Cholera Outbreak Traced to Holy Water From Ethiopia

A sacred pilgrimage ended up in the toilet for several travelers earlier this year. Health officials in Europe have reported an outbreak of superbug cholera traced back to tainted holy water sourced from Ethiopia.

Health officials in Germany and the UK detailed the strange outbreak in a report published Thursday in the journal Eurosurveillance. At least seven people across both countries were sickened with a multidrug-resistant cholera strain that originated from the Bermel Georgis holy well in Ethiopia. Though several people were hospitalized and some even required intensive care, all of the victims thankfully survived.

Cholera is caused by the bacteria Vibrio cholerae. Though many people infected by cholera bacteria don’t become sick, the infection can sometimes cause severe, even life-threatening diarrhea and vomiting. Improved sanitation has greatly reduced the threat of cholera over time, but it still sickens millions of people a year, and anywhere between 21,000 and 143,000 people die from it annually, according to the World Health Organization.

In recent years, there has been an upswing of cholera across the world, including in parts of Europe. While most cases in Europe are travel-associated (meaning the infection was caught in another country), there have been local outbreaks tied to food and water imported from cholera-stricken areas.

In Ethiopia, an ongoing outbreak of cholera has sickened at least 58,381 people and killed over 700 since August 2022. This past February, a resurgence of cholera struck the Amhara region in Northern Ethiopia, home to the Bermel Georgis holy well. The well—a popular travel site revered for its natural waters said to contain miraculous healing powers—was soon found to be contaminated with cholera, raising the risk of further spread.

According to the report authors, health officials in Germany first caught wind of the outbreak in late February. Three residents had developed cholera earlier that month, and all had been exposed to the waters of the Bermel Georgis. Two of the residents had brought home holy water stored in a plastic bottle during a trip to Bermel Georgis. When they arrived back home, the two travelers consumed the water and splashed it onto the face of the third person.

Health officials in the UK confirmed four similar cases around that time. Three of the residents recently traveled to the area and a fourth person reported drinking Bermel Georgis water brought home by the third person (a fifth person was also sick with cholera-like symptoms but recovered without being tested). The multidrug-resistant strains of cholera found in the UK patients bore a genetic close resemblance to strains previously found in Africa, further confirming the outbreak’s origin.

Fortunately, the cholera found in these people was still susceptible to at least one frontline antibiotic (standard cholera treatment is providing people fluids, though antibiotics are also used for more serious cases). Six of the seven people were hospitalized, with two needing intensive care at one point, but all eventually recovered.

Clusters of cholera extending into Europe from Ethiopia are unusual, according to the researchers, though holy water consumption has been identified as a possible risk factor for cholera in the African country. It’s likely that the water had to be heavily contaminated with bacteria for it to still be infectious after the long journey back to Europe. Despite the unusual nature of this outbreak, officials say there are practical steps that travelers can take to limit their risk of catching cholera.

“Travelers eating food cultivated in areas where cholera is endemic should follow the ‘cook it, peel it, or forget it’ rule, ensure drinking water is bottled or boiled, and refrain from transporting food and/or water across borders,” they wrote. “In the case of holy water, purely external use would reduce gastrointestinal infection risks.”