Highlights:

• Since the last situational report (week 17), the following updates are included in this report:
  o One new laboratory-confirmed case of toxigenic respiratory diphtheria from Mpumalanga.
  o Four new asymptomatic carriers of toxigenic C. diphtheriae, two from KwaZulu-Natal and two from Limpopo.
• Appropriate public health responses have been initiated for each case.

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx (Figure 2) – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE

Cholera, an acute diarrhoeal illness caused by ingestion of contaminated food or water, remains a serious global health concern, especially during humanitarian crises involving floods or infrastructure collapse. The disease is caused primarily by toxigenic Vibrio cholerae serogroups O1 and O139, with O1—comprising the El Tor biotype and its hybrid variants—being the predominant cause of current outbreaks. These hybrid El Tor strains, possessing traits from both classical and El Tor biotypes, may have increased virulence.

In 2024, the World Health Organization (WHO) reported 804,721 cholera cases and 5,805 deaths across 33 countries spanning five WHO regions, marking a disturbing increase over previous years . The Eastern Mediterranean and African regions bore the brunt of the burden. With growing spread, rising case numbers, and logistical constraints in global response systems, WHO has maintained a Grade 3 emergency designation since January 2023—its highest level of alert.

By the end of Q1 2025, 25 countries had reported cholera or acute watery diarrhoea (AWD), with 116,574 cases and 1,514 deaths—most notably in Africa, followed by the Eastern Mediterranean and South-East Asia. No outbreaks were observed in the Western Pacific region.

International Transmission and Travel-Related Cases

The globalized movement of people and goods has introduced new vectors for cross-border cholera transmission. In February 2025, Germany reported three cases linked to consumption of holy water brought from Bermel Giorgis, Ethiopia. Toxigenic O1 V. cholerae was found in both patients and the water itself.

In March 2025, the United Kingdom reported four cholera cases, three involving recent travel to Ethiopia and one domestic case caused by consuming imported holy water. These cases underscore how contaminated items can facilitate international disease spread, highlighting the urgent need for global surveillance and health communication.

Situation in Southern Africa

Eighteen African countries are experiencing active cholera transmission as of April 2025, including Angola, DRC, Ghana, Kenya, and more. The Southern African region is especially hard hit, with major outbreaks ongoing in Mozambique, Malawi, Zambia, and Zimbabwe.

Global and Regional Response

WHO and its partners—including the Global Outbreak Alert and Response Network (GOARN) and Standby Partners (SBP)—have deployed multidisciplinary teams to 10–11 countries. These deployments focus on case management, WASH (Water, Sanitation and Hygiene), epidemiology, logistics, and community engagement. Countries receiving technical support include Malawi, Mozambique, Zambia, Ethiopia, South Sudan, and Haiti.

Efforts have included emergency vaccine campaigns, infrastructure repair, and misinformation countermeasures. Zimbabwe, for instance, has launched Oral Cholera Vaccine (OCV) campaigns in hotspot districts. Mozambique has focused on water trucking, chlorine distribution, and public health communication.

Threat to South Africa

Although South Africa has not experienced a cholera outbreak during the current reporting period, the ongoing regional crisis places the country at high risk. Cross-border movement from affected neighboring countries like Zimbabwe, Mozambique, and Zambia elevates this threat. Additionally, flooding—a frequent issue in several South African provinces—could undermine sanitation systems and facilitate cholera transmission. Provinces at greatest risk include Limpopo, Mpumalanga, KwaZulu-Natal, and North West.

The resurgence of cholera presents a formidable global health threat. In Southern Africa, climate shocks, misinformation, infrastructure damage, and vaccine shortages have compounded the problem. Despite international assistance, countries like Mozambique, Zambia, Malawi, and Zimbabwe continue to struggle with controlling transmission. The situation underscores the urgent need for robust regional coordination, enhanced WASH systems, public trust-building, and equitable vaccine access to avoid further cross-border spread and mitigate future outbreaks.

