Update | Outbreak of Cholera in South Africa (1 March 2023)

As of 28 February 2023, a total of six confirmed cholera cases including one death have been reported in Gauteng Province. All cases are adults, ranging in age from 19 to 44 years. No confirmed cases have been reported in other provinces. Isolates from all cases are identified as toxigenic Vibrio cholerae O1 serotype Ogawa, and are susceptible to ciprofloxacin.

The first three cases were imported or import-related cases following travel to Malawi. Cases 4 and 5 acquired infection locally; they had not travelled, had no links to imported cases or to each other, and don’t reside or work in the same area. These two are classified as indigenous cases (Table 1).  The sixth case is newly reported and under investigation.

Table 1. Confirmed cholera cases by origin of infection

Case number Case classification Comment
1 Imported case Cases 1 and 2 were infected in Malawi.

 

Case 3 is a close household contact of case 1 (has a direct link to imported case)

2 Imported case
3 Import-related case
4 Locally-acquired indigenous case No history of local or international travel. No evidence of a direct link to an imported case.
5 Locally-acquired indigenous case No history of local or international travel. No evidence of a direct link to an imported case.
6 Under investigation

 

By definition, the detection of locally-acquired indigenous cholera cases is a confirmed cholera outbreak. The source(s) of infection in these cases is not known at present.

Whilst there is an ongoing risk for imported cases following travel from other African countries currently experiencing cholera outbreaks (especially Malawi, Mozambique, Zambia and Zimbabwe), the detection of locally-acquired cases is critical to guide public health investigations and timely interventions that effectively interrupt cholera transmission in affected communities.

Healthcare workers and laboratorians countrywide have been urged to consider and test for cholera in persons with acute watery diarrhoea.

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