Cholera due to exposure in Europe associated with consumption of holy water from Ethiopia, January to February 2025

In February 2025, public health agencies in Germany and the United Kingdom (UK) reported four cases of domestically acquired cholera caused by consumption of holy water imported from Ethiopia, and a further three cases in travellers to Ethiopia. Multidrugresistant Vibrio cholerae O1, linked to recent outbreaks in Eastern and Middle Africa, was detected in clinical specimens and the holy water. In cholera-endemic regions, visitors should drink potable water and should not bring bottled water back from their travels. In February 2025, the Robert Koch Institute (RKI) in Berlin and the UK Health Security Agency (UKHSA) in London identified seven patients infected with the same multidrug-resistant (MDR) strain of Vibrio cholerae serogroup O1. At least four of the seven cases became infected in Europe. We aimed to review the epidemiology, identify the source and most likely route of transmission and provide recommendations to prevent further infections.