El Nino Southern Oscillation shapes cholera in Africa

Cholera is considered a paradigm for climate-sensitive diseases, yet its relation with El Nino Southern Oscillation (ENSO), the dominant mode of interannual climate variability, remains poorly quantified in Africa where most cholera deaths occur. Using 15 years of surveillance data across 30 African countries and novel statistical and simulation frameworks, we identify five geographically coherent ENSO-cholera teleconnection groups, each characterized by distinct directions, strengths and timing of effects on outbreak occurrence, duration and incidence. For the unfolding major El Nino of 2026-

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