Typhoid Fever Updates

Overview

Typhoid fever update

Between 1 January and 31 October 2025, a total of 147 laboratory-confirmed cases of enteric fever were reported from eight provinces in South Africa. Gauteng accounted for the majority of cases (59%; 86/147), followed by the Western Cape (16%; 24/147) and KwaZulu-Natal (10%; 14/147). By comparison, 139 laboratory-confirmed cases of enteric fever were reported nationally during 2024 from eight provinces. The number of cases reported in 2025 has already surpassed the total recorded in 2024.

In 2025, most cases were diagnosed in public sector laboratories (80%; 118/147). The age range of cases was 0–74 years (median: 18 years). Males accounted for 59% (57/144) of cases. Children under 15 years represented 43% (63/147) of cases, followed by those aged 15–49 years (42%; 62/147) and 50–64 years (7%; 10/147). Gauteng reported the highest number of cases, with the majority (56%; 48/86) originating from the City of Tshwane. Additional cases were reported from the City of Johannesburg (20%; 17/86), Ekurhuleni (15%; 13/86), West Rand (6%; 5/86), and Sedibeng (3%; 3/86).

City of Tshwane Outbreak

Bronkhorstspruit cluster

This cluster comprised 14 cases, identified between epidemiological weeks 30 and 41 (July – October 2025). An average of one case per week was reported during this period, suggesting a persistent or intermittent source of infection. Whole genome sequencing data have been conducted for 11 isolates from this cluster, all of which were closely related, indicating a likely common source of infection. Females accounted for 57% (8/14) of the cases. Most cases occurred among individuals under 15 years of age (8/14; 57%), followed by those aged 15–49 years (4/14; 29%), while the age was unknown for two cases.

Hammanskraal cluster

A more recent cluster was identified in Hammanskraal, consisting of 11 cases. This cluster demonstrated a sudden increase in cases during epidemiological week 42 (13 – 19 October 2025), consistent with a point-source outbreak pattern. Ten cases were detected at Jubilee Hospital within a four-week period. An additional case from Hammanskraal was reported from a private hospital during week 42 (13 – 19 October 2025), bringing the total number of cases from the area to 11 between weeks 39 and 43 (September – October 2025). Males accounted for 82% (9/11) of the cases, and most were aged under15 years (9/11; 82%), followed by individuals aged 16–49 years (2/11; 18%).

Investigations into the two clusters are ongoing. The City of Tshwane Outbreak Response Team has visited affected households in Bronkhorstspruit and Hammanskraal to conduct case investigations, and investigations into possible sources of infection are ongoing.  

What is Typhoid Fever?

Typhoid fever, also known as enteric fever or simply typhoid, is a systemic illness caused by infection with Salmonella enterica subspecies enterica serotype Typhi or serotypes Paratyphi A, B, or C.

The disease spreads through feacal-oral transmission, typically through contaminated food or water. People infected with typhoid can spread the bacteria to others, particularly in areas where sanitation and hygiene are poor.

Signs and Symptoms

Typhoid fever is characterised by:

  • Fever
  • Headache and/or muscle pain
  • Gastrointestinal symptoms such as abdominal pain or cramps, nausea, vomiting, constipation, or diarrhoea
  • In some cases, relative bradycardia (a slower-than-expected heart rate in the presence of fever)

Prevention

The most effective ways to prevent typhoid include:

  • Practicing strict handwashing with soap and water after using the toilet and before handling food
  • Ensuring access to safe water and adequate sanitation
  • Advising patients with typhoid fever to practice excellent hand hygiene and avoid food preparation until they are free of infection.

For more information, read here.

Recent Updates
FAQ
Most frequently asked questions and answers about typhoid fever

Typhoid is endemic within South Africa, and sporadic cases are reported in all provinces every year. In addition to sporadic endemic disease, clusters and outbreaks may occur. There is ongoing risk of typhoid fever in any area where water quality and sanitation is not optimal. Contamination of water supplies has resulted in numerous large-scale outbreaks; for example, Delmas (Mpumalanga Province) has experienced repeated outbreaks of typhoid fever, with over 1000 cases during 1993, and over 400 suspected cases and three deaths in 2005. In Harare, Zimbabwe, a typhoid outbreak that began in 2012, associated with contaminated.

Typhoid is diagnosed when Salmonella Typhi is identified in a culture of blood, bone marrow, stool or other tissue. Stool cultures may only become positive after the first week of illness. Ideally, blood and stool cultures should be submitted simultaneously. Culture of bone marrow is useful as it may remain positive even after 5 days of antibiotic treatment. Positive cultures are confirmed by agglutination with specific typhoid anti-sera, including the Vi antigen. The Widal test which looks for antibodies to S. Typhi may be suggestive of the diagnosis but not confirmatory. The Widal test also does not supply information on antibiotic resistance, which is important to guide treatment.