The current outbreak of Cholera disease in South Africa can be traced from the first two cases reported by Gauteng Province on 5 February 2023. This is the case of two sisters from Diepsloot in Johannesburg who had travelled together by bus to Malawi in January and returned on 30 January 2023.

A husband of one of the women also subsequently tested positive for cholera after developing symptoms. Subsequently, eight more cases were confirmed, six more in Johannesburg mainly in Diepsloot and two cases in Ekurhuleni. The one case in Ekurhuleni, a child unfortunately died from the disease.

The last public statement regarding those early cases was by us on 29th March2023. These cases were linked to travel to an endemic country viz Malawi even though the two in Ekurhuleni could not be directly linked. The transmission was limited to close family members and households and the public health awareness helped to contain them, and there has been no further reports on these.

Free State Province

The first notification of increased diarrhorea in the Free State, in Fezile Dabi District was in Ngwathe Local Municipality in the towns of Vredefort and Parys. A total of 174 patients with diarrhoea were attended at various clinics and hospitals, mainly Parys and Boitumelo District Hospitals.

Unfortunately, due to the fact that some of the patients presented at clinics where conditions were not adequate to can take specimen for laboratory, this was not done. On the 12 May 2023 I received a message from MEC of Health, that eight patients had died from diarrhoea, two at home and 3 each at Parys and Boitumelo hospitals and that laboratory tests were outstanding. Subsequently, laboratory tests confirmed only one of the eight deaths as confirmed cholera.

Further tests on other patients who were admitted or treated for diarrhoea confirmed eight more definite cholera cases bringing the total to 9.

According to report from the Free State Province the water sources were tested but the tests were deemed non-compliant of high nitrate content which is apparently due to too much chloroform.

The last case to test positive was on 23 May 2023. All measures of health education about water and food safety are being promoted by district, provincial, national, and WHO personnel are assisting the district in monitoring and health promotion.

Gauteng Province – Tshwane

The current epicenter of the cholera outbreak is of course Tshwane Metro Municipality, Hammanskraal. The first reported case is 56-year-old male originally from Giyani, Limpopo, who resides in Musina. The patient is a police officer, and he is enrolled for a 3 week course at the SAPS College in Hammanskraal for which he arrived on 7th May and started on 8th May. On 12th May he complained of diarrhoea and vomiting and was taken by ambulance to Muelmed Hospital in Pretoria on 15th May 2023. Laboratory tests confirmed cholera on 15th May and further confirmed by the NICD on 18th May. The patient is still in ICU in stable condition receiving treatment.

Follow-up by Outbreak Response Team revealed that more students were complaining of gastrointestinal symptoms with a total of 33 seen at various health facilities resulting in 8 admissions and all are in stable condition. Health education, screening was carried out and specimens were obtained from one of students for testing.

The National Department of Health and Gauteng Health Outbreak Response Teams were called to Jubilee Hospital on 19th May 2023, where on arrival they were informed of the big number of patients arriving with gastrointestinal symptoms since Monday, 15th May, the same day that the police officer was admitted to Muelmed Hospital. By Friday, 19th May the hospital reported that 52 patients had been seen with mixture of diarrhea and vomiting and already by then 6 patients had died. By then only a limited number of 5 specimens had been taken to the laboratory which is impossible to determine the cause in majority of the patients.

In the 7 days from 17 – 23 May 2023 163 patients presented at Jubilee with diarrhoea and vomiting giving an average of 23 patients per day. The number of deaths was 17 in seven days. In the subsequent 7 days from 24 – 30 May, the number reduced to 30 patients with an average of 4 patients per day and a total of 2 deaths.

Interventions at health services provision included the creation of Special cholera and gastroenteritis wards, the deployment of specialist gastroenteritis physician to Jubilee, the fast-tracking of laboratory results and the setting up of a field hospital/clinic with deployment of additional health personnel. Working with the Ward Councillor of Kanana Community, Health Outreach Teams have been deployed to educate community about cholera and reinforce messages of prevention through basic hand hygiene, water and food safety.

Our colleagues in Water Department both in City of Tshwane and DWS are continuing to examine the water sources to determine any contamination.

Key message is that at this stage the outbreak of cholera 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, we have a total of 99 confirmed cases, 7 in the last 24 hours distributed as: 3 Jubilee Hospital, 1 Military hospital, 1 Eugene Marais Life hospital, 1 Netcare Montana and 1 Odi Hospital.

Again, there is a significant downward trend and the outbreak remains in Tshwane and we are confident that it will be contained.

Source: Government of South Africa