Highlights:

• Since the last situational report (week 40, 2026), the following updates are included in this report
  o No new laboratory-confirmed cases of toxigenic diphtheria.
  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.

READ THE FULL UPDATE HERE

The activation brought together local road traffic services, community health workers, Wits Infectious Diseases and Oncology Research Institute, the Tembisa Hospital NHLS laboratory, and other partners, with support from the Democratic Nursing Organisation of South Africa, the NICD, and the Ekurhuleni Health District. The Wits Reproductive Health and HIV Institute and Ekurhuleni Health District provided fully equipped mobile clinics, clinical materials, and staff. As hosts, the Tembisa Local Taxi Association provided essential on-site support, including sanitary facilities, security, and mobilisation of taxi operators.

The awareness drive, which was organised by NCR began with a community walk, where engagement and information were shared with community members. The awareness drive connected commuters, taxi drivers, and residents and shared information about cancer screening and referral support.

Public engagement continued throughout the day through health talks and one-on-one discussions covering cancer warning signs, the importance of early healthcare-seeking, and screening. About 100 people accessed one or more health-screening services, including blood pressure and blood glucose checks. Additional services included prostate-specific antigen (PSA) blood draws, pap smears, HIV screening, and family-planning services.

The awareness drive led to further collaboration between cancer surveillance, research, healthcare, and community partners. The strength of these connections was evident when the team was invited to take part in another community walk in Tembisa in September, extending the engagement beyond the original activation.

By taking cancer information and screening services into a busy community setting, the activation made these resources more accessible to people where they live, work, and travel. It showed how bringing research, surveillance, healthcare services, and community partners together can turn cancer awareness into meaningful, practical engagement.

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 08 October 2026) from 29 December 2025 to 04 October 2026 (ISO Weeks 1-40) indicated that 6186 laboratory-confirmed measles cases were reported nationally (Table 1). Since the previous report (ISO week 39), 553 additional cases were detected.  Northern Cape reported the highest number of new cases (124), followed by Free State (87), North West (79), Gauteng (60), Western Cape (57), Limpopo (54), KwaZulu-Natal (45), Mpumalanga (40), and Eastern Cape (7).

Public health interventions

For health professionals

Clinicians and public health officials are urged to strengthen measles and rubella surveillance nationally to improve case reporting, laboratory confirmation, and contact tracing, to support national measles elimination goals. All suspected measles and rubella cases should be investigated promptly, with blood specimens collected for laboratory confirmation, and notification should be completed through the Notifiable Medical Conditions Surveillance System (NMCSS ).

For the public

Public awareness campaigns should be intensified to build trust in vaccines and address hesitancy by engaging with community leaders, healthcare workers, and other stakeholders to promote vaccine acceptance and participation in immunisation activities.

Update on the rubella outbreak in South Africa

Between 29 December 2025 and 04 October 2026 (ISO Weeks 1–40), a total of 845 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (data accessed 08 October 2026). Since the previous report, 250 rubella cases have been reported.

Public health interventions

For health professionals

Rubella is a contagious viral infection that is usually mild but can cause serious complications in pregnancy, resulting in Congenital Rubella Syndrome (CRS) in infants. Health professionals should strengthen surveillance and laboratory confirmation of suspected cases to support national elimination goals.

For the community

Rubella, also known as German measles, spreads easily through coughs and sneezes and can be dangerous for unborn babies if a pregnant woman becomes infected. The best way to prevent rubella is through vaccination with the MR vaccine. This vaccine is given as part of the routine childhood immunisation schedule.

Relevant resources, including the case definition, investigation form, and surveillance results, are available on the NICD measles page and the measles-rubella dashboard.

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 38, 2026), the following updates are included in this report:
  o Four new laboratory-confirmed cases of toxigenic diphtheria, two from the Western Cape and one from Gauteng (week 39), and one from Limpopo (week 38).
  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.

