Between 1 January 2024 and 16 March 2025, 33 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 and probable cases and carriers (89%, 64/72) were from the Western Cape, comprising 28 respiratory diphtheria cases and 36 asymptomatic carriers. The median age of cases of confirmed respiratory diphtheria was 30 years (range: 3–51 years), with 79% (26/33) aged over 18 years and the case-fatality ratio among confirmed and probable cases was 26% (9/34).
Highlights:
- Since the last situational report (week 10), the following updates are included in this report:
o Two new laboratory-confirmed cases of toxigenic respiratory diphtheria, both from Mpumalanga, one of whom died
o One probable case from Limpopo who died and was linked to a case in Mpumalanga
o No asymptomatic carriers of toxigenic C. diphtheriae - Appropriate public health responses have been initiated for each case
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 (Figure 2) – 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.
