From 1 January to 30 August 2026, a cumulative total of 275 284 cholera and AWD cases and 2601 deaths were reported from 28 countries across four WHO regions, representing 43% decrease in cases and 58% decrease in deaths compared with the same period last year (480 199 cases and 6180 deaths from 32 countries). The region with the highest reported case count was the African Region (154 064 cases; 19 countries), followed by the Eastern Mediterranean Region (120 172 cases; five countries), the Region of the Americas (722 cases; one country), the South-East Asia Region (326 cases; three countries). No cases were reported from the European Region or the Western Pacific Region. During the same period, cholera deaths were reported in the African Region (2287 deaths), the Eastern Mediterranean Region (312 deaths), the Region of the Americas (two deaths). No deaths were reported in other regions.

Figure 2. Cholera and acute watery diarrhoea (AWD) cases per 100 000, 1 January to 30 August 2026

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Figure 2. Cholera and acute watery diarrhoea (AWD) cases per 100 000, 1 January to 30 August 2026

The data presented here should be interpreted with caution. Potential underreporting and reporting delays may affect timeliness and accuracy, while variations in surveillance systems, standard case definitions, and laboratory capacities can limit direct comparability among countries. These factors also influence the global case fatality rate (CFR), requiring careful examination. Unless otherwise specified, the term ‘cholera cases’ includes both suspected and confirmed cases. Data in this report may be adjusted retrospectively as more information becomes available. For the latest data, please refer to the WHO Global Cholera and AWD Dashboard.

WHO regional overviews

African Region

In August 2026, the African Region reported 20 743 new cholera cases across 12 countries, marking a 39% decrease compared with the previous month. During this period, cases were reported from Nigeria (10 807), Democratic Republic of the Congo (6691), and South Sudan (975). Additionally, there were 260 cholera-related deaths. The highest number of deaths were reported from the Democratic Republic of the Congo (154), Nigeria (62), and Cameroon (24).

From 1 January to 30 August 2026, a total of 154 064 cholera cases were reported across 19 countries in the African Region. The highest number of cases were reported from Nigeria (69 263), the Democratic Republic of the Congo (44 773), and South Sudan (14 190). During the same period, a total of 2287 deaths were reported from 15 countries. The highest number of deaths were reported from the Democratic Republic of the Congo (1303), Nigeria (439), and South Sudan (122).

Figure 3. Global cholera and AWD cases by week, 1 January 2024 to 30 August 2026

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Figure 3. Global cholera and AWD cases by week, 1 January 2024 to 30 August 2026

Eastern Mediterranean Region

In August 2026, the Eastern Mediterranean Region reported 21 171 new cholera and AWD cases across four countries, marking a 3% decrease compared with the previous month. During this period, cases were reported from Afghanistan (18 329 AWD cases, which are not directly comparable with suspected cholera), Pakistan (1270), Sudan (845), and Yemen (727). Additionally, there were 88 cholera-related deaths reported from Sudan (77), Yemen (7) and Afghanistan (4), representing an increase of 31% compared with the previous month, largely driven by Sudan (CFR 9.1%).

From 1 January 2026 to 30 August 2026, a total of 120 172 cholera and AWD cases were reported across five countries in the Eastern Mediterranean Region. The highest number of cases were reported from Afghanistan (103 838), Yemen (6861), and Pakistan (6353). During the same period, a total of 312 deaths were reported from three countries: Sudan (247), Afghanistan (50), Yemen (15).

Region of the Americas

In August 2026, the Region of the Americas reported one new cholera case in Haiti, marking a 95% decrease compared with the previous month. No deaths were reported during this period. This apparent decline should be interpreted cautiously considering potential reporting delays and may not reflect a true reduction in disease transmission.

From 1 January to 30 August 2026, a total of 722 cholera cases and two deaths were reported from Haiti.

South-East Asia Region

In August 2026, no cases or deaths were reported from the South-East Asia Region. However, this should be interpreted with caution, as it likely reflects, at least in part, delays in case reporting and data consolidation rather than a confirmed reduction in transmission.

From 1 January to 30 August 2026, a total of 326 cholera or AWD cases were reported across three countries in the South-East Asia Region. Cases were reported from Myanmar (272), India (36), and Bangladesh (18). No deaths were reported during this period.

Figure 4. Cholera and AWD cases by WHO Region (separate Y scales), 1 January 2024 to 30 August 2026

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Figure 4. Cholera and AWD cases by WHO Region (separate Y scales), 1 January 2024 to 30 August 2026

Focus on selected countries

Cameroon

Between 1 January and 30 August 2026, Cameroon reported a total of 2016 cases and 56 deaths (CFR: 2.8%).

In August 2026, Cameroon reported 890 new cholera cases and 24 associated deaths (CFR: 2.7%). This represents an 8% increase in cases and a 14% increase in deaths compared with the previous month.

The outbreak remains ongoing in the Extreme Nord Region with geographic spread from 10 to 12 affected districts in the past weeks.

Mada district is the most affected district, reporting 39% of the regional cases, followed by Makary, Mora and Kolofata.

Figure 5: Cameroon: Weekly case trend of cholera cases, as of 30 August 2026

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Figure 5: Cameroon: Weekly case trend of cholera cases, as of 30 August 2026

Chad

Between 1 January 2026 and 30 August 2026, Chad reported a total of 699 cases and 20 deaths (CFR: 2.9%).

In August 2026, Chad reported 465 new cholera cases and 11 associated deaths (CFR: 2.4%). This represents a 584% increase in cases and a 57% increase in deaths compared with the previous month.

The outbreak has affected 11 districts across three provinces: Hadjer Lamis, N’Djamena, and Lac.

Lac Province remains the main area of concern. Kouloudia district alone accounted for 48% of new cases reported in week 34, followed by Bol and Kangalom.

Figure 6: Chad: Weekly case trend of cholera cases , as of 30 August 2026

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Figure 6: Chad: Weekly case trend of cholera cases , as of 30 August 2026

Democratic Republic of the Congo

Between 1 January 2026 and 30 August 2026, the Democratic Republic of the Congo reported a total of 44 773 cases and 1303 deaths (CFR: 2.9%).

In August 2026, the Democratic Republic of the Congo reported 6691 new cholera cases and 154 associated deaths (CFR: 2.3%). This represents a 35% increase in cases and a 26% decrease in deaths compared with the previous month. Overall, 19 out of 26 provinces have been affected, with the highest proportions from Sud-Kivu (26%), Nord-Kivu (24%), and Kwango (16%).

There is particular concern around cases reported in Sud-Ubangi, which borders the Central African Republic, and the increase in cases in Kwango, bordering Angola.

In Sud-Kivu and Nord-Kivu, ongoing insecurity continues to restrict access and has led to the suspension of community-level activities.

In addition, the provinces of Nord-Kivu, Sud-Kivu, Ituri, Tshopo, Haut-Uele and Bas-Uele are affected by the ongoing Bundibugyo virus disease outbreak, further straining already limited resources and compounding challenges related to healthcare delivery, sanitation, population displacement, and insecurity.

Figure 7: Democratic Republic of the Congo: Distribution of cases by province in the last four weeks (left) and weekly case, death, and CFR trends of cholera cases (right), as of 30 August 2026

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Figure 7: Democratic Republic of the Congo: Distribution of cases by province in the last four weeks (left) and weekly case, death, and CFR trends of cholera cases (right), as of 30 August 2026

Nigeria

Between 1 January and 30 August 2026, Nigeria reported 69 263 cases and 439 deaths (CFR: 0.6%).

In August 2026, Nigeria reported 10 807 new cholera cases and 62 associated deaths (CFR: 0.6%). This represents a 56% decrease in cases and a 62% decrease in deaths compared with the previous month.

Weekly cases have declined in recent weeks. Borno State remains a key hotspot, accounting for 97% of national cases, with Maiduguri, Monguno, and Jere among the most affected areas.

High mortality has been reported in Bauchi State, where 766 cases and 23 deaths have been recorded, corresponding to a case fatality rate (CFR) of 3%.

In addition, inadequate access to safe water and insufficient chlorination capacity continue to increase the risk of cholera transmission.

Figure 8: Nigeria: Weekly case trend of cholera cases, as of 30 August 2026

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Figure 8: Nigeria: Weekly case trend of cholera cases, as of 30 August 2026

South Sudan

Between 1 January 2026 and 30 August 2026, South Sudan reported a total of 14 190 cases and 122 deaths (CFR: 0.9%).

In August 2026, South Sudan reported 975 new cholera cases and 3 associated deaths (CFR: 0.3%). This represents a 51% decrease in cases and a 40% decrease in deaths compared with the previous month.

