WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 46: 13- 19 November 2023
Data as reported by: 17:00; 19 November 2023
...
South Africa
Diphtheria
9 Cases
1 Deaths
11.1% CFR
EVENT DESCRIPTION
On 9 November 2023, the South African Minister of
Health announced a Diphtheria outbreak at Pollsmoor
Correctional Centre in the Western Cape Province.
On 28 October 2023, a 19-year-old male inmate at the
correctional facility developed symptoms of toxigenic
diphtheria, including. fever, difficulty swallowing, sore
throat, swollen neck, and shortness of breath. He
was referred to a local hospital for further evaluation
and was found to have tonsillitis, the presence of a
pseudomembrane, and subsequently developed renal
and cardiac complications.
Throat swabs were collected the same day and
submitted to the local National Health Laboratory Service
and the National Institute for Communicable Diseases
for confirmatory testing. The results were positive for
diphtheria, on 2 November 2023. The case died on 5
November 2023, despite receiving diphtheria antitoxin
on 2 November 2023.
As of 8 November 2023, a total of 74 contacts, including
55 inmates, 13 correctional staff, and six low-risk
contacts (including hospital staff and patients) have
been identified and were subjected to throat swabs
collection for laboratory testing. Eight inmates (10.8%)
tested positive for diphtheria, with two (25.0%) exhibiting
mild symptoms and six (75.0%) being asymptomatic.
Two staff members exhibited symptoms compatible with
diphtheria and are awaiting laboratory test results. The
age range of the cases was between 18 and 23 years.
Earlier this year, South Africa reported 12 laboratory confirmed cases of
diphtheria in Gauteng, KwaZuluNatal, and Western Cape Provinces,
including seven (58.3%) non-toxigenic and five (41.7%) toxigenic cases.
Of the seven non-toxigenic cases, three (42.9%)
had cutaneous lesions, three (42.9%) presented with
myocarditis and one (14.3%) was asymptomatic.
Almost 80.0% (n=4) of the toxigenic cases had respiratory
diphtheria and only one (20.0%) developed cutaneous
diphtheria.
All cases were reported from the Western Cape Province.
PUBLIC HEALTH ACTIONS
The Western Cape Department of Health initiated
a public health response on 2 November 2023
involving regular meetings with the Western Cape
Department of Correctional Services, National
Department of Health, National Health Laboratory
Service, National Institute for Communicable
Diseases, and other relevant stakeholders.
Contact tracing is being implemented for early
case detection and to control the chain of
transmission in the correctional setting.
Immediate contacts of confirmed cases have
been isolated to prevent further spread of the
disease.
PCR testing are ongoing at the National Institute
for Communicable Diseases with 13 pending
results, so far.
Antibiotic prophylaxis and vaccination were
administered to the identified contacts. A
vaccination campaign is planned by the Western
Cape Department of Health and the Department
of Correctional Services to target all 240 staff and
1200 inmates in the affected cell block.
SITUATION INTERPRETATION
Diphtheria is a vaccine-preventable disease caused
by exotoxin-producing Corynebacterium diphtheriae,
transmitted from person to person through close
physical and respiratory contact. Correctional
facilities are high-risk environments for infectious
disease outbreak including diphtheria.
It is imperative
that all cases be managed in isolation and contacts
should remain under monitoring and in isolation
for the recommended period. Appropriate public
health interventions including vaccination should be
maintained and sustained to control the outbreak.
https://www.afro.who.int/countries/...encies-bulletin-week-46-13-19-november-2023-0
