The World Health Organization says the global spread of cholera, particularly in Africa, has worsened since its last assessment in early February.
Four new countries now report cases of the disease - Tanzania, Zambia, Zimbabwe and South Africa - making 24 countries in total.
Widespread outbreaks remain active in Malawi and Mozambique, and in the Horn of Africa.
Shortages of oral cholera vaccine and overstretched health services mean there is limited capacity to respond to the worsening situation