Transmission remains concentrated in Unity (89%) and Upper Nile (10%) states.

Rubkona County in Unity State continued to drive the cholera caseload, reporting 762 cases and no deaths in August. The majority of new cases have been reported among internally displaced persons (IDPs). Rubkona County hosts the largest IDP camps in the country and has been experiencing sustained community transmission of cholera. Transmission is likely being driven by inadequate WASH conditions, possibly compounded by waning population immunity against cholera.

Figure 9: South Sudan: Distribution of cases per 100 000 population by county in the last 28 days (left) and weekly case trend of cholera cases (right), as of 30 August 2026

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Figure 9: South Sudan: Distribution of cases per 100 000 population by county in the last 28 days (left) and weekly case trend of cholera cases (right), as of 30 August 2026

Sudan

Between 1 January and 30 August 2026, Sudan reported a total of 2887 cases and 247 deaths (CFR: 8.6%).

In August 2026, Sudan reported 845 new cholera cases and 77 associated deaths (CFR: 9.1%). This represents a 29% decrease in cases and 45% increase in deaths compared with the previous month.

The ongoing cholera outbreak began on 8 May in West Kordofan. Cases are concentrated in West Kordofan and North Kordofan, with further spread reported in South Darfur, North Darfur, and Khartoum with displaced populations particularly affected.

Highest cumulative deaths were reported in Al Nuhood locality in West Kordofan (CFR 11.9%). The high CFR points to challenges in early detection and case management.

Ongoing conflict and insecurity continue to increase vulnerability and constrain outbreak response activities.

Annex 1. Data, table, and figure notes

Caution must be taken when interpreting all data presented. Differences are to be expected between information products published by WHO, national public health authorities, and other sources using different inclusion criteria and different data cut-off times. While steps are taken to ensure accuracy and reliability, all data are subject to continuous verification and change. Case definitions, laboratory testing strategies, reporting practices, and lag times differ across countries, territories, and areas. These factors, among others, influence the counts presented, with variable underestimation of the true case and death counts, and variable delays in reflecting these data at the global level.

‘Countries’ may refer to countries, territories, areas, or other jurisdictions of similar status. The designations employed, and the presentation of these materials do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Countries, territories, and areas are arranged under the administering WHO region. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted; the names of proprietary products are distinguished by initial capital letters.

Annex 2. Technical guidance and other resources

General
- Cholera fact sheet
- Ending Cholera: A Global Roadmap to 2030
- Global cholera strategic preparedness, readiness, and response plan 2023/24
- WHO’s Call for urgent and collective action to fight cholera
- Disease Outbreak News: Cholera – Multi-country with a focus on countries experiencing current surges
- Global Task Force on Cholera Control (GTFCC)
- AFRO Weekly outbreaks and emergency bulletin
- WHO Global Cholera and AWD Dashboard
- WHO AFRO Cholera Dashboard
- Cholera upsurge (2021–present) web page

Training
- GTFCC Laboratory training on Sample collection and testing with Rapid Diagnostic Tests for cholera for health care workers available in English, French, Arabic and Portuguese.
- GTFCC Laboratory job aids and fact sheets available in English, French, Arabic and Portuguese.
- GTFCC Cholera surveillance for health care workers. These courses are available in English and French.
- GTFCC Cholera surveillance for health authorities. These courses are available in English and French.
- Countries are encouraged to periodically self-assess their cholera surveillance systems using the GTFCC surveillance assessment method to identify priority activities for strengthening surveillance in line with GTFCC recommendations.

Technical guidance
- GTFCC fixed ORP interim guidance and planning
- Public health surveillance for cholera - Guidance document (2024), including tools and job aids. These recommendations are available in English, French, Arabic and Portuguese.
- GTFCC updated recommendations for cholera reporting to the regional and global levels, accompanied by an Excel reporting template, are available in English, French, Arabic and Portuguese.

Progress towards the 2030 NTD road map targets

The LF-specific targets of the WHO NTD road map 2021–2030 are for MDA to no longer be needed, all endemic countries to implement surveillance following cessation of MDA and for 80% of endemic countries to achieve elimination of LF as a public health problem by 2030.

The status of countries with respect to MDA implementation, surveillance and validation is presented in Table 2. In 2025, 34 countries required MDA (columns I–II), including four countries where MDA had not yet been implemented in all areas requiring intervention (column I). By the end of 2025, 40 countries (columns III–IV) had reached the surveillance phase and no longer required MDA nationally. Of these, 17 countries (column III) were under post-MDA surveillance, while 23 countries (column IV) had achieved elimination of LF as a public health problem and were in the post-validation surveillance phase. At the request of the WHO Regional Office for the Western Pacific, the People’s Republic of China and the Republic of Korea were added to those countries acknowledged for achieving elimination of LF as a public health problem. Achievements in both countries were rigorously evaluated and acknowledged by WHO in 2007 and 2008 respectively. Including the two countries brings the total number of countries considered endemic for LF from 72 to 74.

The milestones preset for LF in 2025 were to have validated 34 countries, 40 countries in the surveillance phase and the population requiring MDA reduced to 180 million. By the end of 2025, the population requiring MDA for LF had decreased by 76.9% to 361 million, above the projected milestone, but still on-track to achieve the cross-cutting target of the NTD road map of a 90% reduction in the population requiring interventions for NTDs.⁴ The cumulative population living in IUs that no longer require MDA now exceeds 1.06 billion. Additionally, surveys were reported pending in 380 IUs across 15 countries. Results are needed to determine whether 158.5 million people in these IUs still require MDA. The population requiring MDA will be updated in the Global Health Observatory preventive chemotherapy data portal as future survey results are reported.⁵

MDA implementation in 2025

MDA results achieved in 2025 by country are presented in Table 3. Since 2000, 10.34 billion cumulative treatments have been delivered to more than 945 million people through LF MDA. In 2025, 361 million people were estimated to require MDA and 21 countries reported treating 244.2 million people, corresponding to 67.6% coverage. Effective coverage was achieved in 89.7% of the 581 IUs in which MDA was implemented. The MDA-delivery gap comprised 61.7 million people living in 295 IUs where MDA was required but had not been delivered and no survey results were pending. In IUs where MDA was delivered, 55.2 million people were not treated. This cohort includes people who were ineligible, refused, or were absent during the MDA.

LF MDA also contributes to the control and elimination of other NTDs through the broader effects of the anthelminthic medicines used. In 2025, among 14 countries co-endemic for LF and onchocerciasis that implemented MDA, 48.2 million people received ivermectin and albendazole during LF MDA, including 26.5 million treatments in known co-endemic IUs. In 16 out of 23 countries requiring preventive chemotherapy for both LF and soil-transmitted helminthiasis (STH) in 2025, 12.2 million preschool-aged children (2–4 years), 61.9 million school-aged children (5–14 years) and an estimated 64.4 million women of reproductive age were treated during LF MDA. Cumulatively, 2043 IUs in 46 countries coendemic with STH no longer require MDA for LF.

Progress in implementing alternative MDA regimens

The triple-drug regimen of IDA is recommended for LF MDA in eligible settings where there is no onchocerciasis or loiasis and other programmatic conditions are met.⁶ In 2025, seven countries reported treating 101.1 million people with IDA. Since 2018, a total of 514.4 million IDA treatments has been distributed in 22 countries. Coverage of the total population in IUs where this type of MDA was targeted ranged by country from 65.0% in Zimbabwe to 89.4% in the Philippines. The number of people treated by country ranged from 759 during targeted surveillance in Malaysia to 91.7 million during MDA in India.

