A global resurgence of chikungunya virus (CHIKV) disease was observed in 2025. Major outbreaks have been documented across multiple World Health Organization (WHO) regions, including the African, South-East Asia, and the Region of the Americas. For the first time, sustained local transmission has been reported in countries within the European region, as well as in China, in the Western Pacific region.

Approximately 502,264 CHIKV disease cases (suspected and laboratory-confirmed) and 186 deaths were reported globally from 41 countries and territories between 1 January to 10 December 2025. The most severely affected region was the region of the Americas, accounting for the highest number of reported cases and deaths, while substantial outbreaks were also reported in the European region, driven largely by transmission in French overseas territories, particularly La Réunion Island.

Chikungunya virus disease

Chikungunya is a vector-borne viral disease caused by CHIKV, a ribonucleic acid (RNA) virus in the genus Alphavirus, and the Togaviridae family. The natural reservoir of the CHIKV includes mosquito vectors Aedes aegypti and Aedes albopictus, which can carry the virus and transmit it to humans. Human infection occurs through the bite of infected female mosquitoes, which bite predominantly during daylight hours. Once a human is infected, the virus can be transmitted to other mosquitoes that bite the infected individual during the viremic period, perpetuating transmission cycles. These same mosquito species also transmit dengue and Zika viruses.

The illness begins after an incubation period of 3-7 days (range 2-12 days), with early symptoms such as sudden high fever (often above 38.5 °C), severe polyarthralgia affecting multiple joints bilaterally and symmetrically, headache, myalgia, and maculopapular rash. In severe cases, patients may experience persistent arthralgia for months to years. Case fatality rates remain low overall, but deaths can occur particularly in vulnerable populations, including neonates exposed during the peripartum period, adults over 65 years, and persons with underlying medical conditions such as hypertension, diabetes, or cardiovascular disease.

Currently, there is no specific antiviral treatment. Clinical case management is supportive and includes rest, adequate hydration and analgesic therapy with paracetamol for fever and pain relief.

Current risk assessment and travel advice

As of 17 December 2025, the WHO conducted a risk assessment based on available information on the chikungunya outbreaks globally. The risk assessment considered the public health risk to be high at the national level (within affected countries) due to factors such as the reported number of deaths; large immunologically-naive populations in newly affected temperate regions, which pose a greater risk of community transmission; as well as widespread presence of Aedes mosquito vectors and conducive environmental conditions. Global risk is assessed as moderate given the unprecedented scale and geographic distribution of the 2025 outbreaks and potential for infected travelers to introduce the virus into receptive areas.

No travel or trade restrictions have been recommended. Travelers are advised to take precautions such as using insect repellent, wearing long-sleeved clothing, staying in accommodations with air conditioning or screens, and avoiding outdoor activity during peak mosquito hours. Travelers should monitor themselves for symptoms for 12 days following any potential exposure. Anyone who develops symptoms such as sudden high fever, severe joint pain, headache, muscle pain, rash, or conjunctivitis should seek medical care, inform healthcare providers of travel history, and avoid further mosquito bites for at least one week to prevent local transmission.

Situation in South Africa

In South Africa, no autochthonous transmission has been documented in association with the current global outbreaks. The presence of Aedes aegypti mosquitoes in South Africa’s urban areas creates potential for local transmission should there be an imported case during periods of high vector density. These mosquitoes are particularly abundant along the eastern seaboard, with established populations documented in the coastal provinces such as KwaZulu-Natal and the Eastern Cape, as well as in the inland Gauteng province.

The risk of importation of chikungunya cases into South Africa exists due to international travel networks (direct flights) between South Africa and affected regions, particularly the Indian Ocean Islands. Vigilance is vital given ongoing outbreaks in the region. Healthcare workers should consider chikungunya in any patient presenting with unexplained acute febrile illness accompanied by severe arthralgia who has recently traveled to an affected area or had potential mosquito exposure. Rapid action is essential, which includes isolation of suspected cases, safe specimen collection and immediate reporting to the relevant public health authority to initiate rapid response and to the National Institute for Communicable Diseases (NICD) for laboratory testing.

Clinicians identifying a suspected case of chikungunya should contact the NICD Clinical Hotline (0800 212 552), a 24-hour service for healthcare professionals, to discuss the case’s risk assessment (based on clinical, travel, and exposure history), as well as laboratory testing. Chikungunya is classified as a Category III notifiable medical condition (NMC) in South Africa and must be notified within seven days of laboratory diagnosis through the NMC notification system.

