NICD warns of increase in cases of respiratory diphtheria

The National Institute for Communicable Diseases (NICD) has asked the public to review the vaccination status of their children after an increase in diphtheria cases.

The NICD said from January 1 until March, diphtheria caused by a bacteria called toxigenic Corynebacterium diphtheriae has been confirmed in 40 people in South Africa.

“Of these, 19 had symptoms, and 21 had no symptoms. These asymptomatic individuals were carriers identified during contact tracing.”

The 21 include 15 respiratory diphtheria cases in the Western Cape, two in Gauteng, three in Mpumalanga and one probable case in Limpopo, not confirmed in the laboratory, but the individual had symptoms consistent with respiratory diphtheria.

The NICD said more than 78% of the cases had been in adults.

“Of the symptomatic cases, it is important to note that nine individuals have died, with a case fatality ratio of 27% (9 of 33) since the beginning of 2024.”

Adults who have not had a diphtheria vaccine in the last 10 years are urged to seek vaccination at a clinic or with their usual healthcare provider.

The NICD said pregnant women were advised to get the vaccine with each pregnancy to protect the baby from diphtheria, tetanus and pertussis.

Diphtheria is a contagious, severe, vaccine-preventable illness, usually associated with a sore throat, fever and large swollen glands in the neck. This is sometimes called a “bull neck”, and on examining a patient, the doctor will see a characteristic adherent membrane over the tonsils and the throat. This is sometimes called a “pseudomembrane”.

The NICD said if not treated early, diphtheria causes difficulty in breathing and can lead to complete blockage of the airway and death. The organism also produces a toxin which affects the heart muscle, kidneys and nervous system, leading to life-threatening illness.

Treatment is with diphtheria antitoxin to neutralise the toxin produced by the bacterium and appropriate antibiotics to eradicate the organism.

The NICD said the best protection against diphtheria was vaccination.

“Infant vaccine is given at six, 10 and 14 weeks of age, with booster doses at 18 months, six years and 12 years.”

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