Recurrence of cholera epidemics in South Africa: inadequate sanitary facilities, poor environmental monitoring practices, and climate change as possible contributing factors

Abstract

Cholera is an acute infectious disease caused by two toxin-producing strains, namely Vibrio cholerae O1, and Vibrio cholerae O139. Its recorded history stretches as far back as 1817, in Bengal, India, yet it continues to be a public health threat to this present day. Although cholera epidemics are now a relatively rare phenomenon in developed countries, frequent epidemics continue to be experienced in sub-Saharan Africa. Africa accounted for 63.33% of the 223 370 cases of and 4 159 deaths from cholera that were reported globally in 2020. Furthermore, of the 342 900 cholera cases and 3 304 cholera deaths reported globally in 2022, 40.28% of the cases and 77.85% of the deaths were in Africa. Inadequate sanitation infrastructure as well as inadequate provision of quality, safe drinking water in South Africa still creates conducive conditions for the transmission of cholera. In addition, climate change is increasingly becoming a risk factor towards the spread of V. cholerae pathogens in inland regions. To make recommendations on how South Africa, and potentially the Southern African region as a whole, can minimise the resurgence of cholera, this review addressed the following questions: Does South Africa have adequate sanitation infrastructure to curb the spread of cholera? Is there enough intentional surveillance of environmental water sources for vibrios as a cholera outbreak predictive tool? What is the impact of climate change on the resurgence of cholera in South Africa? And, what needs to be done to curb the resurgence of cholera in South Africa?