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.
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.
