The Minister of Health, Dr Joe Phaahla calls for vigilance as the country records two laboratory-confirmed cases of cholera imported from Malawi. The cases are sisters who had travelled together from Johannesburg to Malawi to attend a funeral service, and returned by bus on 30 January 2023. Both patients had developed symptoms on their return to Johannesburg.

One patient presented to a local clinic and was then admitted to hospital. During the case investigation and follow-up of close contacts, the sister reported that she also developed diarrhoea whilst travelling back from Malawi but it resolved within a day and she did not seek health care.

A close contact (household family member) of one of the cases/patients was admitted to hospital on 4 February with diarrhoea and dehydration, and is considered a possible case. Laboratory test results are pending and follow-up of close contacts is ongoing.

Cholera is an acute enteric infection caused by the bacteria Vibrio cholerae, and the outbreaks usually occur in settings with inadequate sanitation and insufficient access to safe drinking water. Cholera typically causes acute watery diarrhoea and can affect people of all ages.

It mainly spreads through contaminated/polluted water. People can become infected directly through drinking contaminated water, or indirectly through eating contaminated food. The infection is often mild or without symptoms, but can sometimes be severe and life-threatening.

Symptoms ranges from mild to severe and watery diarrhoea and dehydration. The incubation period (the period from when the person ingests cholera-contaminated water/food to when they first become ill) ranges from few hours to 5 days, usually 2 to 3 days. Most persons infected with cholera will experience mild illness or not feel ill.

Although, cholera is often predictable and preventable. People are urged to ensure proper hand-hygiene which includes thorough washing of hands with water and soap before and after using the bathroom/toilet, and preparing or eating food.  The use of only safe or disinfected water for preparing food, beverages and ice is recommended to prevent possible cholera transmission include. Safe disposal of human excrement and nappies is recommended.

The department is working closely with the affected province, the National Institute for Communicable Diseases and World Health Organization to closely monitor the situation. All people experiencing symptoms such as diarrhoea and dehydration, with or without travel history to cholera outbreak countries are urged to report at their nearest health facilities for health screening and early detection.

The World Health Organization does not recommend any travel or trade restrictions on countries based current available information in line with the international health regulations. The port health officials at the ports of entry (especially land and air) will remain on alert for travellers arriving from countries experiencing cholera outbreak.

South Africa is not endemic for cholera, and the last outbreak was in 2008/9 with about 12 000 cases. That resulted from an outbreak in Zimbabwe which led to surge of imported cases and subsequent local transmission in Mpumalanga and Limpopo provinces through contaminated water.

Distributed by APO Group on behalf of Republic of South Africa: Department of Health.