Diphtheria Cases
By Karabo Marifi
The National Institute for Communicable Diseases (NICD) has issued an urgent plea to South Africans to verify their children’s vaccination status as diphtheria cases surge across the country. This highly contagious and potentially deadly disease, caused by the bacterium Corynebacterium diphtheriae, has seen a marked increase in 2025, prompting swift action from public health officials.
A Growing Concern: 40 Confirmed Cases Since January 2025
As of 23 March 2025, the NICD has confirmed 40 cases of diphtheria in South Africa. Of these, 19 individuals displayed symptoms, while 21 were asymptomatic carriers identified through contact tracing—a process that tracks and tests people who have been in close contact with infected individuals. The Western Cape has borne the brunt of the outbreak, reporting 15 cases of respiratory diphtheria. Gauteng and Mpumalanga have recorded two and three cases respectively, while Limpopo has one probable case, where the patient exhibited symptoms despite negative laboratory confirmation.
Notably, over 78% of these cases have occurred in adults aged 18 and older, a shift from the perception that diphtheria primarily affects children. Since the beginning of 2024, nine symptomatic patients have succumbed to the illness, resulting in a case fatality rate of 27% (nine out of 33 symptomatic cases). This alarming statistic underscores the severity of the outbreak and the urgent need for action.
What is Diphtheria? Symptoms and Risks Explained
Diphtheria is a vaccine-preventable bacterial infection that primarily affects the respiratory system. Common symptoms include:
• A sore throat
• Fever
• Swollen glands in the neck, sometimes leading to a “bull neck” appearanceUpon examination, doctors may observe a grayish-white “pseudomembrane” covering the tonsils and throat—a hallmark of the disease. If left untreated, diphtheria can escalate rapidly. The NICD warns that the bacteria produce a toxin that can:
• Cause difficulty breathing and potentially block the airway entirely
• Damage the heart muscle, kidneys, and nervous systemThese complications can lead to life-threatening conditions or death, making early intervention critical.
The disease spreads through respiratory droplets (e.g., coughing or sneezing) or contact with contaminated objects. Asymptomatic carriers, who show no symptoms, can still transmit the bacteria, complicating efforts to control the outbreak without widespread vaccination.
NICD’s Urgent Vaccination Recommendations
The NICD is calling on specific groups to take immediate action:
• Adults: Those who haven’t received a diphtheria vaccine in the last 10 years should visit a clinic or healthcare provider for a booster shot. Waning immunity over time may explain the high number of adult cases.
• Pregnant Women: Vaccination during each pregnancy is recommended to protect both mother and newborn from diphtheria, tetanus, and pertussis (whooping cough).
• Children: Parents should ensure their children are up to date with the diphtheria vaccination schedule, which includes:
• Initial doses at 6, 10, and 14 weeks of age
• Booster doses at 18 months, 6 years, and 12 yearsAvailable vaccines include Dt (diphtheria and tetanus) and DTaP (diphtheria, tetanus, and acellular pertussis). These vaccines are safe, effective, and the cornerstone of diphtheria prevention. The NICD urges parents to check vaccination records and catch up on any missed doses without delay.
Treatment: A Race Against Time
For those infected, early treatment is essential. The standard approach involves:
1. Diphtheria Antitoxin: Administered to neutralize the toxin produced by the bacteria.
2. Antibiotics: Drugs like penicillin or erythromycin are used to eliminate the infection.The NICD emphasizes that treatment must begin promptly to prevent severe complications or death. Healthcare workers are on high alert and encouraged to report suspected cases immediately via the Notifiable Medical Condition app or the NICD website, ensuring a rapid public health response.
Prevention is Key: Vaccination and Vigilance
The NICD stresses that vaccination is the most effective way to protect against diphtheria. Beyond immunization, simple hygiene practices—such as regular handwashing and avoiding contact with infected individuals—can help reduce transmission. The current outbreak serves as a stark reminder that maintaining high vaccination coverage across all age groups is critical to preventing such preventable diseases from gaining a foothold.
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