cholera. The barrier is not scientific — it is political and financial. OCV buys time; WASH is the durable solution.

How is cholera prevented?

The most effective long-term prevention is universal access to safe water and adequate sanitation. Immediate interventions: chlorination of water supplies; promotion of handwashing with soap; safe food handling; and mass OCV in high-risk settings. In outbreak settings, social mobilisation, point-of-use water treatment (chlorine tablets) and ORT provision reduce mortality rapidly.

What is the role of cholera in Georgia?

Georgia does not have endemic cholera, but as a country along major migration routes and with regional connectivity to affected areas, cholera surveillance is part of PHIG's public health mandate. The Georgian Medical Journal covers cholera in the context of global outbreak surveillance and WASH policy.

How does GMJ News cover cholera?

GMJ News tracks WHO cholera situation reports, GTFCC Ending Cholera progress, OCV stockpile management, climate-cholera links and outbreak responses. The 2022-2023 global cholera emergency and its humanitarian drivers are major editorial priorities.

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Cholera

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

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Cholera — an acute watery diarrhoeal disease caused by Vibrio cholerae — can kill within hours of symptom onset if untreated, yet it is entirely preventable with safe water and sanitation and treatable with oral rehydration therapy (WHO). With 1.3-4 million cases and up to 143,000 deaths per year, cholera remains endemic in over 40 countries and resurges explosively in conflict and disaster settings. The WHO Global Task Force on Cholera Control (GTFCC) targets a 90% reduction in cholera deaths by 2030 through the Ending Cholera roadmap.

Key messages

Kills in hours, prevented by clean water

Cholera — from Vibrio cholerae — can cause profuse watery diarrhoea so severe that dehydration kills within hours. Yet it is entirely preventable with safe water and sanitation, and treatable with oral rehydration therapy (ORT).

Global resurgence

Cholera is resurgent: after declining in the 2010s, cases surged from 2022 onwards — driven by climate-linked extreme weather, conflict, displacement and deteriorating WASH infrastructure. WHO declared a "global cholera emergency" in 2022.

GTFCC 2030 target

The WHO Global Task Force on Cholera Control (GTFCC) targets a 90% reduction in cholera deaths by 2030 through the Ending Cholera roadmap — coordinating surveillance, WASH, oral cholera vaccines (OCV) and case management.

OCV is effective

The oral cholera vaccine (Shanchol, Euvichol) provides 65-80% protection for 3-5 years. Mass OCV campaigns in outbreak settings — combined with WASH — dramatically reduce deaths. Strategic OCV stockpiling and deployment is a GTFCC priority.

Conflict and cholera

Conflict and humanitarian crises are the primary driver of cholera outbreaks: destroyed water infrastructure, displaced populations in crowded camps and collapsed health systems create explosive conditions. Yemen, Haiti, DRC, Sudan and Ethiopia have been the epicentres of recent outbreaks.

Climate amplifies cholera

Climate change — through flooding (which contaminates water supplies), drought (concentrating Vibrio in water bodies) and rising sea surface temperatures (which promote Vibrio growth) — is increasing cholera risk and expanding its range.

Key statistics

1.3-4M

cholera cases/year

WHO

21-143K

deaths/year

WHO

40+

endemic countries

WHO

90%

death reduction target by 2030 (GTFCC)

WHO/GTFCC

65-80%

OCV vaccine efficacy for 3-5 years

WHO/SAGE

2022

WHO global cholera emergency declared

WHO

Reported cholera cases globally (thousands) 2010-2023 — WHO

Source: WHO Global Health Observatory. Real burden is estimated 10-100x higher than reported figures.

Glossary of key terms

Vibrio cholerae O1/O139
WHOThe bacterial pathogen causing epidemic cholera. O1 serogroup (El Tor biotype, Ogawa/Inaba serotypes) causes most current epidemics. V. cholerae produces cholera toxin that triggers massive secretion of fluid into the intestinal lumen — "rice-water" stools.

Rice-water stools
WHO/ClinicalThe characteristic profuse, watery stool of cholera — odourless, without blood or mucus, resembling rice water. Output can exceed 1 litre/hour in severe cholera, causing life-threatening dehydration within hours.

Oral cholera vaccine (OCV)
WHO/SAGETwo-dose oral killed whole-cell vaccine (Shanchol or Euvichol) providing 65-80% protection for 3-5 years. WHO recommends in high-risk populations and outbreak settings. Single-dose strategy in outbreak response achieves 40% protection more quickly.

GTFCC
WHOGlobal Task Force on Cholera Control — multi-agency body coordinating the Ending Cholera global roadmap to reduce cholera deaths by 90% by 2030 through WASH, OCV, surveillance and case management.

Ending Cholera
GTFCC/WHOThe global roadmap (2017) to eliminate cholera as a public health threat by 2030. Targets 47 of the most cholera-affected countries for multi-sector interventions combining WASH improvement, OCV vaccination and surveillance.

Intravenous fluid resuscitation
WHOThe life-saving treatment for severe cholera with severe dehydration — replacing large volumes of fluid rapidly. ORT is sufficient for mild-moderate dehydration; IV Ringer's lactate or normal saline is essential for severe cases. Antibiotics (doxycycline) are recommended for severe cholera to shorten duration.

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Cholera

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