Between 1 January 2024 and 05 October 2025, 77 confirmed cases of respiratory diphtheria, 1 probable respiratory diphtheria case, and 2 cutaneous toxigenic diphtheria cases have been identified, as well as 53 asymptomatic carriers of toxigenic C. diphtheriae who were detected during contact tracing. The majority of confirmed cases and carriers (72%, 95/132) were from the Western Cape, comprising 53 respiratory diphtheria cases, 1 cutaneous toxigenic diphtheria case, and 41 asymptomatic carriers.
Highlights:
- Since the last situational report (week 39), the following updates are included in this report:
- No new laboratory-confirmed case of toxigenic respiratory diphtheria.
- No new asymptomatic carriers of toxigenic C. diphtheriae.
- 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.