READ THE FULL UPDATE HERE

According to the latest consolidated schedule from the South African Health Products Regulatory Authority (SAHPRA), doxycycline is now classified as a Schedule 2 medicine when intended and labelled specifically for the prevention of malaria in individuals aged 8 years and older. This means the medication can be dispensed without a prescription for travellers heading to malaria-endemic areas, increasing ease of access and convenience.

Doxycycline is one of the antimalarial agents recommended in the National Guidelines for the Prevention of Malaria. Read the guidelines here.

To further support South Africa’s malaria elimination efforts, doxycycline was added to both the Primary Healthcare Level and Paediatric Hospital Level Standard Treatment Guidelines (STGs) and the Essential Medicines List (EML) in January 2024. These additions aim to expand access to effective malaria prevention, particularly for vulnerable populations.

For more information on malaria in South Africa, click here.

Highlights:

• Since the last situational report (week 16), the following updates are included in this report:
  o Two new laboratory-confirmed cases of toxigenic respiratory diphtheria, one from Limpopo and one from KwaZulu Natal.
  o No new asymptomatic carriers of toxigenic C. diphtheriae.
  o One additional death has been reported, bringing the total to 11 deaths.
• Appropriate public health responses have been initiated for each case.

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx (Figure 2) – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 15), the following updates are included in this report:
  o Three new laboratory-confirmed cases of toxigenic respiratory diphtheria, one from Mpumalanga and two from Limpopo.
  o No new asymptomatic carriers of toxigenic C. diphtheriae.
  o Two suspected cases awaiting results from the Western Cape.
  o One additional death has been reported, bringing the total to 10 deaths.
• Appropriate public health responses have been initiated for each case.

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx (Figure 2) – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE

World Malaria Day is marked on 25 April. What progress has been made against the disease, where are the gaps and what’s being done to plug them?

As scientists who research malaria in Africa, we believe that the continent can defeat the disease. New, effective tools have been added to the malaria toolbox.

Researchers and malaria programmes, however, must strengthen collaborations. This will ensure the limited resources are used in ways that make the most impact.

The numbers

Some progress has been made, but in some cases there have been reverses.

• Between 2000 and 2015 there was an 18% reduction in new cases from 262 million in 2000 to 214 million in 2015. Since then, progress has stalled.
• The World Health Organization estimates that approximately 2.2 billion cases have been prevented between 2000 and 2023. Additionally, 12.7 million deaths have been avoided. In 2025, 45 countries are certified as malaria free. Only nine of those countries are in Africa. These include Egypt, Seychelles and Lesotho.
• The global target set by the WHO was to reduce new cases by 75% compared to cases in 2015. Africa should have reported approximately 47,000 cases in 2023. Instead there were 246 million.
• Almost every African country with ongoing malaria transmission experienced an increase in malaria cases in 2023. Exceptions to this were Rwanda and Liberia.

So why is progress stagnating and in many cases reversing?

The setbacks

Effective malaria control is extremely challenging. Malaria parasite and mosquito populations evolve rapidly. This makes them difficult to control.

Africa is home to malaria mosquitoes that prefer biting humans to other animals. These mosquitoes have also adapted to avoid insecticide-treated surfaces.

It has been shown in South Africa that mosquitoes may feed on people inside their homes, but will avoid resting on the sprayed walls.

Mosquitoes have also developed mechanisms to resist the effects of insecticides. Malaria vector resistance to certain insecticides used in malaria control is widespread in endemic areas. Resistance levels vary around Africa.

Resistance to the pyrethroid class is most common. Organophosphate resistance is rare, but present in west Africa. As mosquitoes become resistant to the chemicals used for mosquito control, both the spraying of houses and insecticide treated nets become less effective. However, in regions with high malaria cases, nets still provide physical protection despite resistance.

An additional challenge is that malaria parasites continue to develop resistance to anti-malarial drugs. In 2007 the first evidence began to emerge in south-east Asia that parasites were developing resistance to artemisinins. These are key drugs in the fight against malaria.