In areas of the African Region co-endemic with Loa loa, where ivermectin and diethylcarbamazine are contraindicated because of the risk of severe adverse events, WHO recommends albendazole 400 mg administered twice yearly as an alternative LF MDA regimen.⁶ In 2025, 6.4 million treatments with albendazole only were reported. The Central African Republic, Republic of the Congo and Democratic Republic of the Congo reported implementing at least 1 round of treatment. Planned treatment in Equatorial Guinea was not delivered in 2024 or 2025. Democratic Republic of the Congo delivered the recommended two rounds in 24 IUs and a single round in two IUs. WHO recommends complementing this strategy with vector-control measures, including insecticide-treated nets, as part of an integrated approach to LF and malaria control.⁷

Epidemiological survey data reported in 2025

During the reporting period, ten countries, Ethiopia, Ghana, Haiti, India, Indonesia, Liberia, Madagascar, Nepal, Nigeria, and Zambia, submitted epidemiological survey data. An IU is eligible for TAS or IIS when the antigenemia is <2% or microfilaraemia <1% among adults in each of at least 2 communities considered at highest risk as measured through the epidemiological monitoring survey (EMS). An IU ‘passes’ a TAS or IIS when the number of infected individuals is less than the critical cut off value representing the threshold target (<1% antigenemia in TAS or <1% microfilaraemia in IIS). Among 1520 IUs in eight countries that conducted EMS, 971 IUs (63.9%) met the required epidemiological criteria to proceed to TAS or IIS. Of 130 IUs in seven countries that conducted TAS1, 129 (99.2%) passed, indicating that MDA could be stopped and post-MDA surveillance initiated. Similarly, all 18 IUs in Madagascar, Indonesia, and Nepal that conducted IIS1 found less than 1% microfilaraemia. All seven IUs in two countries that conducted TAS2 and 20 out of 21IUs in three countries that conducted TAS3 passed.

Care for people affected by LF-related chronic diseases

MMDP involves providing an essential package of care for people affected by LF, and includes anthelminthic treatment for LF infection, surgery for hydrocoele, management of adenolymphangitis, and management of lymphoedema.⁸ These services should be integrated into primary health care and provided in combination with a mental care package to support both the physical and psychological wellbeing of people affected.⁹ MMDP requires that NTD programmes know for all IUs the number of people with lymphedema and hydrocele (burden estimate) and ensure that health care workers have the capacity to deliver and are providing the essential package of care. Finally, countries should continue monitoring and reporting the number of people affected and the care provided.

In 2025, 23 countries, including five countries that had achieved validation of elimination of LF as a public health problem, submitted updated data on LF morbidity and care. Among the 23 countries reporting the number of people affected, an additional 13 103 people with lymphoedema and 9992 men with hydrocoele were identified. Ten countries reported providing MMDP services for 371 087 people with lymphoedema and hydrocele surgery for 73 347 men. Benin and Nigeria reported 100% coverage of lymphoedema care among newly identified patients in 2025.

Figure 10 provides a crude measure of the progress in achieving the GPELF aim for MMDP. For each Region the number of countries meeting the following criteria is presented: i) reporting MMDP data, ii) providing the essential package of care, iii) completed burden estimate. An important milestone of having all countries reporting on LF morbidity has yet to be reached. There is still work to be done in many countries as the provision of care can only be documented in 49 of the 74 endemic countries. Twenty-two countries have been unable to provide estimates to WHO on the total number of people with lymphedema and hydrocele. Among the countries still under MDA and those that have met criteria to stop MDA nationally, the lack of progress in MMDP risks delaying the achievement and acknowledgement by WHO of eliminating LF as a public health problem.

Figure 10: Implementation of morbidity management and disability prevention by WHO Region

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Figure 10: Implementation of morbidity management and disability prevention by WHO Region

Regional highlights

Figure 11 summarizes cumulative progress by WHO region in endemic IUs, showing a growing population that no longer require MDA, those awaiting impact assessments, and those that continue to require MDA. In the African Region, progress in addition to MDA in 2025 included further refinement of the geographical extent of LF transmission through remapping and impact surveys. In Gabon, confirmatory mapping of districts with uncertain endemicity found that MDA was not warranted in the country. EMS and TAS implementation in Guinea, Madagascar, Nigeria, United Republic of Tanzania and Zambia helped make stop-MDA decisions leading to reductions in the number of IUs and 29.3 million fewer people requiring MDA.

In the Region of the Americas, Guyana implemented a second round of IDA MDA in Regions III and IV as part of its intensified efforts to eliminate LF and coverage results are awaited. In Haiti, insecurity and loss of funding constrained implementation of MDA and surveys. However, TAS3 was conducted in 3 evaluation units (EU) and MMDP activities including peer support groups continued around two designated facilities. The Dominican Republic remained among the countries closest to meeting the criteria for elimination of LF as a public health problem but were unable to submit their dossier in 2025.

Figure 11: Proportion of endemic implementation units (IUs) that no longer require MDA^a, pending impact surveys^b and remaining IUs still requiring MDA and their population in millions, 2025

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Figure 11: Proportion of endemic implementation units (IUs) that no longer require MDA^a, pending impact surveys^b and remaining IUs still requiring MDA and their population in millions, 2025

In the Eastern Mediterranean Region, progress remained constrained by operational and humanitarian challenges. However, Sudan implemented LF MDA despite the ongoing conflict. Egypt and Yemen remained in the post-validation surveillance phase, but no surveillance reports were received.

The South-East Asia Region continued to account for a substantial share of global progress towards LF elimination. Only three of eight LF endemic countries still require MDA. Continued reductions in the population requiring MDA were supported by successful impact surveys in India and Nepal. In India, the population requiring MDA declined by 89.1 million between 2024 and 2025. In Nepal, surveys since 2024 indicated that an additional 2.8 million people no longer required MDA. Limited availability of recommended diagnostic tests for Brugia spp. and W. bancrofti remained an operational constraint in India.

The Western Pacific Region made further progress in 2025. Indonesia officially joined this WHO Region in May 2025 which impacts the total number of IUs and population data reflected in Table 3 and Figure 11 for the South-East Asia Region and the Western Pacific Region. The population requiring MDA in Indonesia has declined by 86.6% in the past 5 years and overall has achieved a 97.6% decline since the program launched. However, the availability of recommended diagnostic tests for Brugia spp. and resources to implement TAS and IIS has limited the progress. In 2025, 33 districts were awaiting surveys to make decisions on stopping MDA for over 7 million people. In Brunei Darussalam, TAS2 was conducted across 3 EUs and identified antibody-positive children in three focus areas and targeted IDA at the mukim level was planned. In 2025 Papua New Guinea launched an Integrated Skin NTD Project which includes LF case-finding and management. The integrated MDA and routine intensified immunization campaign was postponed to 2026. The Philippines implemented IDA in the last remaining IUs requiring MDA. With a large proportion of endemic countries in the Region having achieved the criteria for elimination as a public health problem, sustained post-validation surveillance, rapid response to signals and continued access to morbidity management services remain priorities.

Zoonotic transmission

Zoonotic transmission of nocturnally subperiodic Brugia malayi also poses risk for LF elimination in areas of the South-East Asia and Western Pacific regions.¹⁰ In Indonesia animal reservoirs were identified in an area with re-emergent microfilaremia in humans after having passed TAS3.¹¹ A 2025 systematic review and meta-analysis from Malaysia documented B. malayi infections in both humans and animal hosts, including cats, dogs and non-human primates, highlighting the potential role of animal reservoirs in sustaining transmission.¹² In 2025 as part of their post-MDA surveillance strategy Malaysia implemented targeted treatment and research in 2 communities with zoonotic B. malayi.

Persistence of LF transmission in the Pacific

In Tonga and Wallis and Futuna, investigations of LF infections seven years after validation identified evidence of focal transmission, prompting enhanced epidemiological and entomological investigation and targeted MDA response.¹³¹⁴ Studies in French Polynesia and Samoa where criteria for stopping MDA has not been reached nationally, also indicate persistent transmission.¹⁵¹⁶ Further research is needed to identify why these areas, where day-biting Aedes spp. are the primary vectors, have required multiple rounds of MDA and even after introducing IDA have been unable to sustain infection below target thresholds. New vector control interventions, alternative treatment regimens or test and treat strategies should be evaluated to supplement elimination efforts. Evidence of persistent or re-emergent LF transmission in Pacific Island Countries and Territories underscores the importance of sustained post-validation surveillance and response. Surveillance should be in place as EUs pass TAS3 and continue after validation criteria are achieved. Surveillance in LF endemic countries should follow the latest guidance provided by WHO.¹⁷

Outlook to 2030

Overall, the 2025 results indicate continued progress towards the 2030 LF targets, although the achievements were below the 2025 milestones for country validation (31% vs 49%), surveillance (54% vs 57%) and reduction of the population requiring MDA (362 vs 180 million). Financial sustainability has emerged as a growing concern. 2025 brought major cuts in Official Development Assistance for NTD programmes creating funding gaps for planned LF activities. These shortfalls threaten to delay progress towards the 2030 targets in at least 12 countries and underscore the importance of securing sustainable domestic and international financing for elimination efforts. Accelerating progress will require sustained implementation of MDA in endemic areas, access to diagnostics and resources to implement epidemiological assessments, strengthened post-MDA and post-validation surveillance, and reprioritization to focus on expanding the essential package of care for people with lymphedema and hydrocele.

