Between 29 December 2025 and 12 July 2026, 38 confirmed cases of respiratory diphtheria and ten asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. Most confirmed cases were reported from the Western Cape (84%; 32/38), followed by Limpopo (11%; 4/38) and Gauteng. Asymptomatic carriers were reported from the Western Cape (80%; 8/10) and Limpopo (20%; 2/10). Five probable cases were reported from Limpopo.
Highlights:
- Since the last situational report (week 27, 2026), the following updates are included in this report:
o One new laboratory-confirmed case of toxigenic respiratory diphtheria from the Western Cape.
o Three new asymptomatic carriers of toxigenic C. diphtheriae: two from Limpopo and one from the Western Cape. - Appropriate public health responses were initiated for all suspected and confirmed cases.
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.
