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Two cholera cases confirmed in South Africa

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Health Minister, Dr Joe Phaahla, has called for vigilance as the country has recorded two laboratory-confirmed cases of cholera imported from Malawi.

According to the department, the cases were confirmed in two 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,” the department said in a statement.

The department said it is working closely with the affected province, the National Institute for Communicable Diseases (NICD) and World Health Organisation (WHO) to closely monitor the situation.

It urged all people experiencing symptoms, including diarrhoea and dehydration, with or without travel history to cholera outbreak countries, to report to their nearest health facilities for health screening and early detection.

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

Cholera is an acute enteric infection caused by the bacteria Vibrio cholera, and 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, and 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 range from mild to severe and watery diarrhoea and dehydration. The incubation period (the period from when a person ingests cholera-contaminated water/food to when they first become ill) ranges from a few hours to five days, usually two to three days.

“Most persons infected with cholera will experience mild illness or not feel ill,” the Health Department said. 

Although cholera is often predictable and preventable, the department has urged people to ensure proper hand hygiene, including thorough washing of hands with water and soap before and after using the bathroom/toilet, and preparing or eating food. 

The use of safe or disinfected water for preparing food, beverages and ice is recommended to prevent possible cholera transmission. Safe disposal of human excrement and nappies is recommended. 

The department said cholera is not endemic in South Africa, and the last outbreak was in 2008/9, with about 12 000 cases.

“That resulted from an outbreak in Zimbabwe, which led to a surge of imported cases and subsequent local transmission in Mpumalanga and Limpopo provinces through contaminated water,” the department said.

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