Ethiopian holy water linked to Europe-based patients with multi drug-resistant type of cholera

Vibrio cholerae strain of cholera believed to be linked to contaminated holy water

Use of holy water from Ethiopia has led to the identification of patients with cholera in both Germany and the United Kingdom succumbing to the multidrug-resistant Vibrio cholerae strain, in a study published in Eurosurveillance. Four patients are thought to have been infected through imported water, while three other patients had travelled to Ethiopia. Researchers detected multidrug-resistant Vibrio cholerae O1 in clinical specimens – and the holy water itself – linked to other recent disease clusters in eastern and Middle Africa.

Ethiopia has had an ongoing cholera outbreak since 2022. By 9 February 2025, a total of 58,381 cases and 726 deaths had been officially reported. One identified contamination source is the holy well of Bermel Giorgis, located in the Quara district of the Amhara region of Ethiopia, which is situated in the northwest region of the African country where it is bordered by Sudan.

It is a site of Christian pilgrimage and attracts visitors from across the world being named for Saint George. Typically, pilgrims will consume or bathe in the water for its healing properties and often also take quantities of the water home with them.

In Germany, three people were reported on 25 February 2025, via the European surveillance portal for infectious diseases – EpiPulse – as suspected of having contracted cholera. All patients were identified as being of Ethiopian ethnicity. Two had travelled to Ethiopia in January and acquired a small plastic bottle containing water from the Bermel Giorgis holy well.

Once back in Germany, both people consumed some of the water. A third person received splashes of water to the face, including the lips, and possibly ingested some of it. In early February, all three individuals developed diarrhoea and vomiting, and were hospitalised. One patient was admitted to the intensive care ward but all have since recovered.

In the UK, the Health Security Agency (UKHSA) identified four patients, among whom two said they had recently travelled to Ethiopia to the Amhara region, and one specifically mentioning a nine-day trip to Bermel Giorgis. A third patient had not travelled to Ethiopia but reported that they had drank holy water from the well that had been brought back by the fourth patient, who had also become ill after consuming the water in the UK. Three were admitted to hospital with one needing treatment in intensive care. Another person who had also travelled to Ethiopia had some symptoms of cholera but was not tested and recovered without medical treatment.

Genetic analysis of the bacteria in stool samples from the UK cases showed that they belonged to a multidrug-resistant clade – a group of organisms that hare a single ancestor – of Vibrio cholerae O1 (V. cholerae) which had previously been linked to outbreaks of cholera in Kenya and sub-Saharan Africa, as well as in eastern and Middle Africa.

Ethiopian V. cholerae isolates which were sequenced in Germany and the UK had the same antimicrobial resistance profile as the bacteria samples obtained recently from UK residents. The similarities in these isolates, as well as among the Kenyan and sub-Saharan African strains in England, indicated that multidrug-resistant V. cholerae O1 circulating in Africa was transmitted into Europe.

The spread of cases into Europe related to a cholera outbreak in Africa is unusual. Consumption of holy water is a known risk factor for cholera in Ethiopia. Public authorities have taken preventive measures during religious holidays, and the Ethiopian National Guideline for Cholera Surveillance and Outbreak response has also attempted to address the associated risks.

While genetic data have improved surveillance and identification of cases, prevention will require investment in water systems, hygiene and sanitation, and education.

For further reading please visit: 10.2807/1560-7917.ES.2025.30.14.2500234