Epidemic hazard

According to official data, 2025 has been the worst year in decades for cholera in the African Union, with over 300,000 cases and 7,000 deaths (CFR 2.5%) drawing major media attention. Based on media reports, in recent weeks several countries are experiencing a resurgence after a significant slowdown in cases during the past months. An RFI has been sent to EpiCore members asking support to monitor in real time the epidemiological situation in the Region, to collect reliable information about control measures in place at national/international level and to define factors that may be relevant to assess the risk for the population currently and in the coming weeks. The EpiCore network has provided information and professional comments about the situation at international level as well as at national level for several countries. The common professional opinion is that the current severe cholera situation in the Region may be even exacerbated by the rain season that has just started, with a high risk in the coming weeks of heavy rainfall and floodings that may increase the risk of waterborne diseases, especially in high density areas with shallow water wells and pit latrines. The network considers that the national authorities of AU countries need to be now particularly proactive in the dissemination of awareness and preventive messages to the community to prevent the further spread of cholera cases, while the population needs to carefully adopt hygiene practices especially on the issue of improving sanitation, handwashing and avoid unnecessary handshakes. In addition, the distribution of chlorine for the disinfection of water needs to be ensured and communities should be encouraged to boil water extracted from untrusted sources. In terms of data, Africa CDC is providing regular weekly updates on cholera. Based on the latest figures (Nov 22, 2025), since the beginning of 2025, over 308,000 cases (almost 10,000 lab-confirmed) and 7,131 deaths (CFR: 2.31%) have been reported from 24 AU Member States, mainly from Sudan (approximately 72,000 cases including 2,000 deaths), DRC (63,521; 1,863) and Angola (35,000; 877 deaths). In EW 46, a total of 1,419 new cases and 18 deaths have been reported by the following countries: Angola, Burundi, Chad, Ethiopia, Kenya, Mozambique, South Sudan, Sudan and Zambia. Below is a summary of the information provided so far by the network for specific countries in the African region. This report may be updated in the coming weeks in case of additional contributions received with reference to countries not yet listed below. ANGOLA The network has informed that Angola is among the countries experiencing the worst cholera situation, with almost 35,000 cases (including 863 deaths, CFR 2.6%) documented as of mid November 2025. Cases fell in July and August 2025, but concerns persist due to local clusters and cross-border transmission risks. The outbreak is currently active in 18 out of 21 provinces with the most affected age group being 10-14 years old. The disease remains of particular concern due to several factors including heavy rains, poor sanitation, localized clusters and risk of cross-border transmission in several provinces. mainly Lunda Norte, Huíla, and Cunene. DEMOCRATIC REPUBLIC OF THE CONGO (DRC) Based on the network feedback, DRC is facing this year its worst cholera outbreak in over twenty years, with nearly 60,000 cases and more than 1,700 deaths reported by October 2025. Cholera has spread to most provinces, with ongoing conflict, poor sanitation, and displacement increasing the risk. While efforts are underway to control the outbreak, the situation is assessed as fragile, and the widespread impact makes the response particularly difficult. The authorities are implementing the Multisectoral Cholera Elimination Plan (2023–2027) that is focusing on high-risk areas identified mainly in the Great Lakes Region that is affected by conflict and displacement, which makes response activities and access of the population to healthcare even harder. In August 2025, a major oral cholera vaccine campaign was carried out in heavily affected zones of Kinshasa. Despite all these efforts, MSF recently warns that the situation is still critical and urges rapid international action, noting that upcoming seasonal rains may worsen the outbreak even with vaccination, WASH, and treatment efforts. The network has informed also that UNICEF has reported a recent surge in Tanganyika province and responded by conducting hygiene campaigns, starting school awareness programs, and establishing a facility for liquid chlorine production. KENYA The network has informed that Kenya has seen a drop in cholera cases compared to other countries in the second half of 2025. Most of cases have been reported this year in February, with epidemiological alerts declared in 6 counties. Since then, the country has been actively responding with several actions based on the National Multi-sectoral Cholera Elimination Plan 2021-2025, including vaccination campaigns implemented in the affected areas. Kenya has been recently included by Africa CDC in the list of AU MSs that have controlled the cholera outbreak this year and the current risk of spread is considered limited within the country, however the authorities are closely monitoring the situation in general in East Africa. A recent publication has described cholera intervention policies implemented by the national authorities in vulnerable regions. MAURITIUS Based on the feedback provided, there has been no case of cholera in Mauritius for decades, whether local or imported. All arriving international passengers must submit a health questionnaire and pass through a health control desk manned by public health inspectors. The Ministry of Health and Wellness Centre for Disease Control Unit has developed a preparedness plan to reduce the risk of introduction of cholera in the country and prevent its spread. For example, during the outbreak in Comoros in 2024, control of passengers arriving from that country was reinforced. The Central Health Laboratory in Mauritius has the capacity to culture and serogroup Vibrio cholerae. As tap water in Mauritius is potable and there is adequate sewage disposal, the risk of spread of cholera is considered low but the possibility of encountering the occasional imported case exists. By analogy, typhoid fever is essentially an imported disease in Mauritius with negligible local transmission TANZANIA The network has informed that Tanzania has experienced several cholera outbreaks in 2024. This year, most cases were reported in the early months, particularly in Simiyu, Morogoro, Rukwa, Lindi, Mbeya, Tabora, and Mara regions. In recent months only sporadic cases have been reported however challenges like limited clean water and poor sanitation persist, and the national health authorities are working to address these issues following the national cholera plan 2023-2027. In terms of figures, according to Africa CDC latest data, from January to late October 2025, Tanzania reported around 4,000 cases and 45 deaths, compared to nearly 6,000 cases and 97 deaths during the same period in 2024. ZAMBIA The network has informed that the National Public Health Institute (ZNPHI) is providing daily updates about the cholera situation in the country following the national outbreak declaration of August 2025. Based on the latest figures, almost 600 cases have been reported so far, with most of activity documented in Mpulungu and Nsama districts. During the past weeks, the country has vaccinated over 225,000 people. Based on the authorities’ latest assessment, cholera remains a recurring public health emergency in Zambia, particularly in urban and peri-urban settings, where inadequate water, sanitation, and hygiene (WASH) infrastructure increases the risk of transmission. The latest ZNPHI health issue (Q3/2025) includes further information and examples about the ongoing control measures implemented locally (Northern Province), in addition to an interesting editorial documenting a Social Ecological Model framework recently applied in the county that underscores the need for coordinated interventions, including strengthened WASH infrastructure, vaccination campaigns, and community engagement, to sustainably prevent outbreaks.