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The Ethiopian Ministry of Health (MoH) has declared an end to the country’s first confirmed Marburg Virus Disease (MVD) outbreak. This declaration followed the completion of the World Health Organization (WHO) recommended two consecutive incubation periods (42 days) without reporting a new suspected, confirmed, or death of a suspected MVD case, after the recovery (discharge) or safe burial of the last known case. The last known laboratory confirmed MVD case demised, and a safe burial was conducted on 14 December 2025. The outbreak was first confirmed on 14 November 2025 in Jinka town, South Ethiopia Regional State, following the laboratory detection of the Marburg virus (MARV) by the Ethiopian Public Health Institute (EPHI) National Reference Laboratory in an adult who developed viral haemorrhagic fever (VHF) symptoms on 23 October 2025.

Epidemiological findings

By the end of the outbreak, as of 25 January 2026, 19 cases (14 laboratory-confirmed and five probable cases), including nine deaths (four laboratory-confirmed cases and all five probable cases), have been recorded, with a case fatality rate (CFR) of 64.3%.

Cases were reported from the Jinka, Malle, and Dasench woredas (districts), located in the South Ethiopia Region State, as well as from Hawassa, in the Sidama Region. Through contact tracing, epidemiological links were established, including travel history to Jinka town, where the outbreak was first reported. In total, 857 contacts were identified and completed the 21 days of daily symptoms monitoring.

Molecular analysis of the laboratory confirmed cases indicated that the circulating strain in this outbreak is the same as the strain previously detected in MVD outbreaks in other East African countries. Investigations conducted under the One Health approach identified the presence of certain species of fruit bats in the affected areas, which are recognised natural reservoirs of MARV.

Public health response and control measures

In response to the outbreak, the Ethiopian MoH, in collaboration with EPHI, WHO, Africa Centre for Disease Control and Prevention (Africa CDC), and other partners, implemented a comprehensive outbreak response. National and regional emergency coordination mechanisms were activated, and multidisciplinary rapid response teams were deployed to affected areas to support surveillance, case investigation, contact tracing, infection prevention and control (IPC), and case management.

Enhanced laboratory surveillance was implemented, with approximately 3 800 samples tested during the course of the outbreak to support case detection. Designated treatment centres were established, with a team of trained healthcare workers deployed. Risk communication and community engagement activities were intensified to promote early reporting, health care-seeking behaviour, and safe burial practices.¹

Risk assessment

All reported deaths occurred following unsupervised burials, with the latter recognised as a risk factor for further transmission in the community when appropriate infection, prevention, and control measures are not in place. The identification of healthcare workers among the confirmed cases indicates possible occupational exposure within healthcare facilities.

Although no new cases were reported throughout the 42 days following a safe burial of the last known confirmed MVD case on 14 December 2025, there is still a risk of MVD re-emerging after the outbreak has been declared over, due to potential spillovers from contact with the animal reservoir.¹ In addition to monitoring and responding to community feedback and rumours, risk communication and community engagement initiatives are continuing to raise awareness and to dispel stigma against those impacted by the outbreak. Based on the current risk assessment, WHO does not recommend any travel or trade restrictions on Ethiopia.

Public health considerations and recommendations

Although the outbreak has been declared over, the country has entered the recommended 90-day period of enhanced surveillance. The WHO and partners have emphasised the importance of sustained vigilance, particularly in regions with ecological conditions favourable for MARV spillover. Continued strengthening of VHF surveillance, enhanced health facility and laboratory testing capacity, rapid response mechanisms, as well as cross-border collaboration, remains critical for ensuring early detection and containment of future outbreaks. Ongoing community engagement, including raising public awareness and continued health worker trainings are essential to improve preparedness and reduce the risk of delayed detection and response.

The successful containment of this outbreak highlights the value of rapid case detection, coordinated multisectoral response, and strong national and international partnerships in managing the high consequences related to infectious disease threats. To reduce transmission, WHO recommends limiting bat-to-human exposure, particularly in fruit bat-infested mines and caves, as well as improving human-to-human transmission prevention through early isolation of suspected cases, safe and dignified burials, and strict IPC practices in healthcare facilities.

