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Fighting Cholera - Operational Handbook: Response to outbreaks and risk prevention in endemic areas

Manual and Guideline
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SOLIDARITÉS INTERNATIONAL has made the fight against cholera one of its key priorities for several years, in response to the many epidemics that continue to affect millions of people around the world. Unfortunately, official figures published are often well below the true toll of the disease due to limitations in surveillance systems and fear of negative impacts on tourism and trade. The World Health Organisation (WHO) therefore estimates that there are actually between 1.3 and 4 million cases of cholera, with between 21,000 and 143,000 deaths worldwide each year.

Cholera is a diarrhoeal disease that is usually contracted when drinking water contaminated with Vibrio cholerae bacteria. The fight against this disease requires a multidisciplinary approach that combines a water, hygiene and sanitation (WaSH) response with a monitoring system, improved water supply and quality, sanitation and hygiene, and a health response with the treatment of the disease itself.

SOLIDARITÉS INTERNATIONAL works mainly on the WaSH component to help break down the vectors of disease contamination and prevent cholera outbreaks by providing drinking water, working to make the environment of affected people healthier, and mobilising communities to change practices (hygiene, breastfeeding, funerals, etc.). The association also works and/or supports actively with health actors (health NGOs, Ministry, health centres, etc.).


The purpose of this operational manual is to help missions improve their WaSH response strategies in the context of recurrent outbreaks.

It contains key elements to guide teams in setting up cholera epidemic response and disease prevention programmes in endemo-epidemic areas.

This guide is based on the experience of SOLIDARITÉS INTERNATIONAL. It is complemented by a reference bibliography in the field of cholera control and prevention and, more generally, diarrhoeal diseases. It consists of 3 parts:

  1. General information on cholera
  2. Before and between epidemics
  3. Response to cholera epidemics