Typhoid Fever Updates

Overview

Typhoid (enteric) fever update

National overview

Between 1 January and 31 December 2025, a total of 200 laboratory-confirmed cases of enteric fever were reported from nine provinces in South Africa. Since the previous update on 17 December 2025, nine additional cases were reported, comprising four from Gauteng (GP), three from Mpumalanga (MP), one from North West (NW), and one from Northern Cape (NC). The majority of cases were reported from Gauteng (60%; 119/200), followed by the Western Cape (14%; 28/200) and Mpumalanga (8%; 16/200). Of the total cases, twelve (6%; 12/200) were caused by Salmonella Paratyphi A.

Gauteng Province

Gauteng reported the highest number of cases, with the majority (61%; 72/119) originating from the City of Tshwane. Additional cases were reported from the City of Johannesburg (18%; 21/119), Ekurhuleni (13%; 15/119), West Rand (7%; 8/119), and Sedibeng (3%; 3/119).

City of Tshwane

The majority of cases reported from the City of Tshwane presented at two hospitals: Jubilee District Hospital (n = 28) in the Hammanskraal area and Bronkhorstspruit Hospital (n = 17) in the Bronkhorstspruit area. Notably, eleven of the twelve Salmonella Paratyphi A cases reported nationally were from the City of Tshwane.

The majority (92%; 66/72) of the associated Salmonella Typhi and Salmonella Paratyphi isolates were received at the NICD–Centre for Enteric Diseases (NICD-CED). Whole genome sequencing (WGS) has been completed for 92% (61/66) of the isolates received to date. Analysis of WGS data identified five distinct clusters of genetically related isolates within the City of Tshwane, with cases predominantly residing in the Bronkhorstspruit and Hammanskraal areas.

Bronkhorstspruit Cluster Cases

Most cases in the Bronkhorstspruit clusters occurred among children under 15 years of age and individuals aged 15–49 years, with each group accounting for 43% (12/28) of the reported cases. Males and females were equally affected. One death was recorded in a 28-year-old male.

Hammanskraal Cluster Cases

Similarly, most cases in the Hammanskraal clusters occurred among children under 15 years of age (57%; 17/30), followed by individuals aged 15–49 years (33%; 10/30). Among cases with known gender, 68% (19/28) were male. No deaths were reported in the Hammanskraal clusters.

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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.