Detailed epidemiological update

Epidemiological situation in Africa, 2025

Yellow fever remained a significant public health threat in Africa in 2025, with 120 laboratory-confirmed cases reported from 14 countries, including 17 deaths (Map 1, Table 4). Three countries account for three-quarters of all confirmed cases: Burkina Faso (44 cases), Cameroon (37), and Angola (11).

Map 1: Distribution of confirmed human yellow fever (YF) cases by country, Africa, 2025.

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Map 1: Distribution of confirmed human yellow fever (YF) cases by country, Africa, 2025.

During the year, two YF outbreaks were confirmed in two countries, Angola and the Central African Republic. In addition, 14 events with epidemic potential requiring reactive vaccination were reported from five countries, underscoring the continued risk of YF reemergence and spread across the region.

Most cases occurred in rural settings. Available epidemiological evidence suggests that reported cases were associated with a combination of sylvatic and intermediate transmission cycles. However, incomplete outbreak investigations, including limited entomological assessments, constrained the ability to accurately characterize transmission dynamics in many settings.

Yellow fever cases occurred more frequently among men, who accounted for 66 cases (55%), compared with 48 cases (40%) among women; sex was unknown for 7 cases (6%). Age-specific analysis indicated that transmission primarily affected individuals aged 10 to 49 years, who represented 68% (n=82) of all confirmed cases. Children aged 0 to 9 years accounted for 19 cases (16%), while individuals aged 50 and older accounted for 13 cases (11%). Age was unknown for 7 cases (6%). This distribution suggests continued exposure among adolescents and working-age adults, reflecting occupational and behavioural risk factors associated with agricultural activities, forestry work, mining, and population mobility in endemic areas.

Early diagnosis of YF remains a major challenge across the region, with cases most frequently confirmed after patients are discharged from health facilities. Serological testing remains the primary testing method used for case confirmation, with an increasing contribution of molecular testing by reverse transcription quantitative polymerase chain reaction (RT-qPCR), reflecting an enhanced diagnostic capacity (see: Laboratory and diagnostics). While confirmatory testing at regional reference laboratories (RRL) remains an essential component of the serological confirmation process, delays in specimen referral to that level contribute to prolonged diagnostic turnaround times, highlighting a vulnerability of recent gains. In addition, serological results do not distinguish between natural infection and vaccine-induced immunity, complicating the interpretation of serological results and case classification. Together, these challenges delay case investigation, hinder timely outbreak detection, and limit the effectiveness of response measures.

Operational challenges further affect surveillance and response activities. Limited financial resources, competing public health priorities, and concurrent emergencies in fragile settings constrain the timely investigation of YF suspected cases and events. As a result, the epidemiological significance of several reported cases could only be assessed retrospectively, and in some instances the information available was insufficient to characterize transmission patterns.

For comparison, 141 confirmed cases were reported from 15 countries in 2024, including two confirmed outbreaks from two countries. Although the number of confirmed cases declined slightly in 2025, the geographic distribution of cases and recurring events with epidemic potential indicate persistent transmission across high-risk areas.

Preventive mass vaccination campaigns implemented since 2017 have substantially increased population immunity and are expected to reduce the risk of large-scale outbreaks in the general population. Nevertheless, YF transmission remains a significant public health threat in endemic areas. Ongoing sylvatic transmission continues to affect unvaccinated and under-vaccinated populations living or working in or near forested environments. In addition, population mobility, including labour-related migration and cross-border movement, increases the risk of virus introduction into susceptible communities and contributes to the potential for urban, regional and international spread.

YF outbreaks and responses

This section provides an overview of the YF outbreaks² and response documented in Africa in 2025: Angola and Cote d’Ivoire. Importantly, no large or disruptive outbreak as defined by IA2030³ was reported that year.

Angola

In 2025, Angola reported 11 confirmed YF cases, all confirmed by plaque reduction neutralization test (PRNT). Of these, four confirmed cases were linked to an outbreak detected in Massangano district, Cuanza Norte Province, with symptom onset dates ranging from June to November 2025, including three cases with onset at the end of November. Four confirmed cases were reported from Massangano district (three women and one man), aged 19, 21, 24 and 68 years. Three cases were unvaccinated, and one had an unknown vaccination status. In response, health authorities implemented a prompt limited local vaccination campaign in December 2025. This outbreak follows the detection of four YF cases in 2024, the first confirmed cases reported in Angola since 2016, ending a seven-year period without confirmed infections. The 2016 outbreak originated in the urban area of Luanda following introduction of the virus from sylvatic areas and subsequently spread to 16 provinces. Although YF vaccine has been included in the Angola routine childhood immunization programme since 1997, vaccination coverage remains suboptimal, with WHO/UNICEF Estimates of National Immunization Coverage (WUENIC 2025) estimates indicating coverage of 48% in children under one year of age (Table 4). Consequently, population immunity remains low among cohorts born after 2016, leaving Angola at continued risk of future YF outbreaks despite the expectation of sporadic cases.

Central African Republic

The Central African Republic (CAR) remains at high risk for YF transmission with populations despite the implementation of a nationwide preventive vaccination campaign in 2010. In 2025, an outbreak was detected in Bossembele district, where four laboratory-confirmed YF cases (two by PCR and two by PRNT) were reported from the Gaga health area and the Lambi and Bekadili health areas. Dates of symptom onset ranged from 30 November 2025 to 4 January 2026. Bossembele district has a history of YF transmission, with confirmed cases reported in 2023 that prompted a district-wide reactive vaccination campaign in July 2024, achieving 91% administrative coverage. At least one of the 2025 cases occurred in a military-controlled gold mining site characterized by a highly mobile population of military personnel, miners and their families, many of whom originated from outside the district. The household survey conducted during the investigation indicated low vaccination coverage of approximately 30% among both military personnel and surrounding communities, highlighting substantial immunity gaps. Given the risk of continued transmission among mobile and hard-to-reach populations, including miners, military personnel and herders, a reactive vaccination campaign targeting an estimated 50,000 people living and working in the affected mining area of Gaga is being prepared. More broadly, sustained efforts will be required to close population immunity gaps, including targeted vaccination activities, systematic vaccination of high-risk occupational groups and strengthened surveillance. Although YF vaccine is included in the routine childhood immunization programme, coverage remains suboptimal, with WUENIC 2025 estimates indicating that only 41% of children under one year of age have been vaccinated (Table 4). As a result, immunity remains insufficient among cohorts born after 2010, while displaced populations, refugees and workers in forestry and mining sectors continue to be exposed to an endemic YF virus. Persistent insecurity and political instability further increase the risk of transmission and spread by limiting routine immunization, surveillance and outbreak response capacities.

Situations with epidemic potential

Situations with epidemic potential where YF cases are reported in areas with inadequate RI coverage were identified in Burkina Faso, Cameroon, Cote d’Ivoire, Liberia and Mali.⁴

Burkina Faso

Burkina Faso reported the highest number of confirmed cases of YF (44) in the WHO African Region in 2025, from 10 health regions, demonstrating a broad geographic distribution of YF virus circulation. The Centre-Nord region accounted for the largest proportion of cases (13; 29.5%), followed by Hauts-Bassins (10; 22.7%). The East region reported six cases (13.6%), representing a notable increase in transmission compared with its historical epidemiological pattern). Additional cases were reported from Cascades, Sahel, Centre-West, Central Plateau, Centre-East, Boucle du Mouhoun and Centre regions, further highlighting the widespread distribution of the virus across the country.

Most confirmed cases were reported from rural areas (62%), while 38% occurred in urban settings, suggesting greater exposure to YF vectors in rural and peri-rural environments. Men/boys accounted for a slightly higher proportion of cases (52%) than women/girls (48%). The majority of cases (83%) occurred among individuals aged 10-49 years, whereas children under 10 years represented 7% of cases and adults aged 50 years and above accounted for 10%.

In response to the outbreak detected in Kaya district where 13 cases were reported, a reactive vaccination campaign was carried out in September 2025. Other reactive vaccination campaigns were conducted in the district of Dande, as well as the municipalities of Fada and Sindou, in response to situations with imminent epidemic potential. Overall administrative vaccination coverage for the reactive campaign was 91%, with coverages ranging from 82% in Kaya to over 100% in Fada and Sindou.

Compared with 2024, the number of confirmed cases and the geographic extent of affected areas increased substantially in 2025, indicating an expansion of YF transmission and its detection in Burkina Faso. This trend underscores the need to strengthen surveillance, ensure timely laboratory confirmation, and enhance vaccination activities, including targeted vaccination interventions, to close persisting immunity gaps, prevent further spread, and reduce the risk of future outbreaks.

