South Africa continues to record cases of respiratory diphtheria, with the Western Cape accounting for the bulk of infections identified over the past two years, according to the latest situational update released by the National Institute for Communicable Diseases (NICD).
While no widespread outbreak has been declared, health authorities are maintaining close surveillance as new cases and carriers are detected through ongoing testing and contact tracing.
The illness remains vaccine-preventable, and public health responses have been activated for every confirmed and suspected case.
Between 1 January 2024 and 18 January 2026, South Africa recorded 91 confirmed cases of respiratory diphtheria, alongside two probable cases.
In addition, 61 asymptomatic carriers of toxigenic Corynebacterium diphtheriae were identified during contact tracing efforts.
Data compiled by the NICD shows that the Western Cape accounts for 76% of all confirmed cases and carriers, a total of 116 out of 152 detections. This includes 67 confirmed respiratory cases and 49 asymptomatic carriers identified in the province.
Since the previous situational update issued in the second week of 2026, one new laboratory-confirmed case of toxigenic respiratory diphtheria has been detected in the Western Cape, while a new asymptomatic carrier was also identified in the same province.
Health authorities confirmed that appropriate public health responses, including case management, contact tracing and preventative measures, were initiated immediately following detection.
Respiratory diphtheria is a vaccine-preventable illness caused primarily by toxigenic C. diphtheriae. While it can affect people of all ages, vaccination significantly reduces the risk of severe disease.
Clinicians and the public are advised that symptoms may include:
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sore throat
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low-grade fever
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a greyish-white membrane firmly attached to the nose, throat, tonsils or larynx
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swollen neck glands, sometimes described as a ‘bull neck’
In more severe cases, toxin-related complications may occur, including myocarditis, polyneuropathy, and renal damage.
Management focuses on both treating the patient and preventing further transmission, as treatment includes antibiotics, such as azithromycin or penicillin, to eliminate the bacteria, along with diphtheria antitoxin (DAT) to neutralise circulating toxin.
The NICD stresses that treatment and contact tracing should begin before laboratory confirmation if clinical suspicion is high. Early administration of DAT can be life-saving and should not be delayed.
Supportive care may include oxygen therapy, heart monitoring via electrocardiogram, and advanced airway management where required.
While case numbers remain relatively contained, the NICD continues to emphasise the importance of early detection, vaccination, and swift public health action.
Ongoing surveillance and contact tracing remain key to limiting further spread, particularly in provinces reporting higher case numbers.
With the Western Cape carrying the largest share of detected cases, health authorities remain focused on rapid response, clinical preparedness and prevention, tools that remain critical in keeping the disease under control.
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