Typhoid Fever Updates
Overview
Typhoid (enteric) fever update
National overview
Between 1 January and 29 July 2026, a total of 125 laboratory-confirmed cases of enteric fever were reported from eight provinces in South Africa. No cases were reported from the Northern Cape Province. Most cases were reported from Gauteng (56%; 70/125), followed by Mpumalanga (20%; 25/125) and the Western Cape (14%; 17/125). No cases of enteric fever caused by Salmonella Paratyphi were reported during this period; all reported cases were caused by Salmonella Typhi. The ages of affected individuals ranged from 0 to 78 years, with a median age of 16 years. Males accounted for 53% (65/123) of cases with known sex. Children aged <15 years and individuals aged 15–49 years each accounted for 40% (50/125) of reported cases.
Gauteng Province
Gauteng reported the highest number of cases, with the majority (86%; 60/70) occurring in the City of Tshwane. The remaining cases were reported from the City of Johannesburg (7%; 5/70) and the City of Ekurhuleni (7%; 5/70) (Table 1).
Table 1: Number of enteric fever cases by district and Salmonella serovar, Gauteng Province, 1 January – 29 July 2026 (N = 70).
| District | Paratyphoid fever | Typhoid fever | Total |
|---|---|---|---|
| City of Tshwane | 0 | 60 | 60 |
| City of Johannesburg | 0 | 5 | 5 |
| Ekurhuleni | 0 | 5 | 5 |
| West Rand | 0 | 0 | 0 |
| Sedibeng | 0 | 0 | 0 |
| Gauteng Province | 0 | 70 | 70 |
City of Tshwane
The majority of cases reported from the City of Tshwane presented at Bronkhorstspruit Hospital (52%; 31/60), serving the Bronkhorstspruit area. Additional cases residing in the Bronkhorstspruit area sought care at other healthcare facilities in Pretoria. An increase in enteric fever cases was observed in the Bronkhorstspruit area, with an initial peak occurring in March 2026, followed by a second peak in June 2026. A similar increase in cases was observed in the same area between July and September 2025, suggesting a recurring pattern that warrants continued investigations and enhanced surveillance.
Whole genome sequencing (WGS) identified two distinct Salmonella Typhi strains as the drivers of the sustained increase in enteric fever cases observed in the Bronkhorstspruit area during both 2025 and 2026. The two strains responsible for the clusters identified in 2025 continue to account for the increase in cases observed in 2026.
The first cluster, caused by Salmonella Typhi sequence type (ST) 1, comprised 23 cases reported between July 2025 and May 2026. Of these, 15 cases were reported in 2025 and eight in 2026. Among the 2026 cases, six were residents of Ekangala and two were from the Rethabiseng community in the Bronkhorstspruit area.
The second cluster, caused by Salmonella Typhi ST2, comprised 35 cases reported between April 2025 and May 2026. Of these, 11 cases were reported in 2025 and 24 in 2026. Among the 2026 cases, most resided in Zithobeni (n = 15), followed by Ekangala (n = 9) and Rethabiseng (n = 6). Additional cases are from Mamelodi, Bronkhorstspruit, Dark City, Arcadia, and Daveyton.
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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.
