Risk assessment of cholera outbreaks in Eastern Visayas, Philippines, 2024

This study presents the findings of a joint cholera risk assessment conducted in Eastern Visayas, the region in the Philippines with the highest incidence of the disease in 2022-2023. The study aimed to identify key risk factors, review progress since a 2016 assessment, and highlight persistent gaps in prevention, preparedness and response.

In July 2024, the World Health Organization, the United Nations Children's Fund and the Philippine Department of Health conducted a joint assessment using a standardized checklist for focus group discussions and interviews across four technical areas: partnership and coordination; epidemiology and surveillance; water, sanitation and hygiene (WASH); and risk communication and community engagement. Epidemiological trends between 2022 and 2024 were analysed, and water samples from wells and refilling stations were tested for Escherichia coli and total coliforms.

From 2022 to 2024, 12 284 cholera cases were reported in Eastern Visayas (case fatality rate: 0.5%). Testing showed 100% contamination in Level I and II sources, while 33% of Level III samples tested positive for total coliforms despite no E. coli detection. Partial progress has been made in implementing the 2016 assessment's recommendations, with good practices in surveillance, water sampling and community awareness, although gaps remain in outbreak response, coordination and WASH access.

This assessment identified both progress and persistent challenges across the four technical areas. Key limitations were found in the qualitative design and the limited geographical coverage. Conclusions focused on prioritizing the strengthening of national cholera strategies by embedding them within the broader Food and Waterborne Diseases Prevention and Control Program alongside local ownership and equity-focused WASH investments.