Tropical disease that ‘kills within hours’ threatens holiday hotspots as 41,000 cases recorded across 17 countries

CASES of a tropical disease that can kill sufferers within hours have surged since the start of the year, threatening holiday hotspots.

Some 40,900 cases of cholera – a deadly bacterial infection that causes relentless diarrhoea – have so far been reported in 2024, according to the World Health Organization (WHO).

The multi-country outbreak has resulted in 775 deaths across 17 countries in the Americas, South East Asia, the eastern Mediterranean and Africa.

WHO warned that efforts to curb the spread of cholera were affected “by a critical shortage of oral cholera vaccines”.

The health watchdog last year branded the global resurgence of cholera as a grade 3 emergency, it’s highest classification.

“Based on the number of outbreaks and their geographic expansion, alongside the shortage of vaccines and other resources, WHO continues to assess the risk at global level as very high,” it wrote in a recent alert.

It comes as United Nations agencies told Reuters the emergency global stockpile of cholera vaccines “is empty”, prompting concern about how demand for jabs will be met for the rest of the year.

The countries grappling with the biggest surge in cases this year are Zambia and and Zimbabwe, who recorded 8,300 and 6,600 cases respectively throughout January.

But popular holiday destinations like South Africa have also seen cases of the deadly bacterial infection that’s spread from drinking unclean water and eating tainted food.

Thirty-four people have been infected with cholera in the country at the southernmost tip of the African continent, though none of them have died.

Zambia, another popular holiday spot, also saw a surge in cases between January 1 and February 5: 8,300 fell ill with cholera and 270 people succumbed to the illness.

The Philippines and the Dominican Republic have not seen cholera cases this year, but there’s a lingering threat of outbreaks as both countries reported infections in 2023.

Though no cases have been spotted in the UK or closer to home, people travelling to countries with cholera outbreaks have been warned about the risk of catching the disease.

In a report released at the end of January, the European Centre for Disease Prevention and Control (ECDC) said it was monitoring cholera outbreaks globally after 50,440 new cases of the illness were reported across the globe in December 2023.

“Despite the number of cholera outbreaks reported worldwide, few cases are reported each year among travellers returning to the EU/EEA,” the European health watchdog said.

“In this context, the risk of cholera infection in travellers visiting these countries remains low, even though sporadic importation of cases to the EU/EEA remains possible,” it went on.

Twenty-nine cases of cholera were reported in Europe in 2021, and 25 in 2019, all of which “had a travel history to cholera-affected areas”, the ECDC added.

What is cholera?

Cholera is an infection caused by the the bacterium Vibrio cholerae.

Drinking water contaminated with the bacteria or eating food that been in unclean water – particularly shellfish – can make you sick with cholera.

As the cholera infection attacks the small intestine, one of the most common symptoms of the condition is severe, watery diarrhoea.

According to the WHO, it can also cause nausea, vomiting and stomach cramps.

It can take between 12 hours and five days for a person to show symptoms after ingesting contaminated food or water.

Most people will only experience mild symptoms and be treated with oral rehydration solution, WHO said

But it warned that acute cases of diarrhoeal disease “can kill within hours if left untreated”.

Writing for The Conversation, Professor of Medicine at the University of East Anglia, Paul Hunter, warned: “Cholera causes watery diarrhoea that can be so profuse that the stool loses its brown colouring, giving the diarrhoea a characteristic “rice water” appearance.

“Death, when it occurs, can be very rapid, within a few hours after the onset of symptoms.

“It’s usually due to dehydration or electrolyte imbalance.”

The main drivers behind the recent surge in cases globally have been extreme weather events exacerbated by climate change like cyclones, flooding and drought.

War and political instability instability also play their part, as well as dwindling supplies of cholera vaccines.

But Europe – which has only seen cases in people who’ve travelled to countries with cholera outbreaks – shouldn’t be complacent, Prof Hunter warned.

“If case numbers continue to increase or even continue at current levels we will likely see more cases globally this year than at any time in the past three decades,” he stated.

He noted that high-income countries only face a ‘marginal risk’ of cholera outbreaks, as the deadly disease spreads when water and sanitation infrastructure fails.

But travellers face a small risk of contracting cholera if they travel to countries battling epidemics.

How can I protect myself from cholera when I travel?

“For anybody travelling to a country with local transmission of cholera, it would be wise to seek advice on whether vaccination may be appropriate,” Prof Hunter said.

“Regardless, it’s important to follow strict food and water hygiene practices when in a cholera-affected country.”

The ECDC echoed his advice in telling people going to cholera-endemic areas to seek advice from travel health clinics
to assess whether they’d be at risk and find out more about precautionary sanitary and hygiene measures.

These include:

• Drinking bottled water or water treated with chlorine
• Carefully washing fruit and vegetables with bottled or chlorinated water before eating
• Regularly washing hands with soap
• Eating thoroughly cooked food
• Avoiding consumption of raw seafood
• Not eating ice-cream or having ice in your drinks
• Brushing your teeth with boiled or bottled water