Situation in South Africa

There have been no reports of MVD cases internationally that are linked to this outbreak in Ethiopia, and the risk of MVD importation remains low. However, vigilance is vital given the emergence of MVD outbreaks in the African region. Healthcare workers are encouraged to consider MVD in any patient presenting with unexplained acute febrile illness who has a history of potential exposure from being in the mines or caves known to have fruit bat colonies. The National Institute for Communicable Diseases (NICD) serves as the national reference centre for VHF testing, with laboratory diagnostic capacity, and provides expert guidance.

Clinicians identifying a suspected case of MVD should contact the NICD Clinical Hotline (0800 212 552), a 24-hour service for healthcare professionals, to discuss laboratory testing and provide a detailed clinical, travel, and exposure history. VHF diseases, including MVD, are classified as Category 1 notifiable medical conditions (NMC) in South Africa, and must be reported within 24 hours of clinical suspicion through the NMC notification system.

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On 14 November 2025, the Ethiopian Ministry of Health (MoH) officially confirmed the country’s first Marburg Virus Disease (MVD) outbreak, following laboratory confirmation of the detection of Marburg virus (MARV) from specimens collected from viral haemorrhagic fever (VHF) suspected cases by the Ethiopian Public Health Institute (EPHI) National Reference Laboratory. The outbreak occurred in the South Ethiopia Regional State, Jinka town in the South Omo Zone, near the border with South Sudan.

As of 15 December 2025, the Ethiopian MoH reported 14 laboratory-confirmed cases of MVD and nine (9) deaths in the South and Sidama region. The first MVD case in Hawassa, Sidama region, was reported on 27 November 2025, in an individual with a travel history to Jinka town. Six (6) of the deaths are amongst the laboratory-confirmed cases, while the other three deaths were reported among three epidemiologically linked cases, from whom laboratory tests were not conducted.

The MVD is a severe and often fatal viral haemorrhagic fever caused by the MARV, a member of the filovirus family that also includes the Ebola virus. The natural reservoir of the MARV is believed to be fruit bats of the genus Rousettus, which can carry the virus without showing symptoms. Human infection can occur through contact with infected bats or their environments, such as caves or mines. Once a human is infected, the virus spreads through direct contact with blood, bodily fluids, or tissues of infected individuals, as well as through indirect contact with contaminated surfaces or equipment.

The MVD is a severe and often fatal viral haemorrhagic fever caused by the MARV, a member of the filovirus family that also includes the Ebola virus. The natural reservoir of the MARV is believed to be fruit bats of the genus Rousettus, which can carry the virus without showing symptoms. Human infection can occur through contact with infected bats or their environments, such as caves or mines. Once a human is infected, the virus spreads through direct contact with blood, bodily fluids, or tissues of infected individuals, as well as through indirect contact with contaminated surfaces or equipment.

The illness begins after an incubation period of two to 21 days, with early symptoms such as sudden fever, severe headache, malaise, and muscle pain. In severe cases, patients may experience profuse diarrhoea, bleeding from mucous membranes and injection sites, multi-organ dysfunction, and hypovolemic shock.

Current risk assessment and travel advice

No travel or trade restrictions with Ethiopia have been recommended. Travellers are advised to take precautions such as avoiding contact with sick individuals, avoiding caves or mines inhabited by bats, and avoiding contact with bodily fluids or contaminated materials. Travellers are advised to consider obtaining travel and medical evacuation insurance. Travellers should monitor themselves for symptoms for 21 days following any potential exposure. Anyone who develops symptoms such as fever, headache, muscle pain, rash, gastrointestinal illness, or unexplained bleeding should immediately isolate, avoid travel, and contact local health authorities or a healthcare facility in advance for guidance and a safe assessment.

As of 20 November 2025, the WHO conducted a risk assessment based on available information on the MVD outbreak in Ethiopia. The risk assessment considered the public health risk to be high at national level (within Ethiopia) due to factors such as the reported number of deaths; unsupervised burials reported amongst all deaths which poses a greater risk of community transmission; the confirmed cases includes healthcare workers, which highlight possible risk of exposure in the healthcare facility while attending to patients; as well as limited information available on sources, epidemiology and geographical spread of the outbreak.

Situation in South Africa

The risk of importation of the MVD cases into South Africa exists due to international travel networks (direct flights) between the two countries. Vigilance is vital given emerging outbreaks in the region. Healthcare workers should consider MVD in any patient presenting with unexplained acute febrile illness who has recently travelled to an affected area or had potential exposure. Rapid action is essential: isolate suspected cases, collect specimens safely, and report immediately to the relevant public health authority to initiate rapid response and to the National Institute for Communicable Diseases (NICD) for laboratory testing at the Centre for Emerging Zoonotic and Parasitic Diseases (CEZPD).

