Highlights:

• Since the last situational report (week 40, 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.
• 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.

READ THE FULL UPDATE HERE

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 08 October 2026) from 29 December 2025 to 04 October 2026 (ISO Weeks 1-40) indicated that 6186 laboratory-confirmed measles cases were reported nationally (Table 1). Since the previous report (ISO week 39), 553 additional cases were detected.  Northern Cape reported the highest number of new cases (124), followed by Free State (87), North West (79), Gauteng (60), Western Cape (57), Limpopo (54), KwaZulu-Natal (45), Mpumalanga (40), and Eastern Cape (7).

Public health interventions

For health professionals

Clinicians and public health officials are urged to strengthen measles and rubella surveillance nationally to improve case reporting, laboratory confirmation, and contact tracing, to support national measles elimination goals. All suspected measles and rubella cases should be investigated promptly, with blood specimens collected for laboratory confirmation, and notification should be completed through the Notifiable Medical Conditions Surveillance System (NMCSS ).

For the public

Public awareness campaigns should be intensified to build trust in vaccines and address hesitancy by engaging with community leaders, healthcare workers, and other stakeholders to promote vaccine acceptance and participation in immunisation activities.

Update on the rubella outbreak in South Africa

Between 29 December 2025 and 04 October 2026 (ISO Weeks 1–40), a total of 845 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (data accessed 08 October 2026). Since the previous report, 250 rubella cases have been reported.

Public health interventions

For health professionals

Rubella is a contagious viral infection that is usually mild but can cause serious complications in pregnancy, resulting in Congenital Rubella Syndrome (CRS) in infants. Health professionals should strengthen surveillance and laboratory confirmation of suspected cases to support national elimination goals.

For the community

Rubella, also known as German measles, spreads easily through coughs and sneezes and can be dangerous for unborn babies if a pregnant woman becomes infected. The best way to prevent rubella is through vaccination with the MR vaccine. This vaccine is given as part of the routine childhood immunisation schedule.

Relevant resources, including the case definition, investigation form, and surveillance results, are available on the NICD measles page and the measles-rubella dashboard.

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 38, 2026), the following updates are included in this report:
  o Four new laboratory-confirmed cases of toxigenic diphtheria, two from the Western Cape and one from Gauteng (week 39), and one from Limpopo (week 38).
  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.

READ THE FULL UPDATE HERE

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 23 September 2026) from 29 December 2025 to 20 September 2026 (ISO Weeks 1-38) indicated that 5,306 laboratory-confirmed measles cases were reported nationally. Since the previous report (ISO week 37), 269 additional cases were detected.

The majority of the additional cases were from samples collected in week 37 due to delays in sample shipments received. Free State reported the highest number of new cases (57), followed by Limpopo (50), Northern Cape (47), KwaZulu-Natal (35), North West (24), Gauteng (20), Mpumalanga (19), Western Cape (15), and Eastern Cape (2).

Public health interventions

For health professionals

Clinicians and public health officials are urged to strengthen measles and rubella surveillance nationally to improve case reporting, laboratory confirmation, and contact tracing, to support national measles elimination goals. All suspected measles and rubella cases should be investigated promptly, with blood specimens collected for laboratory confirmation, and notification should be completed through the Notifiable Medical Conditions Surveillance System (NMCSS ).

For the public

Public awareness campaigns should be intensified to build trust in vaccines and address hesitancy by engaging with community leaders, healthcare workers, and other stakeholders to promote vaccine acceptance and participation in immunisation activities.

Update on the rubella outbreak in South Africa

Between 29 December 2025 and 6 September 2026 (ISO Weeks 1–36), a total of 595 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (Data accessed 23 September 2026). Since the previous report, no additional rubella cases have been reported.

Public health interventions

For health professionals

Rubella is a contagious viral infection that is usually mild but can cause serious complications in pregnancy, resulting in Congenital Rubella Syndrome (CRS) in infants. Health professionals should strengthen surveillance and laboratory confirmation of suspected cases to support national elimination goals.

For the community

Rubella, also known as German measles, spreads easily through coughs and sneezes and can be dangerous for unborn babies if a pregnant woman becomes infected. The best way to prevent rubella is through vaccination with the MR vaccine. This vaccine is given as part of the routine childhood immunisation schedule.

Relevant resources, including the case definition, investigation form, and surveillance results, are available on the NICD measles page and the measles-rubella dashboard.

READ THE FULL UPDATE HERE

RSV is a leading cause of bronchiolitis and lower respiratory tract infections (LRTI) in young children and can cause severe illness in infants. It is highly contagious, spreads primarily through respiratory droplets, and reinfections can occur. Risk factors for severe RSV-associated disease include prematurity, congenital heart disease, chronic lung disease of prematurity, neurological conditions, immunodeficiency, lack of breastfeeding, HIV infection or exposure, and age under 6 months.

Over the past decade, excluding the COVID-19 pandemic years 2020 and 2021, the RSV season in South Africa has typically begun around mid-February, with onset ranging from late January to late February. During the past 2 years, the start of the season was delayed compared to previous seasons. The 2026 season began in week 11 (week starting 9 March 2026), when the RSV detection rate among children aged <5 years enrolled in inpatient pneumonia surveillance at public hospitals exceeded the seasonal threshold and was sustained above the threshold for two consecutive weeks (Figure 1). RSV activity subsequently increased and peaked in week 25 (week starting 15 June 2026) at the moderate activity level, with the season ending in week 34 (week starting 17 August 2026).

