In efforts to manage the spread of cholera in the township of Hammanskraal, north of Pretoria, Gauteng Health has set up field hospitals – temporary tents to attend to residents presenting with symptoms of dehydrations, vomiting and diarrhoea.
The Mercury reports that upon arrival at the tented units, patients are treated through oral or intravenous hydration, with critical patients being taken to hospitals across Tshwane.
By Saturday, there were 215 people at the Jubilee District Hospital in the area, with another 23 transferred to Garankuwa’s Dr George Mukhari Academic Hospital.
The Health Department has asked public health specialists to investigate why such a high proportion of SA’s confirmed cholera cases have died, said director-general from the Health Department Sandile Buthelezi.
He added that the country had confirmed 51 cases and 15 deaths from the disease, “which was worrying”.
A case fatality rate (the ratio of deaths to cases) had been reported of almost 30% this week (Tuesday), reports BusinessLIVE. Yet according to the WHO, with early diagnosis and prompt treatment, the case fatality rate should remain below 1%.
Outbreaks have been also reported in Gauteng, the Free State and Limpopo, and this week, two cases were confirmed in the North West, according to provincial health spokesperson Tebogo Lekgethwane. Both cases are men, aged 38 and 68, from the Madibeng and Morelete municipalities.
Limpopo has also recorded its first case, after a Zimbabwean national was admitted to Musina Hospital. News24 reports that the 26-year-old man was admitted to hospital last Friday, and had since been isolated and treated, and was recovering well. The province’s health authorities said the case was not unexpected, due to an outbreak in the neighbouring Beitbridge district in Zimbabwe.
Health facilities in Bela Bela and the Vhembe district were on high alert, it said.
The SA Medical Association Trade Union (Samatu) has warned that the shortage of doctors at public hospitals makes 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.
In the Free State, Ngwathe Municipality blamed sabotage and load shedding after AfriForum announced that water samples taken from the Vaal River in Parys had tested positive for cholera.
Mayor Victoria De Beer-Mthombeni said they were aware of the contamination of the river, which supplies both Parys and Vredefort, and were doing what they could to ensure a supply of clean water.
Earlier this week, AfriForum reported that an accredited laboratory took water samples at different locations in the province under the supervision of a water specialist.
The first water sample taken at the outlet of the waterworks was not contaminated with cholera. The second sample taken from a residential house in Parys tested negative for cholera, but was infected with E. coli.
News24 reports that the third water sample was taken in the Vaal River, just 10m downstream from a manhole pouring sewage into the river. This sample was contaminated both with cholera and E. coli.
“AfriForum is still waiting for the official results, but the laboratory has already notified the municipality of the results.
“It is extremely worrying that the withdrawal point for Vredefort’s water is only a kilometre from the sewage spill.”
The National Institute for Communicable Diseases (NICD), meanwhile, says there is no epidemiological evidence to suggest the outbreaks had spread from one area to another, with pathologist Dr Linda Erasmus saying although the outbreaks in Gauteng and the Free State seem to be simultaneous, “there is no current evidence to suggest the Free State cases are linked to interprovincial travel”, reports TimesLIVE.
The world has seen a surge in cholera since mid-2021, with outbreaks reported in 24 countries, 15 of them in Africa.
WHO data show 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.”
The rise in 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 NICD.
Globally, fears are mounting that other life-threatening diseases, such as polio, which had been eradicated for decades, could return because of the immunisation gap caused by the Covid-19 pandemic, adds The Mercury.
The WHO sounded the alarm after cases of polio, last detected in 1989, were recorded in neighbouring countries.
“It is a sad state of affairs that we are catering for outbreaks of diseases (from) … the middle ages. South Africa is the richest economy on the African continent,” said Jo Barnes, senior lecturer emeritus at the Faculty of Medicine and Health Sciences at the University of Stellenbosch.
The WHO said if the immunisation gap continued unabated, it would create a playground for vaccine-treatable diseases that could be fatal.
Cholera, measles, diphtheria and mumps are some of the illnesses that have cropped up across the country, in some cases causing deaths.
This week, the Western Cape Health Department confirmed a case of diphtheria in a 3-year-old who died last month. Another case was detected in KwaZulu-Natal.
The vaccine for diphtheria is given during childhood.
Dr Simangele Mthethwa and Dr Joseph Wamala of the WHO Emergency Preparedness Response Team (EPR), said any disease could become an outbreak.
“We should be worried about all vaccine-preventable diseases against which our children are not vaccinated, because all have a potential of spiralling into outbreaks,” they said.
Minister of Health Joe Phaala called for vigilance after the detection of the diphtheria cases, saying there was a shortage of vaccines.
Dean of the Wits Faculty of Health Sciences and professor of vaccinology Shabir Madhi said all children were meant to get at least four doses of the diphtheria vaccine in the first two years of life and a booster dose at school entry.
“Unfortunately, around 80% of children receive all of their vaccines in the first two years, and fewer than 20% receive the booster dose at school entry,” he said.
See more from MedicalBrief archives:
Unsafe national water supply sparks fears of larger cholera spread
Cholera tests for two Gauteng rivers after baptisms
Warning of possibly more cholera cases