Cameroon

In 2025, Cameroon reported 37 laboratory-confirmed YF cases, including six transmission events assessed as having epidemic potential. Confirmed cases were identified across multiple regions of the country, highlighting the widespread circulation of the YF virus. These cases were spread across nine regions, including the South (10; 27%), the Littoral (eight; 22%), the Far North (five; 14%) and Adamaoua (four; 11%), which together account for 73% of the total. Most affected individuals lived in rural areas (68%), and the majority were men (65%). An analysis by age group shows that, among these confirmed cases, those aged between 10 and 49 years were more numerous (59%) than those under 10 (30%) or over 49 (11%).

In 2025, a situation with epidemic potential was identified in Gazawa district (Far North Region), where two PRNT-confirmed cases were reported, in a 16-year-old woman student and a 4-year-old boy, with symptom onset on 28 June and 20 September 2025, respectively. The district hosts several vulnerable and mobile populations, including refugees, internally displaced people (IDPs) and nomadic groups. Additional confirmed cases were reported in Ngaoundal district (Adamawa Region; 14-year-old male, onset 9 November), Fotokol district (Far North Region; 13-year-old male, onset 13 September) and Abo district (Littoral Region; 11-year-old male, onset 27 October).

In Mbang district (East Region), a situation with epidemic potential was identified. A PRNT-confirmed case was identified in an unvaccinated 4-year-old child. Although the case was not linked to a special population group, the district includes a large Indigenous community living in forested areas, where access to vaccination and health services may be limited. Given the relatively high routine immunization coverage at district level (82%) but low vaccination coverage (49%) observed in a household survey around the case, a reactive vaccination campaign has been recommended in Mbang Sud health area, where infection likely occurred, and among Indigenous forest communities, alongside strengthened routine immunization and surveillance activities.

In Ndop district (North-West Region), another situation with epidemic potential was identified. Two PRNT-confirmed cases were reported in unvaccinated children aged 4 and 13 years. While neither case belonged to a special population group, routine immunization coverage in the district was only 58%, with half of children identified as zero-dose (never received the first dose of diphtheria-tetanus-pertussis containing vaccine), and in a household survey around the cases coverage was estimated at 49%. A targeted reactive vaccination campaign has therefore been recommended in the affected health areas of Babessi and Bamunka Urban, as well as among special populations including IDPs, nomadic groups and other mobile communities. From February to July 2026, a total of 404,935 people were reached through local response and mass reactive vaccination campaigns in the districts with epidemic potential.

With YF vaccine included in Cameroon’s routine childhood immunization programme, immunity gaps persist in several districts and among underserved populations. Continued efforts to strengthen routine vaccination, improve outreach to vulnerable groups and enhance surveillance will be critical to reduce the risk of future outbreaks. WUENIC estimated national routine immunization coverage of 75% among children under one year of age in 2025 (Table 4).

Côte d’Ivoire

In 2025, Côte d’Ivoire reported five laboratory-confirmed YF cases across five districts: M’Bengué, Korhogo 1, Koro, Kounahiri, Ouangolodougou. Three of these events—reported in Ouangolodougou, Koro and M’Bengué districts—were assessed as having epidemic potential and were considered to require reactive vaccination activities. In Koro district, a 5-year-old boy tested positive by PCR, with symptom onset on 30 November 2025. In Ouangolodougou district, a 9-year-old boy with PCR-confirmed YF developed symptoms on 8 October 2025 and subsequently died. In M’Bengué district, a 18-year-old pregnant woman with PCR-confirmed infection developed symptoms on 2 December 2025 and died; an additional suspected case with a fatal outcome was reported but could not be laboratory tested. In response to these events, health authorities rapidly implemented localized vaccination activities for children through the Expanded Programme on Immunization (EPI) platform ahead of the district-wide reactive vaccination campaign. A total of 490,063 people were reached through the campaigns conducted in March 2026. The occurrence of geographically dispersed confirmed cases, including fatal infections and multiple events assessed as having epidemic potential, underscores the need to strengthen population immunity and maintain sensitive surveillance systems to ensure early detection and rapid response to YF transmission. The nationwide preventive mass vaccination campaign conducted between 2011and 2012 achieved an estimated 96% coverage according to the post-campaign survey. However, routine immunization coverage for YF remains low, with an estimated national coverage among children under one year of 55% in 2025, down from 62% in 2024 (Table 4).

Liberia

In 2025, Liberia reported two confirmed YF (YF) cases, including one from Grand Bassa County and one from Porkpa District, Grand Cape Mount County. The latter case was a PCR-confirmed infection in a 35-year-old miner from Mano River Kongo, with symptom onset in November 2025. Epidemiological investigations suggested that infection was acquired in the mining village of Vinja, consistent with a probable sylvatic spillover event. Given the elevated risk of exposure among mining populations and concerns about low immunity in some local communities, health authorities implemented an immediate local response that protected 7,231 children around the affected area. This was followed by a reactive vaccination campaign in May 2026 that reached 135,401 people in Porkpa District and the neighbouring districts of Gola Konneh, Tewor and Kongba, which include mobile and hard-to-reach populations. Despite the occurrence of these cases, Liberia maintains generally high YF population immunity. The nationwide preventive mass vaccination campaign conducted in 2009 achieved 95% coverage according to the post-campaign coverage survey, and routine immunization coverage for YF remains high across all districts, with an estimated national coverage among children under one year of 85% in 2025 (Table 4).

Mali

In 2025, Mali reported a single YF event assessed as having epidemic potential. The case occurred in Kignan district, Sikasso Region, and involved a 6-year-old boy with no reported travel history whose infection was confirmed by PCR. Symptom onset was reported on 30 November 2025. The case originated from a rural area characterized by high population exposure to YF risk factors and limited access to health services, raising concerns that additional infections may have gone undetected. Given the low level of population immunity in the affected area, health authorities implemented an initial localized response around the case in December 2025, followed by a reactive vaccination campaign in May 2026 that protected 162,793 people. In recent years, Mali has reported only sporadic YF cases, including a single case in Yanfolila district (also in Sikasso Region) in 2024 and three cases reported in Sikasso and Koulikoro regions in 2020. Although Mali completed a nationwide preventive mass vaccination campaign in 2006, routine immunization coverage has remained suboptimal, with an estimated national coverage among children under one year of age of 70% in 2025 (Table 4). As a result, immunity gaps have accumulated among cohorts born since the 2006 campaign, increasing the risk of local transmission and outbreaks following virus introduction.

Countries with sporadic cases

In 2025, seven countries reported confirmed sporadic cases of yellow fever, all with sylvatic exposure: Nigeria (7 cases), Uganda (3), Togo (3), Congo (1), Ghana (1), Niger (1) and Senegal (1).⁵

In Nigeria, the seven confirmed cases were reported in six districts: Ogu/Bolo (2 cases), Orolu (1), Michika (1), Ikorodu (1), Gwoza (1) and Kachia (1). Of these cases, five were women/girsl (71%) and two were men/boys (29%). The majority of cases (71%) were in individuals aged 10-49 years.

In Togo, of the three confirmed cases reported in three different districts (Binah, Kozah and Tandjouaré), two were men/boys (67%) and one was a woman/girl (33%). The patients belonged to three different age groups: 0-9 years, 10-49 years and 50 years and over.

In Uganda, the three confirmed cases were reported in the district of Bundibugyo (2 cases) and in the district of Masaka (1 case). Two cases involved people aged 10 to 49 years, whilst one case involved a person aged 50 years or over. The two cases in Bundibugyo were woman farmers.

In Ghana, one confirmed case was reported in a 60-year-old man from Kadjebi District in the Oti Region, with symptom onset in May.

In the Republic of Congo, one confirmed case reported was a 10-year-old unvaccinated girl from Kibangou district, Niari department, with symptom onset in March.

In Senegal, a confirmed case reported was a 15-year-old unvaccinated man from a rural area in Pité district, Kolda region, with symptom onset in October.

In Niger, the confirmed case involved a 20-year-old woman from the municipality of Agadez, in the Agadez region, with symptom onset in February.

Epidemiological situation in Latin America, 2025

In 2025, 348 confirmed human cases of YF, including 148 deaths, were reported in the Americas Region, representing a 5.6-fold increase compared with the 61 cases reported in 2024. Cases were reported from seven countries (Map 2): the Plurinational State of Bolivia (8 cases, including 2 deaths), Brazil (120 cases, including 48 deaths), Colombia (125 cases, including 51deaths), Ecuador (11 cases, including 8 deaths), Guyana (1 fatal case), Peru (49 cases, including 19 deaths), and the Bolivarian Republic of Venezuela (34cases, including 19 deaths). The increase was driven largely by ongoing outbreaks and expansion of transmission in Brazil, Colombia, Peru and Venezuela, with additional outbreaks reported in Ecuador and continued circulation in endemic areas across the Region.

