Highlights:

• Since the last situational report (week 43, 2026), the following updates are included in this report:
• • • Three new laboratory-confirmed cases of toxigenic diphtheria in Gauteng.
    • One new asymptomatic carrier of toxigenic C. diphtheriae in Gauteng.
• 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

Highlights:

• Since the last situational report (week 42, 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

Highlights:

• Since the last situational report (week 41, 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

Measles surveillance

National measles surveillance has detected an increase in measles cases nationwide. Data available (accessed 20 October 2026) from 29 December 2025 to 18 October 2026 (ISO Weeks 1-41) indicated that 6363 laboratory-confirmed measles cases were reported nationally. Since the previous report (ISO week 41), 177 additional cases were detected. Northern Cape reported the highest number of new cases (68), followed by Free State (32), Limpopo and Mpumalanga (20 cases each, respectively), North West (18), Western Cape (15), Eastern Cape (3) and KwaZulu-Natal (1).

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 11 October 2026 (ISO Weeks 1–40), a total of 911 laboratory-confirmed rubella cases were reported in South Africa through the national fever-rash surveillance system (data accessed 20 October 2026). Since the previous report, 66 rubella cases have been reported. During the reporting period, most cases occurred among children aged 1–14 years (708/911; 77.7%).

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

From 29 December 2025 to 11 October 2026 across the three sentinel surveillance systems (outpatient influenza-like-illness (ILI) surveillance at public primary health care clinics, outpatient ILI surveillance at private general practitioner practices, and inpatient pneumonia surveillance at public hospitals), influenza was detected in 1029 of 6212 specimens tested (16.6%) . Among the cases for which a subtype could be determined (97.1%; 999/1029), 44.0% (453/1029) were influenza A(H3N2), 32.6% (335/1029) were influenza A(H1N1)pdm09 and 20.5% (211/1029) were influenza B (211/1029; 20.5%). Additionally, seven dual infections were detected: one case of A(H1N1) and A(H3N2), one case of A(H3N2) and influenza B, two cases of A(H1N1) and influenza B, and three cases of an inconclusive influenza A subtype and influenza B. Before routine lineage subtyping of influenza B was discontinued in June 2026, 100% (111/111) of tested influenza B samples were B/Victoria.

Message to clinicians

Influenza is an acute respiratory infection caused by influenza viruses. It spreads easily between people through respiratory droplets and causes seasonal epidemics. Most people recover without treatment, but influenza can cause severe illness or death, especially in people at high risk of severe influenza illness or complications.

Although the 2026 influenza season has ended, sporadic influenza infections may continue to occur outside the defined seasonal period. Clinicians should therefore continue to consider influenza in the differential diagnosis of patients presenting with respiratory illness and in patients with highly suggestive symptoms. High-risk groups include pregnant women, individuals living with HIV, those with chronic conditions such as diabetes, lung disease, tuberculosis, heart disease, renal disease, and obesity, older individuals (≥65 years), and children under two years old.

Where to find updated data

Weekly reports documenting respiratory pathogen circulation in South Africa, including influenza, respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Bordetella pertussis, human adenovirus, human metapneumovirus, human parainfluenza virus and human rhinovirus, are available on the NICD website here.

READ THE FULL UPDATE HERE

Between 7-18 October 2026, 408 cases of gastrointestinal illness were reported, with young children under four years old mostly affected. No deaths have been reported to date. Laboratory tests conducted on patient samples detected several disease-causing bacteria, however, no cholera bacteria were detected.

A number of infectious pathogens may cause gastrointestinal illness. Young children, especially those under five years of age, older people and people with weakened immune systems are at increased risk of serious illness.  Gastrointestinal illness may cause any of the following symptoms:

• Diarrhoea
• Vomiting
• Stomach cramps or abdominal pain
• Fever or general weakness
• Dehydration, including reduced urination, dry mouth, dizziness or unusual drowsiness

While arranging medical care, give small, frequent sips of oral rehydration solution if the person is conscious and able to drink, prepared using safe water and according to the instructions.

Residents of the affected areas are advised to seek medical attention promptly if any of these symptoms develop after possible exposure to contaminated water.

Official advisory from the Department of Health:

• Use safe water supplied by municipal water tankers or another officially confirmed safe source for drinking, cooking, food preparation and personal hygiene.
• Use affected tap water only for flushing toilets, as advised by the City of Tshwane.
• Discard previously stored tap water, and washing and disinfecting water storage containers before refilling them with safe water.
• Store water in clean, covered containers and avoiding dipping hands or cups into the stored water.

Prevention of gastrointestinal illness

• Wash your hands with soap and safe water.
• Keep food preparation areas and utensils clean.
• Use safe water when preparing food and drinks.

Stay informed

Residents from affected areas are urged to remain vigilant and follow official announcements/updates from the City of Tshwane and health authorities. Unverified information should not be shared as this may cause alarm. All suspected cases should report to nearest healthcare facilities.

For the official government statement, visit here.

READ THE FULL UPDATE HERE

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