READ THE FULL UPDATE HERE

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 23 September 2026) from 29 December 2025 to 20 September 2026 (ISO Weeks 1-38) indicated that 5,306 laboratory-confirmed measles cases were reported nationally. Since the previous report (ISO week 37), 269 additional cases were detected.

The majority of the additional cases were from samples collected in week 37 due to delays in sample shipments received. Free State reported the highest number of new cases (57), followed by Limpopo (50), Northern Cape (47), KwaZulu-Natal (35), North West (24), Gauteng (20), Mpumalanga (19), Western Cape (15), and Eastern Cape (2).

Public health interventions

For health professionals

Clinicians and public health officials are urged to strengthen measles and rubella surveillance nationally to improve case reporting, laboratory confirmation, and contact tracing, to support national measles elimination goals. All suspected measles and rubella cases should be investigated promptly, with blood specimens collected for laboratory confirmation, and notification should be completed through the Notifiable Medical Conditions Surveillance System (NMCSS ).

For the public

Public awareness campaigns should be intensified to build trust in vaccines and address hesitancy by engaging with community leaders, healthcare workers, and other stakeholders to promote vaccine acceptance and participation in immunisation activities.

Update on the rubella outbreak in South Africa

Between 29 December 2025 and 6 September 2026 (ISO Weeks 1–36), a total of 595 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (Data accessed 23 September 2026). Since the previous report, no additional rubella cases have been reported.

Public health interventions

For health professionals

Rubella is a contagious viral infection that is usually mild but can cause serious complications in pregnancy, resulting in Congenital Rubella Syndrome (CRS) in infants. Health professionals should strengthen surveillance and laboratory confirmation of suspected cases to support national elimination goals.

For the community

Rubella, also known as German measles, spreads easily through coughs and sneezes and can be dangerous for unborn babies if a pregnant woman becomes infected. The best way to prevent rubella is through vaccination with the MR vaccine. This vaccine is given as part of the routine childhood immunisation schedule.

Relevant resources, including the case definition, investigation form, and surveillance results, are available on the NICD measles page and the measles-rubella dashboard.

READ THE FULL UPDATE HERE

RSV is a leading cause of bronchiolitis and lower respiratory tract infections (LRTI) in young children and can cause severe illness in infants. It is highly contagious, spreads primarily through respiratory droplets, and reinfections can occur. Risk factors for severe RSV-associated disease include prematurity, congenital heart disease, chronic lung disease of prematurity, neurological conditions, immunodeficiency, lack of breastfeeding, HIV infection or exposure, and age under 6 months.

Over the past decade, excluding the COVID-19 pandemic years 2020 and 2021, the RSV season in South Africa has typically begun around mid-February, with onset ranging from late January to late February. During the past 2 years, the start of the season was delayed compared to previous seasons. The 2026 season began in week 11 (week starting 9 March 2026), when the RSV detection rate among children aged <5 years enrolled in inpatient pneumonia surveillance at public hospitals exceeded the seasonal threshold and was sustained above the threshold for two consecutive weeks (Figure 1). RSV activity subsequently increased and peaked in week 25 (week starting 15 June 2026) at the moderate activity level, with the season ending in week 34 (week starting 17 August 2026).

Message to clinicians

Although the 2026 RSV season has ended, sporadic RSV infections may continue to occur outside the defined seasonal period. Clinicians should therefore continue to consider RSV in the differential diagnosis of patients presenting with respiratory illness, particularly young infants and children at increased risk of severe disease.

Prevention of RSV

Measures to reduce the spread of RSV and other respiratory viruses remain important throughout the year, even after the defined RSV season has ended. These include avoiding close contact with people who are ill, regular handwashing, avoiding touching the mouth, eyes and nose, and covering coughs and sneezes appropriately. Individuals experiencing respiratory symptoms should stay at home where possible to reduce transmission to others.