Recently this has been shown to be happening in some African countries too. Artemisinin resistance has been confirmed in Eritrea, Rwanda, Tanzania and Uganda. Molecular markers of artemisinin resistance were recently detected in parasites from Namibia and Zambia.

Malaria parasites have also developed mutations that prevent them from being being detected by the most widely used rapid diagnostic test in Africa.

Countries in the Horn of Africa, where parasites with these mutations are common, have changed the malaria rapid diagnostic tests used to ensure early diagnosis.

The progress

Nevertheless, the fight against malaria has been strengthened by novel control strategies.

Firstly, after more than 30 years of research, two malaria vaccines – RTS,S and R21 – have finally been approved by the WHO. These are being deployed in 19 African countries.

These vaccines have reduced disease cases and deaths in the high-risk under-five-years-old age group. They have reduced cases of severe malaria by approximately 30% and deaths by 17%.

Secondly, effectiveness of long-lasting insecticide-treated nets has been improved.

New insecticides have been approved for use. Chemical components that help to manage resistance have also been included in the nets.

Thirdly, novel tools are showing promise. One option is attractive toxic sugar baits. This is because sugar is what mosquitoes naturally eat. Biocontrol by altering the native gut bacteria of mosquitoes may also prove effective.

Fourthly, reducing mosquito populations by releasing sterilised male or genetically modified mosquitoes into wild mosquito populations is also showing promise. Trials are currently happening in Burkina Faso. Genetically sterilised males have been released on a small scale. This strategy has shown promise in reducing the population.

Fifthly, two new antimalarials are expected to be available in the next year or two. Artemisinin-based combination therapies are standard treatment for malaria. An improvement to this is triple artemisinin-based combination therapy. This is a combination of this drug with an additional antimalarial. Studies in Africa and Asia have shown these triple combinations to be very effective in controlling malaria.

The second new antimalarial is the first non-artemisinin-based drug to be developed in over 20 years. Ganaplacide-lumefantrine has been shown to be effective in young children. Once available, it can to be used to treat parasites that are resistant to artemisinin. This is because it has a completely different mechanism of action.

The end game

It has been several years since the malaria control toolbox has been strengthened with novel tools and strategies that target both the vector and the parasite. This makes it an ideal time to double down in the fight against this deadly disease.

In 2020, the WHO identified 25 countries with the potential to stop malaria transmission within their borders by 2025. While none of these countries eliminated malaria, some have made significant progress. Costa Rica and Nepal reported fewer than 100 cases. Timor-Leste reported only one case in recent years.

Three southern African countries are included in this group: Botswana, Eswatini and South Africa. Unfortunately, all these countries showed increases in cases in 2023.

With the new tools, these and other countries can eliminate malaria, getting us closer to the dream of a malaria-free world.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pre-exposure prophylaxis is recommended for individuals at high or continual risk of exposure to the rabies virus. This includes persons who may be at risk of exposure due to their occupation (for example veterinarians, animal health technicians etc.) or hobbies. Rabies post-exposure prophylaxis is provided when persons have been potentially exposed to the virus.

There is currently a shortage of Verorab rabies vaccine in South Africa. Chirorab® has been identified as a suitable alternative, which the National Department of Health has procured through Kahma Biotech (Pty Ltd) as of January 2025.

The dosing schedule for Chirorab® remains the same as outlined in the national and World Health Organisation guidelines for rabies pre- and post-exposure vaccination. Note that although the product volume per vial differs for Chirorab® and Verorab, the total content of one vial constitutes a single intramuscular dose.

Public-sector facilities requiring Chirorab® are advised to contact their respective provincial pharmacy depot for procurement. Private-sector providers should follow the procurement guidelines as per their organisational guidelines.

