# Between 29 December 2025 and 24 May 2026, 23 confirmed cases of respiratory diphtheria and seven asymptomatic carriers have been identified in South Africa.

*biotech · news · 2026-05-29 · NICD*

## Key points

- Since week 20 of 2026, no new confirmed respiratory diphtheria cases or carriers have been found.
- All 23 respiratory diphtheria cases and 7 carriers in South Africa originated in the Western Cape.
- Immediate initiation of treatment, contact tracing, and chemoprophylaxis is advised before lab confirmation.
- Early administration of diphtheria anti-toxin is emphasized as potentially life-saving for suspected cases.

Between 29 December 2025 and 24 May 2026, 23 confirmed cases of respiratory diphtheria and seven asymptomatic carriers of toxigenic C. diphtheriae have been identified in South Africa. All respiratory cases and carriers were from the Western Cape. Highlights: Since the last situational report (week 20, 2026), the following updates are included in this report: o No new laboratory-confirmed cases of toxigenic diphtheria. o No new asymptomatic carriers of toxigenic C. diphtheriae. Information for clinicians Clinical presentation of respiratory diphtheria Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages. The clinical presentation includes the following signs and symptoms: sore throat low-grade fever AND an adherent membrane of the nose, pharynx, tonsils, or larynx – the membrane is greyish-white and firmly adherent to the tissue AND/OR enlarged glands in the neck (bull neck) toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage Patient management Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary. To access previous diphtheria situational reports, click here.

**Countries:** South Africa

[Read the full story on NICD](https://www.nicd.ac.za/diphtheria-situational-report-week-21-of-2026/)

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