Message to clinicians

Although the 2026 RSV season has ended, sporadic RSV infections may continue to occur outside the defined seasonal period. Clinicians should therefore continue to consider RSV in the differential diagnosis of patients presenting with respiratory illness, particularly young infants and children at increased risk of severe disease.

Prevention of RSV

Measures to reduce the spread of RSV and other respiratory viruses remain important throughout the year, even after the defined RSV season has ended. These include avoiding close contact with people who are ill, regular handwashing, avoiding touching the mouth, eyes and nose, and covering coughs and sneezes appropriately. Individuals experiencing respiratory symptoms should stay at home where possible to reduce transmission to others.

During the RSV season, additional RSV-specific preventive options are available for groups at increased risk of severe disease. Palivizumab, which requires monthly administration during the RSV season, has been available in South Africa for some time, although its high cost may limit its use. Long-acting monoclonal antibodies are also available in the private sector for infant protection, while maternal RSV vaccination is available in the private sector to protect infants. Introduction of maternal RSV vaccination into the public sector is being considered but is not currently available. As these interventions are targeted to specific groups and, in some instances, timed in relation to the RSV season, general measures to reduce respiratory virus transmission remain important throughout the year.

Where to find updated data

Weekly reports documenting respiratory pathogen circulation in South Africa, including influenza, RSV, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Bordetella pertussis, are available here.

READ THE FULL UPDATE HERE

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.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 03 September 2026) from 29 December 2025 to 30 August 2026 (ISO Weeks 1-35) indicated that 4188 laboratory-confirmed measles cases were reported nationally. Since the previous report (ISO week 34), 125 additional cases were detected. Limpopo reported the highest number of new cases (22), followed by Gauteng (21), Northern Cape (21), KwaZulu-Natal (17), Free State (16), Western Cape (9), North West (8), Eastern Cape (6), and Mpumalanga (5).

Public health interventions

For health professionals

Clinicians and public health officials are urged to strengthen measles and rubella surveillance nationally to improve case reporting, laboratory confirmation, and contact tracing, to support national measles elimination goals. All suspected measles and rubella cases should be investigated promptly, with blood specimens collected for laboratory confirmation, and notification should be completed through the Notifiable Medical Conditions Surveillance System (NMCSS ).

For the public

Public awareness campaigns should be intensified to build trust in vaccines and address hesitancy by engaging with community leaders, healthcare workers, and other stakeholders to promote vaccine acceptance and participation in immunisation activities.

Update on the rubella outbreak in South Africa

Between 29 December 2025 and 30 August 2026 (ISO Weeks 1–35), a total of 506 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (data accessed 3 September 2026). Since the previous report, 10 new rubella cases have been reported. During the reporting period, most cases occurred among children aged 1–14 years (381/506; 75.3%).

Public health interventions

For health professionals

Rubella is a contagious viral infection that is usually mild but can cause serious complications in pregnancy, resulting in Congenital Rubella Syndrome (CRS) in infants. Health professionals should strengthen surveillance and laboratory confirmation of suspected cases to support national elimination goals.

For the community

Rubella, also known as German measles, spreads easily through coughs and sneezes and can be dangerous for unborn babies if a pregnant woman becomes infected. The best way to prevent rubella is through vaccination with the MR vaccine. This vaccine is given as part of the routine childhood immunisation schedule.

Relevant resources, including the case definition, investigation form, and surveillance results, are available on the NICD measles page and the measles-rubella dashboard.

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 34, 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.
• 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.

READ THE FULL UPDATE HERE

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 20 August 2026) from 29 December 2025 to 16 August 2026 (ISO Weeks 1-33) indicated that 3,891 laboratory-confirmed measles cases were reported nationally. Since the previous report (ISO week 32), 144 additional cases were detected. The Western Cape reported the highest number of new cases (38), followed by Limpopo (30), Northern Cape (20), Gauteng (16), Free State (14), Mpumalanga (12), North West (7), KwaZulu-Natal (5), and Eastern Cape (2).

Public health interventions

For health professionals

Clinicians and public health officials are urged to strengthen measles and rubella surveillance nationally to improve case reporting, laboratory confirmation, and contact tracing, to support national measles elimination goals. All suspected measles and rubella cases should be investigated promptly, with blood specimens collected for laboratory confirmation, and notification should be completed through the Notifiable Medical Conditions Surveillance System (NMCSS ).

For the public

Public awareness campaigns should be intensified to build trust in vaccines and address hesitancy by engaging with community leaders, healthcare workers, and other stakeholders to promote vaccine acceptance and participation in immunisation activities.

Update on the rubella outbreak in South Africa

Between 29 December 2025 and 16 August 2026 (ISO Weeks 1–33), a total of 480 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (data accessed 20 August 2026). Since the previous report, 37 new rubella cases have been reported. During the reporting period, most cases occurred among children aged 1–14 years (384/480; 79.0%).

Public health interventions

For health professionals

Rubella is a contagious viral infection that is usually mild but can cause serious complications in pregnancy, resulting in Congenital Rubella Syndrome (CRS) in infants. Health professionals should strengthen surveillance and laboratory confirmation of suspected cases to support national elimination goals.

For the community

Rubella, also known as German measles, spreads easily through coughs and sneezes and can be dangerous for unborn babies if a pregnant woman becomes infected. The best way to prevent rubella is through vaccination with the MR vaccine. This vaccine is given as part of the routine childhood immunisation schedule.

Relevant resources, including the case definition, investigation form, and surveillance results, are available on the NICD measles page and the measles-rubella dashboard.

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 32, 2026), the following updates are included in this report:
  o One new laboratory-confirmed case of toxigenic cutaneous diphtheria from Gauteng.
  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.

READ THE FULL UPDATE HERE