Yes, cholera is very much still around. While it’s rare in the United States and other industrialized countries, cholera remains a significant cause of illness and death across parts of Africa, South Asia, and the Caribbean. The disease kills tens of thousands of people each year, and outbreaks have actually been increasing in recent years as climate instability and conflict disrupt water systems in vulnerable regions.
Where Cholera Is Active Today
Cholera’s footprint is concentrated in places where clean water and sanitation infrastructure are limited or have been damaged. Several African countries, including Zambia, Zimbabwe, Malawi, Kenya, and Mozambique, continue to deal with significant outbreaks. Southeast Asia, particularly Bangladesh and India, has the largest populations at risk. And in October 2022, Haiti reported a new cholera outbreak after more than three years with no cases, a painful setback for a country that had been close to eliminating the disease.
Large outbreaks tend to cluster in areas experiencing overlapping crises. When war or natural disasters destroy water treatment plants or force people into overcrowded camps, cholera can spread explosively. Rapid urbanization also plays a role: in many countries, people moving into cities strain water and sanitation systems that were already underfunded.
How It Spreads
Cholera is a waterborne disease. People get it by drinking water or eating food contaminated with the bacterium that causes it. The diarrhea produced by an infected person contains huge quantities of bacteria, and when that sewage reaches a water supply, the cycle continues. This is why outbreaks accelerate so quickly in places where sewage and drinking water aren’t adequately separated.
The bacterium also lives naturally in brackish (slightly salty) and coastal waters, which means eating raw or undercooked shellfish can occasionally be a source of infection. Street food vendors in affected areas are another common transmission point. One thing cholera is not, though, is easily spread through casual person-to-person contact. You won’t catch it from being near someone who’s sick. It’s almost entirely a water and food problem.
Why Cholera Is Resurging
Climate change is making cholera harder to control. Flooding spreads contaminated water across wide areas, and rising water temperatures allow the bacterium to thrive in environments where it previously couldn’t survive. Research has shown that warming sea surface temperatures and rising sea levels expand the coastal and estuarine habitats where the bacterium naturally lives. The Chesapeake Bay watershed, for example, is already showing the effects of rising annual temperatures, with projected sea level increases of close to 10 inches by 2030.
Conflict zones compound the problem. When infrastructure is destroyed and populations are displaced, the basic systems that keep water clean break down. Refugee camps and besieged cities create exactly the conditions cholera exploits: overcrowding, limited sanitation, and contaminated water sources. The combination of more extreme weather and more prolonged conflicts helps explain why cholera has been spreading to new areas and returning to places that thought they had moved past it.
How Dangerous It Is
Cholera can kill remarkably fast. The hallmark of the disease is sudden, severe watery diarrhea that can drain the body of fluids within hours. Left untreated, the mortality rate is between 25% and 50%. With prompt treatment, that drops to less than 1%. The gap between those two numbers is staggering, and it underscores that cholera deaths are almost entirely preventable.
Treatment is straightforward. Most people can be fully rehydrated by drinking oral rehydration solution, a simple mixture of salts, minerals, and clean water. For children between six months and five years old, zinc supplementation speeds recovery. Severe cases may need intravenous fluids, but the vast majority of patients recover with basic oral rehydration. The challenge isn’t medical complexity. It’s getting supplies and clean water to the people who need them.
Vaccines and Prevention
Oral cholera vaccines exist and are used in outbreak response and in high-risk areas. Two main options are available globally. One provides protection for about two years and requires two doses given one to six weeks apart (three doses for young children). The other, more widely used in mass vaccination campaigns, offers at least three years of protection from two doses, or about one year of short-term protection from a single dose.
Vaccines help, but they’re a stopgap. The real solution to cholera is clean water and functioning sewage systems. A global initiative launched in 2017 set a target of reducing cholera deaths by 90% and eliminating the disease in 20 countries by 2030. Progress has been uneven, with outbreaks continuing to outpace vaccine supply in many regions. The core problem remains infrastructure: communities that gain reliable access to treated water and proper sanitation stop seeing cholera, while those without it remain vulnerable no matter how many vaccine doses are distributed.
Risk for Travelers
If you live in the U.S., Canada, Europe, or another country with modern water treatment, your risk of encountering cholera at home is essentially zero. Travelers to affected regions face a low but real risk, particularly if they drink untreated water, eat raw shellfish, or buy food from street vendors in areas with active outbreaks. Sticking to bottled or boiled water and thoroughly cooked food eliminates most of that risk. Vaccination before travel is an option worth discussing if you’re heading to a high-risk area, though basic water and food precautions are more protective day to day.
Cholera can feel like a disease from another century, but for roughly 1.3 billion people living in endemic areas, it’s an ongoing and very present threat. The tools to stop it, clean water, oral rehydration, vaccines, are simple and well understood. The obstacle is delivering them consistently to the places that need them most.