**1. Introduction**

In mid-March 2019, Tropical Cyclone Idai from category 4 hit Mozambique, devastating the port city of Beira and surrounding areas, following torrential rains and strong winds, causing massive flooding and leaving entire communities submerged [1–3]. It has damaged supplies, cut off clean water and sanitary facilities, and destroyed different infrastructures including schools, hospitals, houses (239,731), roads, rails, disrupting regional trade, and supplies of fuel, wheat, medicines, and other goods, even from neighbor countries such as Zimbabwe and Malawi [3–5].

Thousands of displaced people were sheltering in 136 accommodation sites, including schools, across Sofala, Manica, Zambezia, and Tete, as reported by the National Institute of Disaster Management (INGC) [4, 6, 7].

Idai caused a range of public health consequences, including mortality (598 confirmed deaths until 02 April 2019), injury, and infections [8, 9] due to waterborne and vector-borne diseases including cholera, malaria, and measles, and more than half of affected people are children [2, 10, 11]. Two weeks after Cyclone Idai's landfall, the index of cholera was confirmed in Mozambique with the death of five

people. After the Ministry of Health declared a cholera outbreak on 27 March, 4979 cases and six deaths were confirmed [1, 3, 5, 8, 12].

Cholera is an acute, secretory diarrhea caused by strains of the Gram-negative bacterium *Vibrio cholerae* that occurs in both endemic and epidemic patterns, presenting symptoms like watery diarrhea, rice-water stools, fishy odor to stools, vomiting, rapid heart rate, loss of skin elasticity, dry mucous membranes, and low blood pressure. This bacterium is usually found in food or water contaminated by stools from a person with the infection, and, if untreated, the fatality rate can be as high as 30–50%, but with rehydration and electrolyte replacement, the death rate decrease to 1% [8, 13].

Environmental factors play an important role in the epidemiology of cholera. The flooding and displacement of people has increased the risk of cholera because many of them spent days without accessing safe water supplies, resorting to drink the floodwaters. There are some videos of children playing with the same water that unfortunately were strewn bodies of humans and animals. Beyond that, menstruated women are also susceptible to waterborne diseases due to the use of unsafe water to wash their clothes, during the bath or while collecting water to prepare food [1, 8, 14–16].

Idai survivors received supplies to purify their drinking water, food supplies, and items such as soap, nappies, towels, and blankets, to stop spreading cholera. The Mozambican Ministry of Health (MISAU), World Health Organization (WHO), Cooperative for Assistance and Relief Everywhere (CARE), and other NGOs worked in setting up treatment centers and clinics, as well as helping to run a massive campaign, where 800,000 doses of oral cholera vaccines were distributed and dispensed [2, 4, 10]. This paper aims to summarize the status of the outbreak of cholera in Mozambique due to the deadliest storm Cyclone Idai.