The NICD serves as the national reference centre for viral haemorrhagic fever testing, providing diagnostic capacity and expert guidance. Strict IPC measures, including the use of appropriate personal protective equipment (PPE), dedicated equipment, effective waste management, and environmental decontamination, are required when handling suspected or confirmed cases. Safe burial practices are also critical due to the high risk of transmission from deceased individuals.

Clinicians identifying a suspected case of MVD should contact the NICD Clinical Hotline (0800 212 552), a 24-hour service for healthcare professionals, to discuss laboratory testing and provide a detailed clinical, travel, and exposure history. Viral haemorrhagic fever (VHF) diseases, including MVD, are classified as Category 1 notifiable medical conditions (NMCs) in South Africa, and must be reported within 24 hours of clinical suspicion through the NMC notification system.

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Cholera, an acute diarrhoeal illness caused by ingestion of contaminated food or water, remains a serious global health concern, especially during humanitarian crises involving floods or infrastructure collapse. The disease is caused primarily by toxigenic Vibrio cholerae serogroups O1 and O139, with O1—comprising the El Tor biotype and its hybrid variants—being the predominant cause of current outbreaks. These hybrid El Tor strains, possessing traits from both classical and El Tor biotypes, may have increased virulence.

In 2024, the World Health Organization (WHO) reported 804,721 cholera cases and 5,805 deaths across 33 countries spanning five WHO regions, marking a disturbing increase over previous years . The Eastern Mediterranean and African regions bore the brunt of the burden. With growing spread, rising case numbers, and logistical constraints in global response systems, WHO has maintained a Grade 3 emergency designation since January 2023—its highest level of alert.

By the end of Q1 2025, 25 countries had reported cholera or acute watery diarrhoea (AWD), with 116,574 cases and 1,514 deaths—most notably in Africa, followed by the Eastern Mediterranean and South-East Asia. No outbreaks were observed in the Western Pacific region.

International Transmission and Travel-Related Cases

The globalized movement of people and goods has introduced new vectors for cross-border cholera transmission. In February 2025, Germany reported three cases linked to consumption of holy water brought from Bermel Giorgis, Ethiopia. Toxigenic O1 V. cholerae was found in both patients and the water itself.

In March 2025, the United Kingdom reported four cholera cases, three involving recent travel to Ethiopia and one domestic case caused by consuming imported holy water. These cases underscore how contaminated items can facilitate international disease spread, highlighting the urgent need for global surveillance and health communication.

Situation in Southern Africa

Eighteen African countries are experiencing active cholera transmission as of April 2025, including Angola, DRC, Ghana, Kenya, and more. The Southern African region is especially hard hit, with major outbreaks ongoing in Mozambique, Malawi, Zambia, and Zimbabwe.

Global and Regional Response

WHO and its partners—including the Global Outbreak Alert and Response Network (GOARN) and Standby Partners (SBP)—have deployed multidisciplinary teams to 10–11 countries. These deployments focus on case management, WASH (Water, Sanitation and Hygiene), epidemiology, logistics, and community engagement. Countries receiving technical support include Malawi, Mozambique, Zambia, Ethiopia, South Sudan, and Haiti.

Efforts have included emergency vaccine campaigns, infrastructure repair, and misinformation countermeasures. Zimbabwe, for instance, has launched Oral Cholera Vaccine (OCV) campaigns in hotspot districts. Mozambique has focused on water trucking, chlorine distribution, and public health communication.

Threat to South Africa

Although South Africa has not experienced a cholera outbreak during the current reporting period, the ongoing regional crisis places the country at high risk. Cross-border movement from affected neighboring countries like Zimbabwe, Mozambique, and Zambia elevates this threat. Additionally, flooding—a frequent issue in several South African provinces—could undermine sanitation systems and facilitate cholera transmission. Provinces at greatest risk include Limpopo, Mpumalanga, KwaZulu-Natal, and North West.

The resurgence of cholera presents a formidable global health threat. In Southern Africa, climate shocks, misinformation, infrastructure damage, and vaccine shortages have compounded the problem. Despite international assistance, countries like Mozambique, Zambia, Malawi, and Zimbabwe continue to struggle with controlling transmission. The situation underscores the urgent need for robust regional coordination, enhanced WASH systems, public trust-building, and equitable vaccine access to avoid further cross-border spread and mitigate future outbreaks.

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