Cholera preparedness for South African travellers and healthcare workers 

The most recent bulletin posted by the World Health Organization’s African regional office reports ongoing cholera outbreaks in seven African countries, including Zimbabwe, Angola, Tanzania, Cameroon, Niger, Nigeria and the Democratic Republic of Congo.

The outbreak in Zimbabwe continues, with 10 443 suspected cases (including 59 deaths) reported between 4 September and 1 December 2018. Although case numbers in Harare city are declining, new foci of cases have emerged in other districts and nine of ten provinces have reported cases.

There have been four laboratory-confirmed cases of cholera in South Africa since the Zimbabwean outbreak began. In October, two cases were diagnosed in Gauteng Province (a traveller who returned from Zimbabwe, and her spouse). During November, two cases were diagnosed in Limpopo Province; one case-patient reported recent travel to Zimbabwe, but no relevant travel history or overt epidemiological link could be established for the second case.

Travellers to areas affected by cholera outbreaks should observe good hand hygiene and food preparation practices. Wash hands with soap and water after going to the toilet and changing nappies, before cooking, and before eating.  Wash fruits and vegetables with clean water before eating. Cook food thoroughly, and keep it at safe temperatures. Travellers may use the following measures to ensure safe water:

  1. Boiling: Place water in a clean container and boil it for at least 5 minutes.
  2. Bleach: Add 1 teaspoon of household bleach (containing 5% chlorine) to 20-25 litres of water. Leave it to stand (in a clean, closed container) for at least half an hour before use.
  3. Water purification tablets: These can be bought at your local pharmacy. Follow the instructions on the packaging.
  4. Store safe water in a clean, closed container. Use a clean cup each time to scoop water from the container, or pour water directly from the container when you need it.

Healthcare workers countrywide should suspect cholera in a person of any age presenting with acute onset of watery diarrhoea (with or without dehydration), especially if there is a history of recent travel to/from Zimbabwe or other countries reporting cholera outbreaks

All suspected cholera cases must immediately be notified to relevant Department of Health officials. Healthcare workers should ensure that stools or rectal swab specimens are collected from all suspected cholera cases. Specimens should be sent in Cary-Blair transport medium to the laboratory with a specific request for cholera testing. Healthcare facilities and laboratories should have adequate resources for specimen collection, laboratory testing, and management of cases. The public, especially those living in close proximity to the Zimbabwean border, are encouraged to use safe water and practice good hygiene to reduce the risk of cholera and other diarrhoeal diseases. Healthcare workers are referred to the document ‘Cholera alert for Health Care workers’ and other material on the NICD website:, Diseases A-Z, under ‘Cholera’

Diseases A-Z Index



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