South Africa: Diphtheria situational report (week 37 of 2026)

Between 29 December 2025 and 13 September 2026, 39 confirmed cases of respiratory diphtheria and 10 asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. Most confirmed cases were reported from the Western Cape (85%; 33/39), followed by Limpopo (10%; 4/39) and Gauteng (5%; 2/39). Asymptomatic carriers were reported from the Western Cape (80%; 8/10) and Limpopo (20%; 2/10). Five probable cases were reported from Limpopo.

Highlights:

• Since the last situational report (week 36, 2026), the following updates are included in this report
  o One new laboratory-confirmed case of toxigenic diphtheria from the Western Cape.
  o No new asymptomatic carriers of toxigenic C. diphtheriae.
• Appropriate public health responses were initiated for all suspected and confirmed cases

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

Distributed by APO Group on behalf of National Institute for Communicable Diseases, South Africa (NICD).

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