In 2025, eight new large/disruptive outbreaks were identified, in addition to three outbreaks continuing from 2024. Countries affected by outbreaks include Colombia, Plurinational State of Bolivia, Brazil, Ecuador, Peru, and Bolivarian Republic of Venezuela.

Map 2: Distribution of confirmed human yellow fever cases in the Americas, 2020–2025.

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Map 2: Distribution of confirmed human yellow fever cases in the Americas, 2020–2025.

Colombia

Colombia reported 125 confirmed YF cases and 48 deaths in 2025, representing the largest outbreak reported in the country in recent years. Transmission was overwhelmingly concentrated in Tolima department, which accounted for 115 cases and 43 deaths, while sporadic cases were also reported from Caldas, Cauca, Guaviare, Meta and Putumayo. The outbreak was a continuation of transmission that began in September 2024 in the area surrounding the Bosque de Galilea Regional Natural Park and subsequently expanded into the Magdalena Valley, affecting multiple municipalities classified as high risk. The outbreak was characterized by sustained sylvatic transmission in a mountainous forest ecosystem outside the traditional Amazonian focus of yellow fever, highlighting the ongoing expansion of transmission into previously unaffected ecological settings. Approximately 80% of reported cases occurred among men, and all cases were associated with exposure in areas with ongoing epizootics among non-human primates.

Plurinational State of Bolivia

In 2025, the Plurinational State of Bolivia reported eight confirmed YF cases, including two deaths. Cases were identified in the departments of Beni, La Paz, Pando and Tarija, with probable exposure occurring in forested and endemic municipalities including Rurrenabaque, Palos Blancos, Guanay, Santa Rosa and Tarija. The outbreak represented a continuation of transmission that had re-emerged during 2024 and was associated with the sylvatic cycle of YF virus. Most cases occurred among men, and a wide age range was affected, from infants to adults. In addition to human infections, three YF epizootics were confirmed in non-human primates in La Paz and Beni departments, providing evidence of ongoing viral circulation in enzootic areas.

Brazil

In 2025, Brazil reported 120 confirmed human cases of YF, including 48 deaths (case fatality ratio 40%). Cases were reported in the states of São Paulo (61 cases, including 35 deaths), Pará (46 cases, including seven deaths), Minas Gerais (12 cases, including five deaths), and Tocantins (one fatal case). Most cases occurred among adult men (89%), and only one case had a documented history of YF vaccination. Symptom onset occurred between January and June 2025, with the last confirmed case reported on 22 June 2025. All cases were associated with exposure to jungle or forested environments during occupational or recreational activities, consistent with sylvatic transmission. The outbreak was notable for extensive transmission in São Paulo State, where cases were reported across 29 municipalities in six health regions, indicating a broader geographic distribution than observed in previous years. In parallel, 124 YF epizootics in non-human primates were confirmed during 2025, including 70 in São Paulo, 38 in Goiás, and 16 in Minas Gerais, providing evidence of widespread enzootic viral circulation. No additional human cases or confirmed epizootics were reported after June 2025 or during the first weeks of 2026.

Ecuador

Ecuador reported a localized YF outbreak during the first half of 2025, with 11 confirmed cases and eight deaths. Cases were detected in the provinces of Morona Santiago, Sucumbíos and Zamora Chinchipe, with the latter accounting for more than half of all reported infections and the majority of deaths. The outbreak in Zamora Chinchipe involved transmission in several cantons, including Zamora, Nangaritza, Yantzaza, Centinela del Cóndor and Zumba, all located within the Amazon basin ecosystem. Most cases occurred among men, and three cases reported a history of YF vaccination. No additional confirmed cases were reported after epidemiological week 31 of 2025, suggesting interruption of transmission following outbreak response measures.

Peru

Peru reported 49 confirmed YF cases and 19 deaths in 2025, reflecting concurrent outbreaks in several endemic forest areas. The largest outbreak occurred in Amazonas department, which reported 24 cases and nine deaths. A second outbreak was documented in Junín department, where six cases were reported, while a third outbreak represented continued transmission from 2024 in San Martín department, which reported 14 cases and seven deaths during 2025. Additional isolated cases were reported from Huánuco, Loreto and Madre de Dios. The epidemiological pattern was consistent with sylvatic transmission associated with exposure in Amazonian and forested regions, and approximately 80% of cases occurred among men. The occurrence of multiple simultaneous outbreaks highlighted the widespread circulation of YF virus across several ecological corridors in the Peruvian Amazon.

Bolivarian Republic of Venezuela

The Bolivarian Republic of Venezuela reported 32 confirmed YF cases and 19 deaths in 2025, with evidence of geographic expansion beyond traditionally recognized risk areas. Transmission was reported from multiple states, including Amazonas, Apure, Barinas, Bolívar, Monagas and Portuguesa. Of particular concern were outbreaks in Barinas and Portuguesa, areas not previously classified as endemic or high-risk for YF transmission. Human cases were also reported in additional parishes within Aragua and Lara states that had not previously been considered risk areas, reflecting an expansion of sylvatic transmission into new locations, also detected through epizootics among non-human primates. The states located along the expanding enzootic wave originating from the San Camilo area accounted for most reported infections. This epidemiological pattern underscored the spread of YF virus beyond its traditional ecological range and raised concerns regarding the potential for further transmission in areas with low population immunity.

Clinical management and case fatality rate

YF outbreaks in the Americas during 2025 were associated with high mortality, with 346 confirmed cases and 143 deaths reported (overall case fatality ratio, CFR: 41%). The Pan American Health Organization (PAHO)/WHO emphasized early case detection and prompt supportive management, particularly for severe disease. As no specific antiviral treatment exists, clinical management focuses on hospitalization, monitoring, life-support measures, and management of complications such as acute liver failure, renal dysfunction, bleeding disorders, and secondary infections. To guide health professionals in the region, PAHO/WHO published new clinical guidelines that aim to improve care for severe YF patients in the Americas⁶.

Epizootic surveillance and One Health approach

Non-human primate surveillance remained a key component of YF early warning systems, as epizootics can signal viral circulation before the occurrence of human cases. During 2025, confirmed epizootics were reported in several countries, including the Plurinational State of Bolivia, Brazil, Colombia and the Bolivarian Republic of Venezuela, indicating ongoing enzootic transmission. PAHO/WHO recommends that detection of epizootics trigger enhanced human surveillance, field investigations and targeted vaccination activities in at-risk populations.

PAHO/WHO continued to promote a One Health approach to YF prevention and control, integrating human, animal and environmental surveillance. Given the expansion of transmission in forest ecosystems, countries were encouraged to strengthen coordination across epidemiological, epizootic and entomological surveillance systems, supported by vaccination, vector control, risk communication and community engagement to identify and respond rapidly to areas at increased risk.

Yellow fever prevention

Protecting high-risk populations

Only 13 of the 40 countries classified as high-risk for YF have achieved the 80% population immunity threshold considered necessary to limit viral amplification and transmission within communities. This highlights the urgent need to further expand vaccination efforts in at-risk settings.

Global routine immunization coverage has shown steady progress, increasing from 58% in 2022 to 62% in 2023, 64% in 2024 and 66% in 2025. In 2025, an estimated 20 million children (20,043,860) were protected through routine YF vaccination, including 15.1 million (15,080,602) in Africa and 5.0 million (4,963,258) in Latin America and the Caribbean (LAC). These estimates are based on data reported through the WUENIC 2025 platform.

Africa

Routine immunization

In Africa, 25 of the 27 high-risk countries have introduced YF vaccine into their routine immunization schedules, including 24 countries with nationwide introduction. Regional routine immunization coverage increased from 64% in 2024 to 66% in 2025. The sub-national YF risk assessments completed in Ethiopia and Kenya, or initiated in South Sudan, with support from the EYE risk analysis working group, intend to inform routine immunization introduction (Ethiopia, South Sudan) or scale up to nationwide (Kenya) decisions. Of the 24 countries with nationwide YF routine immunization programmes, eight (Burkina Faso, Congo, Ghana, Liberia, Niger, Senegal, Sierra Leone, and Togo) achieved the 80% routine immunization coverage target in 2025. A further eight countries reported coverage between 79% and 60%, while the remaining eight countries had coverage below 60% (Table 4). The largest gains in coverage were observed in Ghana (+12 percentage points), Equatorial Guinea (+10 percentage points), and Angola (+7 percentage points). In contrast, Côte d’Ivoire and Guinea-Bissau experienced the largest declines, with coverage decreasing by seven percentage points in each country.