During the RSV season, additional RSV-specific preventive options are available for groups at increased risk of severe disease. Palivizumab, which requires monthly administration during the RSV season, has been available in South Africa for some time, although its high cost may limit its use. Long-acting monoclonal antibodies are also available in the private sector for infant protection, while maternal RSV vaccination is available in the private sector to protect infants. Introduction of maternal RSV vaccination into the public sector is being considered but is not currently available. As these interventions are targeted to specific groups and, in some instances, timed in relation to the RSV season, general measures to reduce respiratory virus transmission remain important throughout the year.

Where to find updated data

Weekly reports documenting respiratory pathogen circulation in South Africa, including influenza, RSV, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Bordetella pertussis, are available here.

READ THE FULL UPDATE HERE

The majority (15) of these cases were reported in the Western Cape, City of Cape Town in particular, 3 in Gauteng and 1 in KwaZulu-Natal. Of concern is that 13 of the total cases were recorded between 13 August and 17 September, which suggests a rapid local transmission of this preventable viral infection. All cases/patients range in age from 23 to 50 years, with a median age of 36.5 years, and 18 of them are males with only 1 female.

One of the most recent cases involved an individual who travelled to Spain earlier this month and returned to South Africa on 14 September. This person underwent testing in Spain after being informed of his probable case status. South African health authorities are in are contact with the Spanish counterparts regarding laboratory test results of the individual to confirm his mpox status.

Mpox cases may present in any person who was in close contact with someone who tested positive for the virus in the last few days (up to 21 days) and will present by displaying similar symptoms.

The importance of continued surveillance, early detection, and public cooperation cannot be overemphasised in preventing further transmission. Mpox is a viral disease that can affect anyone regardless of race, gender, sexual orientation and socioeconomic status. Members of the public are reminded of mpox symptoms which include fever, headache, muscle aches, back pain, fatigue and rash or skin lesions that may appear on the face, hands, feet, genitals or other body parts. Typically, the skin lesions start as flat red spots before progressing to bumps, followed by fluid-filled blisters, then pus filled bumps and eruptions into crusted scabs.

The symptoms usually appear within 6 to 13 days after exposure but can range from 5 to 21 days. Therefore, anyone experiencing these symptoms, particularly if they have had close contact with a confirmed case or a suspected case, should seek medical attention immediately and avoid close contact with others.

Mpox is transmitted mainly through close physical contact with an infected person, including skin-to-skin contact with the rash or lesions, and contact with contaminated materials such as bedding, clothing, or towels used by an infected person.

Mpox-positive persons can also transmit the virus through respiratory droplets during prolonged face-to-face contact, uncovered coughing or sneezing. Vigilance remains essential, particularly in households, healthcare settings and among close social networks. Hand hygiene through frequent washing or use of sanitisers is one of the effective methods to prevent the spread of the virus.

The government, through the support of the World Health Organization, has secured limited doses of mpox vaccines (MVA-BN) and treatment (Tecovirimat) as part of its outbreak response strategy to disrupt local transmission. The health authorities will decide where and how to use these does to contain outbreaks. Vaccination should be accompanied by continued adherence to preventive measures.

Individuals and communities are urged to support those diagnosed with mpox and those suspected of being infected with the virus, because stigma and discrimination have the potential to undermine an outbreak response by deterring people from seeking medical care.

READ THE FULL MEDIA STATEMENT HERE

Highlights:

• Since the last situational report (week 36, 2026), the following updates are included in this report
  o One new laboratory-confirmed case of toxigenic diphtheria from the Western Cape.
  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.

READ THE FULL UPDATE HERE

Published on Monday, 14 September 2026 in Nature Microbiology, the researchers also found that older adults and young children are more vulnerable during periods of high air pollution, and that improving air quality could lower disease risk. They also suggest that understanding what type of bacterial strains are circulating and how environmental factors shape infection rates could inform future public health policies, protect those most at risk, and prepare hospitals for outbreaks.

S. pneumoniae is found in the respiratory microbiome, the collection of microbes that live in the human nose and throat, in almost 20 per cent of adults globally1. While many adults and children carry the bacteria without any symptoms, when S. pneumoniae gets into the lower respiratory tract or bloodstream, it can lead to invasive pneumococcal disease (IPD).

