Angola faces its most severe cholera outbreak since 2006

The ongoing cholera outbreak in Angola has rapidly escalated, spreading nationwide. On January 7, 2025, the Ministry of Health in Angola declared the country’s first cholera outbreak since 2018 (1,2), with the index case reported in Cacuaco Municipality, Luanda Province. The outbreak rapidly spread throughout Luanda and reached neighboring Bengo Province within the first week (1). As of March 28, a total of 9,274 suspected cases have been reported across 17 of the 21 provinces (3). Furthermore, 356 deaths have been recorded, which represents a case fatality rate of 3.8% (3). This indicates potential challenges such as limited access to healthcare, inadequate case management capacity and delays in outbreak response. A striking 30% of deaths have occurred outside of cholera treatment centers (3).

Luanda Province has the highest caseload, followed by Bengo, Icolo e Bengo, Cuanza Norte and Benguela (3). The situation is particularly concerning in Bengo Province, where cholera cases have been reported in rural areas with limited access to healthcare (4). As the outbreak spreads across Angola, there is also a high risk of expansion into neighboring countries. Indeed, Namibia has reported its first cholera case in a decade - in the northwest Kunene Region - which borders Angola (5).

Children aged 6-14 years are the most affected, representing approximately 23% of all cases (6). This observation highlights the critical need for rapid and targeted interventions to protect young and other vulnerable populations.

The outbreak is driven by conditions of poor sanitation and limited access to potable water, which is particularly challenging in rural areas of Angola (1,7). Furthermore, intense rainfall and flooding in affected areas are causing contamination of drinking water sources, significantly accelerating cholera transmission especially in densely populated areas (1,4). With above-average rainfall predicted for the current rainy season (8), continued flooding could exacerbate the magnitude and geographical spread of the outbreak.

This ongoing emergency bears a striking resemblance to the most devastating cholera outbreak the country has faced in over 20 years. In 2006, Angola experienced a large-scale cholera outbreak that started in the crowded neighborhood of Bairro 1 de Boa Vista (Ingombota Municipality) in Luanda (9,10). The outbreak then rapidly spread throughout the country, with 16 of 18 provinces reporting cholera cases by the end of the year (9,10). In 2006, over 67,000 suspected cases were reported in Angola (2). Before 2006, the country had not experienced a cholera outbreak for a decade, rendering it extremely unprepared to manage the public health crisis. Consequently, cholera outbreaks persisted in the country until late 2018, with provinces in the northwest and southwest bearing the highest burden (11). Case numbers exhibited an annual pattern, characterized by an increase during the rainy season (11). Between 2006 and 2018, Luanda Province bore the highest burden, accounting for 29% of all reported cases (11).

Currently, the cholera response is critically underfunded and incapable of supporting preparedness efforts in unaffected at-risk areas (4). Furthermore, the response capacity at the municipal and community levels is weak and reliant on support from the provincial and central governments (4). Given the rapidly deteriorating situation amid the ongoing rainy season, the risk of further transmission in Angola and into neighboring countries is very high, necessitating urgent action to scale up response efforts and bolster local capacity to quickly contain the outbreak.