Between 1 January 2024 and 25 January 2026, 92 confirmed cases of respiratory diphtheria, 2 probable respiratory diphtheria cases and 62 asymptomatic carriers of toxigenic C. diphtheriae, detected during contact tracing, have been identified in South Africa. The majority of confirmed cases and carriers (76%, 118/154) were from the Western Cape, comprising 68 respiratory diphtheria cases and 50 asymptomatic carriers.
Highlights:
- Since the last situational report (week 3, 2026), the following updates are included in this report:
- One new laboratory-confirmed case of toxigenic respiratory diphtheria from the Western Cape.
- One new asymptomatic carrier of toxigenic C. diphtheriae from the Western Cape.
- Appropriate public health responses have been 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.
