The health department has asked public health specialists to investigate why such a high proportion of SA’s confirmed cholera cases have died, director-general Sandile Buthelezi said on Tuesday.
As of Tuesday midday, the country had confirmed 51 cases and 15 deaths from cholera, according to health department spokesperson Foster Mohale.
“We are worried. It is a very high case fatality rate,” Buthelezi said.”
The data on hand on Tuesday pointed to a case fatality rate (the ratio of deaths to cases) of almost 30%. With early diagnosis and prompt treatment, the case fatality rate should remain below 1%, according to the World Health Organisation (WHO).
“We want the whole country to be on alert and treat every acute diarrhoea case as cholera until proven otherwise,” he said.
Cholera has been reported in Gauteng, the Free State and Limpopo, with the community of Hammanskraal north of Pretoria hardest hit. It is not clear at this stage what proportion of the cases are imported or due to local transmission.
The SA Medical Association Trade Union (Samatu) warned that the shortage of doctors at public hospitals, including Jubilee Hospital in Hammanskraal, made it more difficult to manage the outbreak.
“Public healthcare facilities in SA are under-resourced, understaffed and overburdened. Without adequate resources and staffing, the ability of hospitals to cope with the outbreak will be drastically reduced,” it said.
Cholera is a bacterial disease spread by ingesting contaminated water or food, or direct contact with someone who is infected. While most cases are mild, it can quickly cause more serious illness that can cause severe dehydration and lead to death within hours.
The world has seen a surge in cholera since mid-2021, with outbreaks reported in 24 countries, 15 of them in Africa.
WHO data shows cholera has been reported in several of SA’s neighbouring states, including Zimbabwe, Mozambique and Eswatini. Outbreaks have also been declared in Zambia and Malawi.
“Given the ongoing cholera outbreaks in the southern African region, there is a high probability of continued importation,” said the health department’s acting chief director for communicable diseases control Aneliswa Cele. “We have alerted points of entry and port health authorities — we are on high alert,” she said.
The rise in cholera outbreaks, many in regions that had been cholera-free for decades, has led to such an acute shortage of cholera vaccines that the WHO advised countries in 2022 to administer only a single dose instead of the usual two.
State-backed vaccine manufacturer Biovac has signed a licensing and technology-transfer agreement with the International Vaccine Initiative to manufacture an oral cholera vaccination, but it is not expected to reach the market until late 2026.
As stocks of cholera vaccines are critically low, a global stockpile is managed by the WHO's International Co-ordinating Group on Vaccine Provision, said Juno Thomas, head of the centre for enteric diseases at the National Institute of Communicable Diseases. Countries with cholera outbreaks can apply to this group for emergency supplies, she said.
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