The World Health Organization (WHO) has reported a 30% increase in cholera deaths in 2025, despite a decline in the number of cholera cases reported to the organisation. The latest WHO data also highlight trends in bacterial meningitis and plague worldwide.
In 2025, 47 countries reported 451,499 cholera cases and 7,870 deaths to WHO. The number of deaths was the highest annual total reported to the organisation since 1999.
WHO cautioned that the reported figures reflect surveillance data submitted to the organisation and do not represent the actual global burden of cholera, which is likely to be substantially higher because many cases remain unreported.
Seven countries — Angola, Bangladesh, the Democratic Republic of the Congo (DRC), Nigeria, South Sudan, Sudan and Yemen — accounted for around 90% of all reported cholera cases and deaths globally.
The WHO African Region recorded the largest burden, with cases increasing by 34% and deaths by 58% compared with 2024.
The findings were published in the latest edition of the Weekly Epidemiological Record, alongside updates on two other epidemic-prone bacterial diseases: meningitis and plague.
“The rise in cholera deaths is a reminder of the challenge ahead,” said Dr Chikwe Ihekweazu, executive director of WHO’s Health Emergencies Programme.
“No one should be dying from cholera today when we have the tools to prevent and treat this disease. The concentration of cases and deaths in a small number of countries shows where targeted investments in safe water, sanitation and hygiene could have the greatest impact,” he added.
According to Ihekweazu, investments in safe water, sanitation and hygiene, combined with stronger disease surveillance, community engagement, vaccination and access to quality healthcare, could help reverse the trend.
Cholera is an acute diarrhoeal disease caused by Vibrio cholerae bacteria. It spreads through food and water contaminated with faeces, particularly in areas without access to safe water and adequate sanitation. Although cholera is preventable and treatable, severe cases can be fatal if dehydration is not treated promptly.
WHO reported that more than one in five cholera deaths occurred outside health facilities in 2025, highlighting gaps in timely access to care. Among patients treated in health facilities, the global case fatality rate remained below 1%, which WHO considers the threshold for adequate care. However, the rate exceeded 1% in 12 countries during 2025.
Bacterial meningitis cases decline in Africa’s meningitis belt
Bacterial meningitis continues to place a substantial burden on countries in Africa’s meningitis belt, which stretches from Senegal to Ethiopia and experiences recurrent epidemics.
In 2025, 24 of the 26 countries in the region reported 21,526 suspected meningitis cases and 971 deaths to WHO, corresponding to a case fatality rate of 4.5%.
Among countries that reported data for both 2024 and 2025, suspected cases declined by 5.9% compared with the previous year.
Meningitis refers to inflammation of the tissues surrounding the brain and spinal cord, with bacterial meningitis considered the most serious form.
Plague remains endemic in parts of Africa
Plague is a bacterial disease that primarily spreads among animals through fleas and can occasionally infect humans.
Between 2019 and 2025, 10 countries reported suspected human plague cases to WHO, with six reporting confirmed cases. During this period, 3,847 suspected cases and 423 deaths were reported, corresponding to a case fatality rate of 11%.
Most cases were reported from the Democratic Republic of the Congo and Madagascar, where plague remains endemic in some areas.
WHO noted that plague may also occur in countries that do not report cases. Annual case numbers fluctuated depending on the timing, location and scale of outbreaks.
The organisation emphasised the importance of continued surveillance of rodent and other animal populations, alongside rapid outbreak response, to detect plague early, limit transmission and prevent larger outbreaks.
Vaccine production and coverage
According to WHO, global production of oral cholera vaccines more than doubled between 2022 and 2025, rising from around 30 million to approximately 80 million doses annually. The organisation said the increase has significantly improved vaccine availability.
In 2025, the International Coordinating Group (ICG) on Vaccine Provision approved 71 million doses for use in affected countries, including 20 million doses for preventive vaccination. Preventive vaccination resumed earlier this year after being suspended for more than three years.
Vaccination has also significantly reduced meningococcal meningitis, a major cause of bacterial meningitis. Since the introduction of the meningococcal A conjugate vaccine in 2010, cases of serogroup A have declined by more than 99% among vaccinated populations. No confirmed cases have been reported since 2017 in countries that introduced the vaccine, as per WHO.
A broader vaccine targeting five meningococcal serogroups, Men5CV/MMCV, is now being introduced across the region through outbreak-response vaccination supported by the ICG, as well as preventive vaccination campaigns. In 2025, Niger became the first country to carry out a country-wide campaign using this vaccine.
