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Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year there are an estimated 3 to 5 million cholera cases and 100 000 to 120 000 deaths due to cholera. The short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks.

Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. About 75% of people infected with Vibrio cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment, potentially infecting other people.

Globally, cholera incidence has increased steadily since the beginning of the millenium with cholera outbreaks persisting in Sub-Saharan Africa. There are a number of countries in the Eastern Mediterranean Region that are in a state of complex emergency. Lack of safe water supply and poor environmental sanitation in war ravaged countries are formidable challenges.

A photograph of a medical staff checking a young child during an outbreak of choleraAmong people who develop symptoms, 80% have mild or moderate symptoms, while around 20% develop acute watery diarrhoea with severe dehydration. This can lead to death if untreated. Photo credit: WHO

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year, there are an estimated 3 to 5 million cholera cases and 100 000 to 120  000 deaths due to cholera. The short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks.

Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. About 75% of people infected with Vibrio cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment, potentially infecting other people.

Cholera remains a major public health risk in the WHO Eastern Mediterranean Region. During the last decade, at least 14 out of 22 countries in the Region have reported cholera cases, often in epidemic proportions. Countries in the Region facing complex emergencies are particularly at risk, as they lack safe drinking-water and sanitation resources. The full extent of the burden of cholera in the Region is difficult to estimate due to weak surveillance systems in some endemic countries, in addition to underreporting of cases, although it is estimated that the number of cases may be around 188 000 per annum. Explosive outbreaks of cholera have been reported from Afghanistan, Djibouti, Iraq, Pakistan, Sudan, Somalia and Yemen in the last decade. 

Effective and proven prevention and control measure for cholera are dependent on provision of adequate environmental health services, such as safe drinking-water, improved access to safe sanitation and health hygiene measure. The availability of oral cholera vaccines is offering hope for cholera prevention and control, particularly in situations where other conventional public health measures, such as improving the access to safe water and sanitation, cannot be scaled up rapidly due to conflict or other environmental factors.