Cholera still kills thousands each year. In places without clean water, it’s far from history

Many Americans have heard about cholera only from “The Oregon Trail,” the retro computer game in which players try to get their 1830s pioneers to the Oregon Territory. If your wagon train comes down with this highly contagious bacterial infection, the pioneers could die from diarrhea and dehydration before they get out of Nebraska.

In the 21st century, the US records fewer than 20 cholera cases per year, nearly all of them in travelers who were infected abroad.

While cholera has nearly disappeared from wealthy countries, it remains one of the world’s deadliest waterborne diseases in places where clean water and basic healthcare are unreliable.

The latest reminder came in the summer of 2026 in Sudan, where a long conflict has devastated hospitals and water systems, allowing cholera to spread rapidly.

As an epidemiology professor, I teach the story of John Snow, the London physician who traced an 1854 cholera outbreak to the contaminated Broad Street public water pump. His work not only helped establish modern epidemiology, it also illustrates a lesson that remains true today: Cholera spreads wherever safe water fails.

A worsening problem

Cholera has surged over the past five years: Reported cases rose about 175%, from 223,370 in 2021, to 614,828 in 2025. In fact, 2025 was the deadliest year for the disease in more than a decade, with almost 7,600 deaths across 33 countries. Over that period, there was an average of about 481,000 cases a year globally.

But the true burden is likely far higher, because many countries with the largest outbreaks lack the laboratory and surveillance systems needed to detect and report every case. The World Health Organization estimates the real figure is closer to 1.3 million to 4 million cases and 21,000 to 143,000 deaths each year.