South Africa is currently grappling with a cholera outbreak, which can be traced back to the first two cases reported in Gauteng Province on 5 February 2023. The initial cases involved two sisters from Diepsloot, Johannesburg, who had travelled to Malawi in January and returned at the end of the month.
The husband of one of the women also tested positive for cholera after developing symptoms. Following this, eight more cases were confirmed, six in Johannesburg, primarily in Diepsloot, and two in Ekurhuleni. Tragically, one of the Ekurhuleni cases, a child, succumbed to the disease.
The last public statement regarding these early cases was made on 29 March 2023. These cases were linked to travel to Malawi, an endemic country, although the two cases in Ekurhuleni could not be directly linked. The transmission was limited to close family members and households, and public health awareness helped contain them. Since then, no further reports have emerged.
In the Free State Province, the first notification of increased diarrhoea was in the Fezile Dabi District, specifically in the towns of Vredefort and Parys in Ngwathe Local Municipality. A total of 174 patients with diarrhoea were attended at various clinics and hospitals, mainly Parys and Boitumelo District Hospitals.
Unfortunately, due to inadequate conditions at some clinics, specimens for laboratory testing were not taken. On 12 May 2023, the MEC of Health reported that eight patients had died from diarrhoea. Subsequent laboratory tests confirmed only one of the eight deaths as cholera. Further tests confirmed eight more definite cholera cases, bringing the total to nine.
Water sources in the Free State Province were tested but were deemed non-compliant due to high nitrate content, apparently due to excessive chloroform. The last case to test positive was on 23 May 2023. Health education about water and food safety is being promoted by district, provincial, national, and WHO personnel.
The current epicentre of the cholera outbreak is Tshwane Metro Municipality, Hammanskraal. The first reported case is a 56-year-old male police officer from Giyani, Limpopo, who resides in Musina. He was enrolled for a three-week course at the SAPS College in Hammanskraal and was taken by ambulance to Muelmed Hospital in Pretoria on 15 May 2023 after complaining of diarrhoea and vomiting. Laboratory tests confirmed cholera on 15 May, further confirmed by the NICD on 18 May. The patient is still in ICU in stable condition.
Follow-up by the Outbreak Response Team revealed that more students were complaining of gastrointestinal symptoms, with a total of 33 seen at various health facilities, resulting in eight admissions. Health education and screening were carried out, and specimens were obtained from one of the students for testing.
The National Department of Health and Gauteng Health Outbreak Response Teams were called to Jubilee Hospital on 19 May 2023, where they were informed of a large number of patients arriving with gastrointestinal symptoms. By 19 May, the hospital reported that 52 patients had been seen with a mixture of diarrhoea and vomiting, and six patients had died.
In the seven days from 17 – 23 May 2023, 163 patients presented at Jubilee with diarrhoea and vomiting, with 17 deaths. In the subsequent seven days from 24 – 30 May, the number reduced to 30 patients with an average of four patients per day and a totalof two deaths.
Interventions at health services provision included the creation of Special cholera and gastroenteritis wards, the deployment of a specialist gastroenteritis physician to Jubilee, the fast-tracking of laboratory results, and the setting up of a field hospital/clinic with additional health personnel. Health Outreach Teams have been deployed to educate the community about cholera and reinforce messages of prevention through basic hand hygiene, water, and food safety.
Water Department colleagues in the City of Tshwane and DWS are continuing to examine the water sources to determine any contamination.
At this stage, the cholera outbreak is limited to a small area in Free State, Ngwathe municipality, with no reported new cases since 23 May 2023. In the case of Tshwane, there are a total of 99 confirmed cases, with seven in the last 24 hours distributed as follows: 3 at Jubilee Hospital, 1 at Military hospital, 1 at Eugene Marais Life hospital, 1 at Netcare Montana, and 1 at Odi Hospital.
There is a significant downward trend, and the outbreak remains in Tshwane. However, authorities are confident that it will be contained. The situation is being closely monitored, and the public is urged to maintain high standards of hygiene to prevent further spread of the disease.
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