Among the countries with nationwide YF routine immunization programmes, 13 (57%) reported a gap between YF vaccine coverage and coverage with the first dose of measles-containing vaccine (MCV1), despite both vaccines being scheduled at the same age. In three countries, the gap was less than five percentage points; however, substantial discrepancies were observed in Angola (48% vs. 71%), Sierra Leone (85% vs. 90%), and Uganda (69% vs. 92%).

While the number of countries reporting a coverage gap remained unchanged compared with 2024, the number with significant gaps (≥5 percentage points) declined, reflecting improvements in Ghana and Cote d’Ivoire. To better understand the drivers of these discrepancies, the EYE Vaccine Delivery Working Group (VDWG) is advocating for operational research to identify and address the underlying barriers to vaccine uptake.

Expanding platforms for yellow fever routine immunization and life-course vaccination

To further increase YF routine immunization coverage, the VDWG is exploring innovative approaches to real missed and under-vaccinated populations through an expanded immunization platform⁷. These efforts include leveraging second-year-of-life (2YL) contacts and broader life-course vaccination opportunities, such as school health programs, occupational health services, and travel vaccination platforms. Such approaches have the potential to strengthen coverage, enhance equity, and increase population immunity beyond infant immunization services.

Protecting high-risk occupational groups

The EYE strategy prioritizes the prevention of international spread of YF through targeted vaccination of high-risk populations, particularly workers exposed to sylvatic transmission in forested areas, such as those engaged in mining, logging, and construction activities. In 2025, reactive vaccination campaigns successfully reached high-risk occupational groups identified in Guinea and Cameroon. In January 2025, 11,516 workers, including migrant miners, were vaccinated in Gueckedou district, Guinea, accounting for 3.3% of all individuals vaccinated during the campaign. In June 2025, approximately 5,000 people working in mining areas were vaccinated in Kette district, Cameroon, representing 7% of the total campaign vaccinated population. These interventions highlight the importance of integrating occupational risk considerations into outbreak response strategies to reduce the risk of cross-border spread and prevent outbreaks in underserved populations.

Preventive mass vaccination campaigns

Since 2017, more than 374 million people in Africa have been protected against YF through preventive and reactive vaccination campaigns, as well as catch-up vaccination activities. In 2025 alone, approximately 38 million people were vaccinated, including 2.8 million through reactive outbreak response campaigns.

In 2025, PMVCs implemented in the Democratic Republic of the Congo, Guinea-Bissau, Niger, and Uganda vaccinated more than 29 million people (Map 3). These efforts strengthened population immunity and contributed to progress towards eliminating the risk of YF epidemics. Consistent with the EYE Strategy recommendations and IA2030 principles, campaigns increasingly integrated other health interventions and prioritized equitable access for underserved populations, including refugees, internally displaced people, high-risk occupational groups, and hard-to-reach or zero-dose communities.

Map 3: Yellow fever preventive mass vaccination campaigns implementation status, Africa, 2025

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Map 3: Yellow fever preventive mass vaccination campaigns implementation status, Africa, 2025

Niger successfully conducted its first national YF PMVC, vaccinating 5.1 million people. The campaign achieved 99% administrative coverage in Maradi Region, where 4.6 million individuals were vaccinated, and 104% administrative coverage in Agadez Region, where more than 500,000 people were reached. This campaign represents a major milestone towards achieving nationwide population immunity against YF.

In May 2025, Guinea-Bissau implemented its first nationwide YF PMVC, vaccinating 1.6 million people of the 2 million people targeted. Administrative coverage reached 76.5%, while a post-campaign coverage survey estimated coverage at 77%, below the EYE-recommended threshold required to effectively prevent outbreaks. Coverage varied considerably across the country’s 11 regions, ranging from 51% to 89%, with particularly low coverage reported in Bolama, SAB, and Farim (<62%). Coverage was also suboptimal in urban settings, including Bissau.

Uganda completed the final phases of its national PMVC, extending vaccination activities to the Bugisu, Bukedi, and Busoga sub-regions, where 4.2 million of the 4.6 million targeted individuals were vaccinated (92% coverage). Community engagement activities were integrated with malaria vaccine introduction efforts, strengthening demand generation and community participation. An additional 4.9 million people were vaccinated in Jina and Mubende, corresponding to 93% coverage of the 5.2 million target population. With the completion of these campaigns, approximately 30.7 million Ugandans are now protected for life against YF across all 146 districts, resulting in an estimated national population immunity of 81%.

The Democratic Republic of the Congo completed Block 6 PMVCs in Haut Katanga, Haut Lomami, Tanganyika and Lualaba, reaching 17.6 million people and achieving 81% coverage. The campaign was integrated with the delivery of measles-containing vaccine (MCV). However, implementation of the final PMVC phase may be delayed because of the ongoing Ebola outbreak affecting, among others, the North Kivu and Ituri provinces where the last campaigns’ increments are planned. Since the launch of the EYE Strategy, more than 76 million people have been vaccinated against YF in the country.

Despite these achievements, important challenges remain. Campaign implementation continues to be affected by operational and logistical constraints, insecurity and conflict, competing public health emergencies, delays in campaign scheduling, and weaknesses in data management systems.

Closing persisting immunity gaps

YF outbreaks have re-emerged since 2020 in several countries that conducted PMVCs 10 to 15 years earlier under the YF Initiative (2006-2014). Resurgence has been associated with insufficient routine immunization coverage to sustain population immunity following campaigns and/or gaps in campaign reach, particularly in fragile and conflict-affected settings where some communities were not adequately covered. Fourteen countries have been identified as being at heightened risk of outbreak resurgence: Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Cote d’Ivoire, Gambia, Ghana, Guinea, Liberia, Mali, Senegal, Sierra Leone, and Togo.

To address these risks, the EYE Strategy is supporting immunity gap analyses in these priority countries using a methodology piloted in Guinea, Cameroon, and the Central African Republic in 2023. The tool enables countries to identify geographic areas and population groups with suboptimal immunity and increased vulnerability to outbreaks. Findings from these assessments will inform national planning and the implementation of targeted vaccination interventions aimed at closing immunity gaps and strengthening population protection against yellow fever. The immunity gap maps are practical planning tools that can help identify underserved communities and special populations for proactive vaccination, guide yellow fever reactive and catch-up campaigns. Used alongside immunity maps for other vaccine-preventable diseases, they can also help target integrated interventions and support integrated activities such as Child and Adolescent Health Weeks.

Latin America and the Caribbean (LAC)

Routine immunization

Between 2019 and 2025, routine vaccination against YF in Latin America and the Caribbean showed significant fluctuations, influenced by the impact of the COVID-19 pandemic and by national vaccine administration strategies. Before the pandemic, regional coverage was below the recommended threshold of 95% needed to prevent outbreaks in areas with sylvatic transmission. Disruption of health services during the 2020–2022 period led to a significant decline in coverage, increasing the number of susceptible individuals in all endemic countries. Since 2023, a gradual recovery has been observed, reaching 76% in 2024 and 77% in 2025; however, these levels remain insufficient to ensure uniform and sustained protection in the Region^8,9.

The recovery has been uneven among endemic countries. Guyana maintains coverage rates close to 100%, making it a regional benchmark. Colombia reached 95.9% in 2025, while Paraguay and Suriname have exceeded 80% in recent years. In contrast, Argentina, Brazil, Peru, and Venezuela continue to report coverage rates below 80%, a situation that maintains the risk of outbreaks and highlights the need for targeted interventions to reduce the pool of susceptible individuals^8,9.

A key programmatic factor is the vaccine administration strategy. PAHO recommends co-administering the YF vaccine with the first dose of the measles-containing vaccine (MCV1) at 12 months of age, a practice that minimizes missed vaccination opportunities and reduces coverage gaps. Countries that administer both vaccines during the same visit—such as Guyana, Suriname, Trinidad and Tobago, Venezuela, Bolivia, and Ecuador—tend to maintain differences of less than 5% between the two coverage rates. In contrast, countries that use sequential schedules typically experience larger gaps and a slower recovery in coverage¹⁰.

