South Africa: Elevated cholera activity reported in multiple provinces through May

Event

South African health authorities reported elevated cholera activity in multiple provinces, with more than 40 confirmed cases reported Feb. 5-May 22. Gauteng is the most affected province reporting 34 confirmed cases, most of which are identified in the Hammanskraal region. Other provinces reporting disease activity include the Free State (6 cases) and Limpopo (1 case). Health officials are conducting tests on the water supply to Hammanskraal and its surrounding areas to determine the source of infection. This represents the most complete data available as of May 23.

Context

On Feb. 5, the first three cholera cases in the current 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. Lack of access to clean drinking water and poor water quality in the affected areas is the suspected source of infection in this outbreak. 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.