South Africa: Elevated cholera activity reported in Gauteng, South Africa through March

Event

South African health authorities have declared a cholera outbreak in Gauteng Province, with 10 confirmed cases reported Feb. 5-March 30. Three cases in this outbreak were imported, while the remaining seven were locally acquired. The locally acquired cases have been recorded in the City of Johannesburg and Ekhurhuleni in Gauteng Province. Some locally acquired cases reported exposure to, or consumption of, untreated water from the Jukskei and Klip rivers, which are being investigated as possible sources of infection. This represents the most complete data available as of March 30.

Context

On Feb. 5, the first three cholera cases in this outbreak were recorded in Gauteng. These were identified as imported or import-related cases following travel to Malawi. All subsequent cases reported no history of travel and acquired infection locally. Contaminated water in Gauteng rivers is the suspected source of infection in this outbreak and is currently being investigated. Cholera is not endemic in South Africa, and the last outbreak was recorded in 2008 when approximately 12,000 cases were reported.

Cholera is transmitted directly through food or water contaminated with fecal material from an infected person. Most infected people develop no symptoms or only mild diarrhea. However, approximately one in 10 infected people develop severe cholera, which causes symptoms including profuse, watery diarrhea, vomiting, rapid heart rate, low blood pressure, muscle cramps, restlessness, or irritability. Symptoms typically appear two or three days after exposure but can develop up to five days after exposure. Individuals with severe cholera can develop acute renal failure, severe electrolyte imbalances, and coma. If left untreated, these can lead to shock and rapid death.

Advice

Consult a travel medicine provider regarding cholera vaccination before traveling to the country. Practice strict food and water precautions. Seek immediate medical attention if symptoms develop within a week of being in areas of high cholera transmission.