To strengthen routine vaccination, several countries have begun to implement the regional microplanning methodology. In 2025, Argentina, Brazil, Ecuador, Paraguay, and Suriname used this tool to improve the identification of susceptible populations, optimize access to services, and strengthen the integration of vaccination into primary health care. Microplanning is also becoming established as an essential strategy for outbreak preparedness and response¹¹.

Vaccination campaigns

Mass preventive and catch-up vaccination campaigns have been limited in recent years due to operational restrictions resulting from the pandemic, financial pressure on national immunization programs, and regional vaccine procurement challenges. In this context, Venezuela was the only country to move forward with a PMVC, achieving 92.7% coverage during the first phase, implemented between 2020 and 2021 in ten high-risk states. The second phase, initially planned for 2022, began in 2023 and was partially implemented in four additional states.

PAHO/WHO continues to promote preventive campaigns during inter-epidemic periods and strategies based on geographic risk analysis, with an emphasis on protecting susceptible populations before outbreaks occur. Through the Regional Revolving Fund, technical cooperation is provided to improve demand planning, vaccine supply, supply chain management, and the financial sustainability of national programs.

Controlling epidemic risk and outbreaks

During 2024 and 2025, the increase in YF cases in several countries in the Americas prompted the implementation of intensive vaccination response activities, particularly in Bolivia, Colombia, Ecuador, and Peru. In response to the rise in cases outside traditionally endemic areas, PAHO issued epidemiological alerts urging the strengthening of surveillance and the acceleration of vaccination of susceptible populations¹².

In Colombia, the response to the outbreak that began in 2024 intensified following the declaration of a national public health emergency on April 16, 2025. Faced with global vaccine shortages, the country requested support from the International Coordination Group (ICG), which approved 1,331,428 doses to protect more than 1.2 million susceptible people in 139 municipalities across 13 departments. The response included territorial micro-planning, extramural vaccination, documented screening campaigns, strengthening of the cold chain, and nominal monitoring via the web-based Expanded Programme on Immunization system (PAIWEB). Between September 2024 and December 2025, more than 4.8 million doses of the YF vaccine were administered^13,14.

In Ecuador, the response to the 2025 outbreak focused primarily on the Amazonian provinces of Zamora Chinchipe, Morona Santiago, and Sucumbíos, which accounted for the highest number of confirmed cases. Faced with the increase in cases and limited vaccine availability, the Ministry of Public Health implemented an intensive vaccination strategy using one fifth of the standard dose (0.1 mL), known as fractional dosing, in the susceptible adult population, while maintaining the full dose for children according to the regular immunization schedule. This measure made it possible to rapidly expand vaccination coverage in the affected areas and optimize the use of available vaccine stocks, complemented by rapid monitoring of coverage, active community-based case finding, and vector control activities¹⁵.

Recent experience in the Americas demonstrates that timely vaccination, combined with microplanning, risk analysis, and a rapid response to outbreaks, remains the primary intervention for preventing the spread of YF and reducing the morbidity and mortality associated with the disease ^8,9.

Laboratory and diagnostics

A key milestone in 2025 was to sustain and build upon the achievements in improving the diagnostic capacity for YF across all high-risk countries in Africa. This was marked by a complete year of testing by the African laboratory members of the Global YF Laboratory Network (GYFLaN), exclusively using the commercially available kits recommended for use following kit performance evaluations in a standardized testing approach as per WHO guidance, both for serological and for molecular testing. This transition not only improved diagnostic accuracy but also optimized procurement and logistics, with Gavi and the UNICEF Supply Division coordinating reagent deliveries. Molecular testing is particularly key as it has the potential to allow for in-country laboratory confirmation of cases through direct detection of the virus. In 2025, 8 additional countries in Africa namely Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Ethiopia, Guinea, Kenya, Mali, and Togo, started to implement RT-qPCR testing for YF using the commercial assay. This translated into a cumulative total of 15 countries having received the WHO-endorsed YF RT-qPCR detection kits from UNICEF Supply Division for use in routine surveillance testing, according to the most updated testing algorithm. These include Burkina Faso, Cameroon, Central African Republic, Republic of Congo, Democratic Republic of the Congo, Cote d’Ivoire, Ethiopia, Ghana, Kenya, Mali, Nigeria, Senegal, Sierra Leone, Togo and Uganda, for a total of 342 kits, sufficient to perform 32,832 molecular tests.

In 2025 alone, the rollout of quality assurance measures and the strengthening of accreditation review, covering eleven laboratories (Central African Republic, Côte d’Ivoire, Ethiopia, Kenya, Nigeria (4 laboratories), Cameroon, Senegal, and Uganda), further reinforced diagnostic reliability and network cohesion. By the end of 2025, 18 laboratories in 18 countries¹⁶ were routinely conducting YF molecular testing, with nine of them fully accredited by WHO: the Nigeria National Reference Laboratory in Abuja (NCDC), the Laboratoire des Fièvres Hémorragiques of Guinea in Conakry, the Kenya Medical Research Institute in Nairobi, the Ghana National Public Health and Reference Laboratory in Accra, the Institut Pasteur de Bangui in Central African Republic, Institut Pasteur de la Côte d’Ivoire, and the three Regional Reference Laboratories (RRLs).

In the Americas, including in all 13 countries where YF is endemic, RT-qPCR has been implemented in 27 national public health laboratories. Although ELISA IgM is widely available in the Region, RT-qPCR remains the first-line tool for diagnosis and surveillance. Additionally, implementation of differential PCR to specifically detect vaccine virus has been critical to study potential adverse events following immunization. On the other hand, Immunohistochemistry (IHQ) is also a critical tool used in the Americas to confirm human fatal cases and epizootic events. The PAHO/AMRO Regional Office regularly provides reagents and other critical material to ensure sustained surveillance. In 2025, four trainings on integrated epizootic surveillance following the One-Health approach have taken place: one each in Bolivia and Ecuador, and two in Colombia. These were conducted in the places where the cases were being detected. They are expanding this to other endemic countries, and plan to maintain these collaborations. They are working closely with PANAFTOSA, the PAHO center for animal health, and trainings are in collaboration with either Fundação Oswaldo Cruz (Fiocruz) or the Ministry of Health in Brazil, because of their extensive experience with epizootic surveillance. They have also been working on the decentralization of molecular detection of arboviruses including YF to remote areas, chiefly in the countries with current cases, especially Colombia, Bolivia and Ecuador.

Global coordination and partnership

In 2025, through combined partners efforts and coordination by the EYE Secretariat, the EYE partnership provided strategic leadership and implementation for global YF prevention and control at a time of increasing complexity and pressure on global health resources, and while preparing for the next phase of YF prevention and control.

Governance was sustained through 11 Programme Management Group (PMG) working sessions and three Leadership Group (LG) meetings. The LG provided strategic oversight on implementation priorities, emerging programme risks, resource constraints, organizational changes among core partners, and planning for the transition and sustainability of YF prevention and control efforts beyond the Strategy’s end date in 2026.

The PMG applied the EYE Strategy vaccine allocation framework for PMVCs to guide decisions on the allocation of more than 55 million YF vaccine doses projected for use in 2026. Taking into account epidemiological risk, programmatic readiness and financing considerations, the PMG approved the allocation of 8.7 million doses to Niger to support the final phases of its nationwide PMVCs. A decision on vaccine allocation for Ethiopia was deferred pending clarification of Gavi co-financing arrangements, while allocations for Gabon and Equatorial Guinea were postponed until financing commitments are confirmed.

Two WHO Information Network for Epidemics (EPI-WIN) webinars were held in June 2025 to review the YF epidemiological situation and response priorities in Africa and the Americas^17,18in preparation for the 8th EYE Annual Partners’ Meeting¹⁹, held on 14-16 October 2025. The meeting brought together partners to review progress and priorities as the Strategy entered the final year of its 10-year implementation period. Discussions focused on closing immunity gaps through strengthened routine immunization and risk-informed vaccination strategies, enhancing surveillance and laboratory capacity, improving preparedness for urban transmission, and ensuring a sustainable and reliable vaccine supply. The meeting also provided an opportunity to discuss the development of the EYE Transition and Sustainability Plan. Core EYE partners, including Gavi, UNICEF and WHO, emphasized the importance of maintaining critical EYE functions beyond 2026 through strengthened country ownership, sustained global and regional coordination, integration with immunization and health security agendas, and alignment with broader global initiatives addressing arboviral diseases under the Global Arbovirus Programme.

Broad partner consultations will be held in 2026 to inform the EYE Transition and Sustainability Framework, and define the way forward for sustaining critical YF functions beyond 2026, in alignment and integration with the Global Arbovirus Programme, IA2030, regional agendas and other relevant initiatives.