The Western Cape Department of Health (WC DoH) has issued an alert to inform healthcare providers that there have been reported diphtheria cases in a community in the Eastern sub-district of the Cape Town Metropolitan District.

Diphtheria is a contagious and potentially life-threatening disease that is caused by a bacterium called Corynebacterium diphtheria. The disease is transmitted by droplet spread and direct contact with infected persons.

Diphtheria usually affects the upper respiratory tract but can also affect the skin and rarely other sites including the eye, ear or genitals. A toxin produced by the bacteria causes local tissue damage and can be absorbed into the bloodstream affecting the heart, nervous system or kidneys.

Diphtheria is preventable by vaccination given at 6,10, 14 weeks, with booster doses given at 18 months, 6 years and 12 years of age.

The incidence of diphtheria worldwide and in South Africa has been reduced due to increasing immunisation levels, such that only sporadic cases of disease have been identified and reported.

Two confirmed cases of diphtheria were identified in KwaZulu-Natal in 2016, and an outbreak of 15 cases occurred in eThekwini, KwaZulu-Natal in 2015, affecting incompletely immunised children of primary school-going age.

According to the WC DoH, on the 3rd of August 2017 a diagnosis of diphtheria was confirmed in a 10-year old child at a provincial hospital. The child subsequently died the next day. The child reported with symptoms compatible with diphtheria, a fever and sore throat, during the week ending on the 26th of July 2017.

The child’s two siblings and mother of have since tested positive for diphtheria and have been administered with diphtheria anti-toxin, along with appropriate antibiotic treatment. According to the WC DoH they remain in a stable condition.

Since the initial case, provincial and district health services have identified and, as required, treated contacts of the family, including household members, pupils at the school attended by the infected child and healthcare workers who provided initial care in order to prevent additional cases.

In response to the confirmed cases, more than 600 individuals have been vaccinated in the affected community and there are plans to continue the selective vaccination campaign targeting at-risk groups.

The WC DoH has emphasised that persons who are in contact with a confirmed case should receive post-exposure prophylaxis including antibiotics and vaccination to prevent spread of the bacterium, and should have a pharyngeal swab taken.

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