IPD includes bacterial sepsis, pneumonia and meningitis. It is a major cause of disease and death globally and often peaks during colder months. In South Africa, there were over 1800 reported cases of IPD in 20223, and in England, the UK Health Security Agency reports that there are more than 5,000 cases per year, particularly impacting children under the age of five, people over 65 years old, and those with underlying conditions. There are currently over 100 different serotypes, which are specific subtypes of S. pneumoniae.

While it is known that different subtypes of S. pneumoniae can lead to varying infection rates in different populations, important gaps remain in our collective understanding of how things such as humidity, temperature, and air pollution impact the timing of disease, and how risks vary by individual age and bacterial subtype.

The study examined around 59,000 cases of IPD across 19 years from South Africa’s national GERMS-SA surveillance programme.  In South Africa, between 40-60 per cent of children carry S. pneumoniae.

The researchers found that different subtypes of S. pneumoniae responded differently to higher air pollution exposure, noting three subtypes (14, 19A, and 8) were linked to the greatest risk of IPD following exposure.

Professor Anne von Gottberg, co-senior author at the NICD, said: “Invasive pneumococcal diseases are a significant public health issue in South Africa and globally. This research adds to the ongoing evidence that air quality greatly impacts our health and shows that it has different effects depending on the strain of bacteria that is found in an area. We need to focus on monitoring and improving air quality in areas with high disease risk to prevent or reduce some of these infections.”

Professor Rachel Lowe, co-senior author at the Barcelona Supercomputing Center and the Catalan Institution for Research & Advanced Studies, said: “Climate change and rapid urbanisation are fundamentally altering the environmental conditions that influence risk of infectious disease. By linking long-term climate and air quality monitoring with health outcomes, this work highlights how shifting environmental patterns can amplify public health risks. Protecting communities most at risk will require cross-sector collaboration and adaptive health strategies that can keep pace with a changing environment.”

Dr Sophie Belman, first author previously at the Wellcome Sanger Institute, and Barcelona Supercomputing Center, currently at Yale School of Public Health, said: “While we found that temperature and air pollution generally increase the risk of invasive pneumococcal diseases, such as bacterial meningitis, our research also suggests that it is the bacterial subtypes a person is carrying that modulate infection rates. The strain of bacteria impacts the timing of disease and who might be more at risk depending on their respiratory microbiome, meaning that the risk is not the same in every situation or for every person. By extending our findings to other parts of the globe, we will better understand who has the highest health risk from environmental exposures, and what factors need to be addressed in different regions, such as improving air quality in cities.”

For enquiries and interview requests, please send a request to: Media@nicd.ac.za.

READ THE FULL MEDIA STATEMENT HERE

As part of these celebrations, the NCR will host a 40th Anniversary Symposium and Gala, which will reflect on four decades of cancer surveillance, highlight the importance of cancer data and surveillance, and look towards the future of cancer prevention and control in South Africa. Cancer remains an important public health challenge, and reliable data is essential to understanding who is affected, which cancers are most common, where the burden is greatest, and how cancer trends change over time.

For 40 years, the NCR has contributed to this evidence base through tracking cancer incidence across South Africa; collecting, analysing and reporting cancer statistics to strengthen understanding of the country’s cancer burden; supporting the Department of Health and other stakeholders in cancer prevention, control and care initiatives; and informing cancer policy and guidelines in South Africa.

The symposium will provide media an opportunity to hear from cancer surveillance experts, gain insight into four decades of cancer data and its impact on public health, and explore the future of cancer surveillance in South Africa.

Members of the media are invited to attend and cover this significant milestone in South Africa’s public health history.

Event details:

• Date: Thursday, 10 September 2026
• Time: 09:00–15:00
• Arrival time: 08:30
• Venue: 1 Modderfontein Road, Sandringham. National Institute for Communicable Diseases (NICD), PRF Auditorium.

READ THE FULL MEDIA STATEMENT HERE