Between 29 December 2025 and 5 July 2026, 37 confirmed cases of respiratory diphtheria and seven asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. Most confirmed cases (84%; 31/37) and all carriers were from the Western Cape, while four of the remaining confirmed cases (11%, 4/37) were from Limpopo and two (5%, 2/37) were from Gauteng.
Highlights:
- Since the last situational report (week 26, 2026), the following updates are included in this report:
o Four new laboratory-confirmed cases of toxigenic diphtheria: two from Limpopo, one from Gauteng and one 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.
To access previous diphtheria situational reports, click here.
