South Africa: 2025+ Diphtheria

[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-8-of-2025/


Diphtheria Situational Report (Week 8 Of 2025)

27 February , 2025

Between 1 January 2024 and 23 February 2025, 29 confirmed cases of respiratory diphtheria and 33 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed cases and carriers (95%, 59/62) were from the Western Cape, comprising 27 respiratory diphtheria cases and 32 asymptomatic carriers. The median age of cases of confirmed respiratory diphtheria was 28 years (range: 3–67 years), with 75% (22/29) aged over 18 years and the case-fatality ratio was 21% (6/29).
Highlights:

Since the last situational report (week 7), the following updates are included in this report:
o 3 new laboratory-confirmed cases of toxigenic respiratory diphtheria from the Western Cape.
o 6 asymptomatic carriers of toxigenic C. diphtheriae from the Western Cape.
Appropriate public health responses have been initiated for each case...

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https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates

 

[Shiloh]

Source: https://centralnews.co.za/diphtheri...cination-checks-amid-rising-cases/#diphtheria

Diphtheria Outbreak in South Africa: NICD Urges Vaccination Checks Amid Rising Cases
March 31, 2025​

The National Institute for Communicable Diseases (NICD) has issued an urgent plea to South Africans to verify their children’s vaccination status as diphtheria cases surge across the country. This highly contagious and potentially deadly disease, caused by the bacterium Corynebacterium diphtheriae, has seen a marked increase in 2025, prompting swift action from public health officials.

A Growing Concern: 40 Confirmed Cases Since January 2025

As of 23 March 2025, the NICD has confirmed 40 cases of diphtheria in South Africa. Of these, 19 individuals displayed symptoms, while 21 were asymptomatic carriers identified through contact tracing—a process that tracks and tests people who have been in close contact with infected individuals. The Western Cape has borne the brunt of the outbreak, reporting 15 cases of respiratory diphtheria. Gauteng and Mpumalanga have recorded two and three cases respectively, while Limpopo has one probable case, where the patient exhibited symptoms despite negative laboratory confirmation.

Notably, over 78% of these cases have occurred in adults aged 18 and older, a shift from the perception that diphtheria primarily affects children. Since the beginning of 2024, nine symptomatic patients have succumbed to the illness, resulting in a case fatality rate of 27% (nine out of 33 symptomatic cases). This alarming statistic underscores the severity of the outbreak and the urgent need for action.​..

 

[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-14-of-2025/


Diphtheria Situational Report (Week 14 Of 2025)

11 April , 2025

Between 1 January 2024 and 6 April 2025, 40 confirmed cases of respiratory diphtheria, 1 probable respiratory diphtheria case and 38 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed cases and carriers (83%, 65/78) were from the Western Cape, comprising 30 respiratory diphtheria cases and 35 asymptomatic carriers. The median age of cases of confirmed respiratory diphtheria was 29 years (range: 2–52 years), with 78% (31/40) being 18 years and older. The overall case-fatality ratio (CFR) among probable and confirmed respiratory diphtheria cases was 22% (9/41). Among children and adolescents under 18 years, the CFR was 22% (2/9), compared to 17% (7/32) among adults...


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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-18-of-2025/


Diphtheria Situational Report (Week 18 Of 2025)

9 May , 2025

Between 01 January 2024 and 04 May 2025, 49 confirmed cases of respiratory diphtheria, 1 probable respiratory diphtheria case and 44 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed cases and carriers (71%, 66/93) were from the Western Cape, comprising 31 respiratory diphtheria cases and 35 asymptomatic carriers. The median age for cases of confirmed respiratory diphtheria was 27 years (range: 2–55 years), with 73% (36/49) being 18 years and older. The overall case-fatality ratio (CFR) among probable and confirmed respiratory diphtheria cases was 22% (11/50). Among children and adolescents under 18 years, the CFR was 23% (3/13), compared to 22% (8/37) among adults.

Highlights:

Since the last situational report (week 17), the following updates are included in this report:
o One new laboratory-confirmed case of toxigenic respiratory diphtheria from Mpumalanga.
o Four new asymptomatic carriers of toxigenic C. diphtheriae, two from KwaZulu-Natal and two from Limpopo.
Appropriate public health responses have been initiated for each case...

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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-19-of-2025/


Diphtheria Situational Report (Week 19 Of 2025)

16 May , 2025

Between 01 January 2024 and 11 May 2025, 50 confirmed cases of respiratory diphtheria, 1 probable respiratory diphtheria case, 1 case of cutaneous toxigenic diphtheria, and 44 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed respiratory diphtheria cases (62%, 31/50) were from the Western Cape. The median age for cases of confirmed respiratory diphtheria was 26.5 years (range: 2–55 years), with 72% (36/50) being 18 years and older. The overall case-fatality ratio (CFR) among probable and confirmed respiratory diphtheria cases was 22% (11/51). Among children and adolescents under 18 years, the CFR was 21% (3/14), compared to 22% (8/37) among adults.

