Since the first disease outbreak news on the global cholera situation was published on December 16, 2022, the global situation has further deteriorated with additional countries reporting cases and outbreaks, says a report released by the Word Health Organization (WHO) on February 11.

According to the report, since mid-2021, the world is facing an acute upsurge of the 7th cholera pandemic characterized by the number, size and concurrence of multiple outbreaks, the spread to areas free of cholera for decades and alarming high mortality rates.

In 2021, 23 countries reported cholera outbreaks, mainly in the WHO Regions of Africa and the Eastern Mediterranean. This trend reportedly continued into 2022 as 30 countries across five of the six WHO regions reported cholera cases or outbreaks.  

As of February 1, 2023, at least 18 countries continue to report cholera cases.  The report notes that as according to the seasonality patterns large parts of the world are in currently in low or interepidemic transmission period this number could increase in the months to come.

The mortality associated to those outbreaks is of particular concern as many countries reported higher case fatality ratios (CFR) than in previous years. The average cholera CFR reported globally in 2021 was 1.9% (2.9% in Africa), a significant increase above acceptable (<1%) and the highest recorded in over a decade.  Preliminary data suggests similar trend for 2022 and 2023. 

The potential drivers of the outbreaks and challenges impacting response activities were highlighted in the last Disease Outbreak News. The simultaneous progression of several cholera outbreaks, compounded in countries facing complex humanitarian crises with fragile health systems and aggravated by climate change, poses challenges to outbreak response and risks further spreading to other countries.

The overall capacity to respond to the multiple and simultaneous outbreaks reportedly continues to be strained due to the global lack of resources, including the oral cholera vaccine, as well as overstretched public health and medical personnel, who are dealing with multiple disease outbreaks at the same time.

Based on the current situation, including the increasing number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO assesses the risk at the global level as very high.

According to WHO, Africa is facing an exponential rise in cholera cases, with infections in the single month of January already at a third of the level reached in the whole of 2022. 

More than 1,200 people have died in the deadliest cholera outbreak in Malawi's history and several other African nations have reported outbreaks, WHO said on February 10 calling for strong interventions.

Malawi has reported nearly 37,000 confirmed cases since March 2022 in its worst cholera outbreak on record.

As far as Tajikistan is concerned, media reports said in the early 1990s the Tajik refugees returning from Afghanistan were bringing home cholera. 

WHO noted on July 1993 that seven cases of cholera have been diagnosed so far and two of the victims have died.  Two more people were reportedly diagnosed as carriers.  All the cases reportedly occurred in villages near the town of Panj on the Tajik-Afghan border in the southern province of Khatlon.

The disease came from Afghanistan, where more than 600 cases of cholera were diagnosed in July 1993.  

No cholera death cases were reported in Tajikistan in 1994, down by 100 percent from the previous year.

In August 2013, Tajikistan temporarily closed the border it shares with Afghanistan's province of Badakhshan amid reports of a cholera outbreak there.  Some 1,500 residents in Afghanistan's Badakhshan province were diagnosed with cholera in August 2013.