Cholera Deaths Rise 30% as WHO Reports Highest Annual Toll in More Than Two Decades

Countries across Africa’s meningitis belt, stretching from Senegal to Ethiopia, continue to face recurring epidemics as vaccination advances efforts to defeat meningitis by 2030.

Cholera killed 7870 people across 47 countries in 2025, a 30% increase in reported deaths despite fewer reported infections, according to the World Health Organization (WHO). The annual death toll was the highest reported since 1999, exposing gaps in access to prevention and timely treatment for a disease that can be prevented and treated. Countries reported 451,499 cases, but these surveillance figures capture only part of the picture, with the actual global burden estimated to be substantially higher because many infections go unreported.

WHO published the findings in its latest Weekly Epidemiological Record, alongside updates on bacterial meningitis and plague. Seven countries: Angola, Bangladesh, the Democratic Republic of the Congo, Nigeria, South Sudan, Sudan and Yemen, accounted for around 90% of reported cholera cases and deaths. The African Region carried the largest burden, recording a 34% increase in cases and a 58% rise in deaths compared with 2024.

Cholera deaths expose gaps in access to care

Cholera spreads through food or water contaminated with faeces containing Vibrio cholerae bacteria, particularly where safe water and sanitation are unavailable, and severe dehydration can become fatal without rapid treatment. More than one in five reported deaths occurred outside health facilities, indicating that many patients failed to reach care in time. Among patients treated in facilities, the global fatality rate remained below the 1% threshold used to indicate adequate care, although 12 countries exceeded that level in 2025.

Dr Chikwe Ihekweazu, Executive Director of WHO's Health Emergencies Programme, called the increase a reminder of the challenge ahead, stressing that available prevention and treatment tools should make cholera deaths avoidable. He identified safe water, sanitation and hygiene as priorities for targeted investment in the hardest-hit countries, supported by stronger surveillance, community engagement, vaccination and quality care. Oral cholera vaccine production grew from around 30 million doses in 2022 to approximately 80 million in 2025; the International Coordinating Group (ICG) on Vaccine Provision approved 71 million doses for affected countries, including 20 million for preventive vaccination, which resumed after a suspension lasting more than three years.

Broader vaccination strengthens protection against meningitis

Countries across Africa's meningitis belt, stretching from Senegal to Ethiopia, continue to face recurring epidemics as vaccination advances efforts to defeat meningitis by 2030. In 2025, 24 of the belt's 26 countries reported 21,526 suspected cases and 971 deaths, a fatality rate of 4.5%. Cases fell by 5.9% among countries providing data for both years. Meningitis involves inflammation of the tissues surrounding the brain and spinal cord, with bacterial meningitis its most serious form and four types of bacteria responsible for most bacterial cases worldwide.

Vaccination has dramatically reduced meningococcal meningitis caused by serogroup A, with cases falling by more than 99% among vaccinated populations following the introduction of the meningococcal A conjugate vaccine in 2010. Countries that introduced it have reported no confirmed serogroup A case since 2017. The broader Men5CV/MMCV vaccine protects against five meningococcal serogroups and is being introduced for outbreak response through the ICG and preventive campaigns, with Niger becoming the first country to conduct a nationwide campaign using it in 2025.

Plague control depends on early detection and rapid response

Plague usually circulates among animals through fleas and can infect people, making surveillance of rodents and other animal populations essential. Between 2019 and 2025, 10 countries reported suspected human cases to WHO, including six that reported confirmed infections. The combined total reached 3847 suspected cases and 423 deaths, a fatality rate of 11%, with most cases reported in the Democratic Republic of the Congo and Madagascar, where the disease remains endemic in some areas. Annual numbers varied with the timing, location and size of outbreaks; countries reporting no cases may still experience infections, underscoring the need for continued surveillance and rapid responses to reduce transmission and prevent larger outbreaks.