For further information on rabies, as well as guidelines for management of potential exposure, click these links: Rabies (Disease Index) – NICD and Human-Rabies-Prophylaxis-Guidelines_DRAFT_29-October-2021.pdf

For clinical rabies queries, clinicians can contact the NICD hotline: 0800 212 552

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 14), the following updates are included in this report:
  o Three new laboratory-confirmed cases of toxigenic respiratory diphtheria, one from Limpopo, one from Mpumalanga and one from the Western Cape
  o Two new asymptomatic carriers of toxigenic C. diphtheriae, both from Limpopo
• Appropriate public health responses have been initiated for each case

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE

How to prevent contracting malaria?

All individuals travelling to malaria-endemic areas should take the appropriate pharmaceutical and/or non-pharmaceutical precautions.

Antimalarial prophylaxis should be considered, particularly if travelling to high-risk areas. Doxycycline is now available in the public sector without a prescription at no cost to travellers. Both doxycycline and atovaquone-proguanil can be procured without a prescription from pharmacies and private sector travel clinics.

Every effort should be made to reduce contact with mosquitoes by limiting outdoor activity after dark, covering up bare skin (particularly feet and ankles), using mosquito repellents containing at least 10% DEET, ensuring window screens are closed, and using bed nets, fans, or air-conditioning, if available. While these precautions will reduce the chance of acquiring malaria, the risk is never completely removed.

Malaria symptoms

Malaria symptoms are very similar to “flu” symptoms and include headache, fever, chills, fatigue, muscle and joint pain. All travellers returning from malaria-endemic areas, including very low-risk areas, should immediately report a flu-like illness (headache, fever, chills, fatigue, muscle and joint pain) to the nearest healthcare facility and request a malaria test. Particular care should be taken with young children, as their symptoms are very nonspecific (fever, loss of appetite, vomiting). Malaria rapidly progresses to severe illness, often with severe consequences; therefore, early diagnosis and treatment are critical.

A malaria risk map, Frequently Asked Questions, and further information on prevention are available on the NICD website. Please click here for more details.

READ THE FULL MEDIA STATEMENT HERE

This early start doesn’t mean that this year’s flu season will be more severe than in previous years, but it does mean that now is the time to protect yourself and your loved ones by getting the flu vaccine. The seasonal influenza vaccine is available at public health clinics and through private healthcare providers, including general practitioners and pharmacies.

Although the vaccine is most effective when given before the season starts, it is not too late to get vaccinated. Protection develops about two weeks after vaccination, and annual vaccination is needed as flu viruses change over time and protection does not last from one year to the next.

For most people, flu symptoms are mild and resolve in a few days. But for some, influenza can lead to severe illness, hospitalisation, or even death. Those most at risk include:

• Pregnant women
• People living with HIV
• Individuals with chronic conditions like diabetes, lung disease, heart disease, tuberculosis, kidney disease, or obesity
• Older adults (65 years and older)
• Children younger than 2 years

These groups are strongly encouraged to get vaccinated as soon as possible, and to seek medical care early if they develop flu symptoms.

In addition, healthcare workers are also encouraged to get vaccinated to protect themselves and their patients who may be at increased risk of having severe influenza illness should they be infected.

The National Department of Health provides influenza vaccination free of charge to healthcare workers, individuals aged 65 years and older, individuals with cardiovascular disease (including chronic heart disease, hypertension, or stroke), diabetes, chronic lung disease (including asthma, or chronic obstructive pulmonary disease), immunosuppressive conditions (e.g. living with HIV and AIDS, or malignancy), as well as pregnant women.

To reduce the spread of flu in your community, remember to:

• Wash your hands often
• Cover coughs and sneezes with your elbow or a tissue
• Avoid close contact with people who are sick
• Stay home if you are feeling unwell

If your symptoms worsen or don’t improve within 3–7 days, seek medical attention.

Clinicians are urged to consider influenza when diagnosing patients with respiratory illness this season.

Weekly updates on influenza and other circulating respiratory viruses such as RSV, SARS-CoV-2, and pertussis are available from the NICD: Weekly Respiratory Pathogens Surveillance Report

For guidelines on flu diagnosis and management: Influenza Guidelines 2024 (PDF)

READ THE FULL MEDIA STATEMENT HERE