Highlights:

Since the last situational report (week 18), the following updates are included in this report:
o One new laboratory-confirmed case of toxigenic respiratory diphtheria from Limpopo.
o No new asymptomatic carriers of toxigenic C. diphtheriae.
o One new laboratory-confirmed toxigenic cutaneous diphtheria from Gauteng.
Appropriate public health responses have been initiated for each case...

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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-31-of-2025/


Diphtheria situational report (week 31 of 2025)

8 August , 2025

Between 1 January 2024 and 3 August 2025, 66 confirmed cases of respiratory diphtheria, 1 probable respiratory diphtheria case, 2 cutaneous toxigenic diphtheria cases and 52 asymptomatic carriers of toxigenic C. diphtheriae was detected during contact tracing, has been identified in South Africa. The majority of confirmed cases and carriers (69%, 83/120) were from the Western Cape, comprising 42 respiratory diphtheria cases, 1 cutaneous toxigenic diphtheria case, and 40 asymptomatic carriers. The median age for cases of confirmed respiratory diphtheria was 25 years (range: 2–55 years), with 70% (46/66) aged ≥ 18 years. The overall case-fatality ratio (CFR) among probable and confirmed respiratory diphtheria cases was 19% (13/67). Among children and adolescents aged < 18 years, the CFR was 20% (4/20), compared to 19% (9/47) among adults.

Highlights:

Since the last situational report (week 30), the following updates are included in this report:
One new laboratory-confirmed case of toxigenic respiratory diphtheria, from the Western Cape.
No new asymptomatic carriers of toxigenic C. diphtheriae.
No new laboratory confirmed cases of toxigenic cutaneous diphtheria.
Appropriate public health responses have been initiated for all suspected and confirmed cases...

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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-36-of-2025/


Diphtheria situational report (week 36 of 2025)

12 September , 2025

Between 1 January 2024 and 7 September 2025, 73 confirmed cases of respiratory diphtheria, 1 probable respiratory diphtheria case, and 2 cutaneous toxigenic diphtheria cases have been identified, as well as 52 asymptomatic carriers of toxigenic C. diphtheriae who were detected during contact tracing. The majority of confirmed cases and carriers (71%, 90/127) were from the Western Cape, comprising 49 respiratory diphtheria cases, 1 cutaneous toxigenic diphtheria case, and 40 asymptomatic carriers. The median age for cases of confirmed respiratory diphtheria was 24 years (range: 2–55 years), with 68% (50/73) aged ≥ 18 years. The overall case-fatality ratio (CFR) among probable and confirmed respiratory diphtheria cases was 20% (15/74). Among children and adolescents aged < 18 years, the CFR was 22% (5/23), compared to 20% (10/51) among adults.

Highlights:

Since the last situational report (week 35), the following updates are included in this report
No new laboratory-confirmed cases of toxigenic respiratory diphtheria
No new asymptomatic carriers of toxigenic C. diphtheriae.
Appropriate public health responses have been initiated for all suspected and confirmed cases...

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[Pathfinder]

Diphtheria - African Region (AFRO)

21 November 2025
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Summary of individual country situations from 1 January to 2 November 2025
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South Africa

From 1 January to 26 October 2025, South Africa has reported 106 diphtheria cases, including 66 laboratory-confirmed respiratory cases, two laboratory-confirmed cutaneous cases, one probable respiratory case, and 37 asymptomatic carriers. The outbreak has affected 5 of 9 provinces (55%), highlighting the involvement of multiple provinces. Most cases and carriers are from the Western Cape, with additional clusters in Limpopo, Gauteng, KwaZulu-Natal, and Mpumalanga. CFR among probable and confirmed respiratory diphtheria cases was 18% (12/67). Most respiratory cases occurred in adults aged 18 years and older. Clusters have been documented among vulnerable populations, including individuals in correctional facilities. According to WUENIC in 2024, the immunization coverage remains below 80% in most provinces (76% for the first DTP dose and 74% for the third), and immunity gaps are widening. The outbreak response is challenged by competing priorities, limited human resources, and limited global supply of diphtheria antitoxin. Detailed case investigations and in-depth risk assessments are needed to guide targeted interventions.
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https://www.who.int/emergencies/disease-outbreak-news/item/DON588

 

[Pathfinder]

Diphtheria situational report (week 49 of 2025)

• 12 December , 2025

Between 1 January 2024 and 7 December 2025, 84 confirmed cases of respiratory diphtheria, 2 probable respiratory diphtheria cases and 59 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed cases and carriers (75%, 107/143) were from the Western Cape, comprising 60 respiratory diphtheria cases and 47 asymptomatic carriers.

In the first half of 2024, two confirmed respiratory diphtheria cases were reported—one in KwaZulu-Natal and one in the Western Cape. Between week 31 (week starting 29 July 2024) and week 37 (week starting 9 September 2024), a cluster of three respiratory diphtheria cases and seven asymptomatic carriers was identified in a school-linked community in the Western Sub-District of Cape Town.

Highlights:

• Since the last situational report (week 48), the following updates are included in this report:
  o Three new laboratory-confirmed cases of toxigenic respiratory diphtheria from the Western Cape.
  o Three new asymptomatic carriers of toxigenic C. diphtheria from the Western Cape.
• Appropriate public health responses have been 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.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE
​https://www.nicd.ac.za/diphtheria-situational-report-week-49-of-2025/

 

[Shiloh]

Source: https://iol.co.za/capetimes/news/20...-emerges-as-epicentre-of-diphtheria-outbreak/

Western Cape emerges as epicentre of diphtheria outbreak
Lilita Gcwabe|Published 6 hours ago​

The Western Cape has emerged as the epicentre of a diphtheria outbreak, carrying a disproportionate share of cases, clusters and deaths compared to the rest of the country.

This is according to the latest situational report by the National Institute for Communicable Diseases (NICD), which shows 91 laboratory-confirmed cases of toxigenic respiratory diphtheria have been recorded nationally between January 2024 and January 18, 2026.

Of these, 67 cases, nearly three quarters were reported in the Western Cape, exceeding numbers seen in other provinces such as Limpopo (9), Mpumalanga (8), Gauteng (4) and KwaZulu-Natal (3).

The NICD notes that "the majority of confirmed cases and carriers (76%) are from the Western Cape."

Since late 2024, 25 diphtheria clusters have been identified across South Africa, 15 of them in the Western Cape, mainly in Cape Town. These clusters have occurred repeatedly in households, communities and correctional facilities, indicating persistent transmission rather than isolated flare-ups. Limpopo has recorded five clusters, Gauteng two, and KwaZulu-Natal and Mpumalanga one each.​..

 

[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-8-of-2026/


Diphtheria situational report (week 8 of 2026)

27 February , 2026

Between 1 January 2024 and 22 February 2026, 93 confirmed cases of respiratory diphtheria, two probable respiratory diphtheria cases and 62 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed cases and carriers (77%, 119/155) were from the Western Cape, comprising 69 respiratory diphtheria cases and 50 asymptomatic carriers.

Highlights:

Since the last situational report (week 7, 2026), the following updates are included in this report:
No new laboratory-confirmed case of toxigenic diphtheria.
No new asymptomatic carriers of toxigenic C. diphtheriae...

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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-17-of-2026/


Diphtheria situational report (week 17 of 2026)
30 April , 2026

Between 29 December 2025 and 26 April 2026, 20 confirmed cases of respiratory diphtheria and four asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. All respiratory cases and carriers were from the Western Cape.

Highlights:

Since the last situational report (week 16, 2026), the following updates are included in this report:
One new laboratory-confirmed case of toxigenic diphtheria was reported in week 16 from the Western Cape.
No new asymptomatic carriers of toxigenic C. diphtheriae.
Appropriate public health responses were initiated for all suspected and confirmed cases...


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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-21-of-2026/


Diphtheria situational report (week 21 of 2026)
29 May , 2026

Between 29 December 2025 and 24 May 2026, 23 confirmed cases of respiratory diphtheria and seven asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. All respiratory cases and carriers were from the Western Cape.

Highlights:

Since the last situational report (week 20, 2026), the following updates are included in this report:
o No new laboratory-confirmed cases of toxigenic diphtheria.
o No new asymptomatic carriers of toxigenic C. diphtheriae...

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Diphtheria situational report (week 23 of 2026)

• 12 June , 2026

Between 29 December 2025 and 7 June 2026, 27 confirmed cases of respiratory diphtheria and seven asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. The majority of confirmed cases (96%, 26/27) and all carriers were from the Western Cape, while one of the 27 confirmed cases (4%) was from Gauteng.
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Highlights:

• Since the last situational report (week 22, 2026), the following updates are included in this report:
  • One new laboratory-confirmed case of toxigenic diphtheria from Gauteng.
  • No new asymptomatic carriers of toxigenic C. diphtheriae.
• Appropriate public health responses were initiated for all suspected and confirmed cases.

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READ THE FULL UPDATE HERE​

https://www.nicd.ac.za/diphtheria-situational-report-week-23-of-2026/
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[Shiloh]

Source: https://www.nicd.ac.za/diphtheria-situational-report-week-25-of-2026/


Diphtheria situational report (week 25 of 2026)
29 June , 2026

Between 29 December 2025 and 21 June 2026, 32 confirmed cases of respiratory diphtheria, five probable cases and seven asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. The majority of confirmed cases (91%; 29/32) and all carriers were from the Western Cape, while two of the remaining confirmed cases (6%, 2/32) were from Limpopo and one (3%, 1/32) was from Gauteng.

Highlights:

Since the last situational report (week 24, 2026), the following updates are included in this report:
o Two new laboratory-confirmed cases of toxigenic diphtheria from Limpopo.
o Five new probable cases of toxigenic diphtheria of whom two died from Limpopo.
o No new asymptomatic carriers of toxigenic C. diphtheriae.
Appropriate public health responses were initiated for all suspected and confirmed cases...

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