Links between cholera resurgence in Africa and El Niño

An urgent call to strengthen cholera elimination efforts

In a recent Commentary published in Pan African Medical Journal, Taty et al. discuss the cholera resurgence in Africa potentially induced by the climate consequences of El Niño. The authors urgently call for strengthened efforts to control and prevent the disease. 

In a recent Commentary published in Pan African Medical Journal, Taty et al. discuss the resurgence in cholera in Africa potentially induced by the climate consequences of El Niño and urgently call for strengthened cholera elimination efforts. El Niño is a phenomenon characterized by abnormal warming of the Pacific Ocean leading to significant changes in weather conditions worldwide (1). Studies have shown that El Niño phenomena are associated with increased rainfall in East Africa and decreased rainfall in Southern Africa, West Africa and parts of the Sahel (1). Reduced rainfall can result in water scarcity and insufficient access to clean water sources, forcing vulnerable communities to use contaminated water and reduce proper hygiene practices. Meanwhile, severe rainfall and flooding can lead to contamination of drinking water sources and disrupt sanitation infrastructures. Both scenarios increase the risk of cholera transmission in areas experiencing outbreaks. One of the strongest El Niño events on record occurred from 2015 to 2016. The following year in 2017, global cholera cases increased by 828% and deaths increased by 133% compared to 2016 (2).

In 2023, a resurgence in cholera cases was observed in many countries throughout Africa, including Malawi, Mozambique, Zimbabwe, Kenya, Ethiopia, Somalia, Democratic Republic of the Congo, Cameroon, Nigeria and Sudan (3,4). Following the onset of El Niño conditions in July 2023, forecasts indicate a greater than 80% chance that El Niño continues through March-May of 2024 (5). Given the links observed between El Niño and cholera transmission, there is a high risk of increased cholera outbreaks this year.

Therefore, it is critical to ensure consistent and coordinated action at all levels to mitigate the impact of these outbreaks on health systems and societies in general. Affected and at-risk countries and all supporting agencies should revisit their strategic cholera plans to adapt the geographic targeting of operational response packages considering the challenges posed by El Niño. There is also an urgent need to strengthen country leadership for more effective management of cholera control at all levels. Finally, international aid agencies working to combat cholera epidemics should also harmonize their approaches to support countries, with each operational strategy adapted according to the updated classification of cholera hotspots. 


  1. Moore SM, Azman AS, Zaitchik BF, Mintz ED, Brunkard J, Legros D, et al. El Niño and the shifting geography of cholera in Africa. Proc Natl Acad Sci U S A. 2017 Apr 25;114(17):4436–41.
  2. World Health Organization. Cholera case and death numbers by country [Internet]. The Weekly Epidemiological Record. Available from:
  3. WHO. Weekly Bulletin on Outbreaks and other Emergencies: Week 40: 02 October - 08 October 2023 [Internet]. 2023 Oct [cited 2023 Oct 30]. Available from:
  4. Cholera platform. Cholera Outbreaks in Central and West Africa : 2023 Regional Update - Week 1 - 39. 2023.
  5. FAO. El Niño: Anticipatory Action and Response Plan, October 2023–March 2024 [Internet]. 2023. Available from: