Cholera outbreak: source of water-borne disease remains unknown, says Health Minister Joe Phaahla

Health Minister Joe Phaahla briefs the media on the latest outcomes of the cholera outbreak. Picture: GCIS

Health Minister Joe Phaahla briefs the media on the latest outcomes of the cholera outbreak. Picture: GCIS

Published May 31, 2023


The government is yet to locate the source of the deadly cholera outbreak that has claimed 24 lives in South Africa.

Health Minister Joe Phaahla said that due to a variety of reasons, the tracking and tracing team could establish a definite source in only one of the earlier cases, that of the two sisters from Diepsloot in Johannesburg who had travelled to Malawi for a funeral and upon their return, were diagnosed with cholera.

In the other cases, the source of the disease had yet to be determined.

The minister cautioned against declaring the supply of water in Hammanskraal as the source of the outbreak in the area without definitive proof.

“Because of fact that for many years, Hammanskraal has had issues with the supply of water, it is very easy for us to say the water supply is the source of cholera. At this stage, we still have our work cut out in terms of digging deeper into where is the origin of cholera there,” Phaahla said in a media briefing on Wednesday.

He said that while it was important and desirable to locate the source of cholera, “it is not always the case that we will find the original cause of the outbreak”.

The minister provided an update on the department’s efforts and interventions in response to the outbreak.

Hammanskraal residents collect water from a water truck, Skampaneng, Hammanskraal. Picture: Jacques Naude / African News Agency (ANA).

The epicentre of the cholera outbreak is Hammanskraal in the Tshwane Metro Municipality.

Phaahla reported that in the past seven days, the number of patients presenting with symptoms had reduced to 30but noted that two people had died in the past week.

The first reported case in Tshwane was that of a 56-year-old man originally from Giyani, Limpopo, who resides in Musina. The patient was a police officer who was enrolled for a three-week course at the SAPS College in Hammanskraal. Days after arriving at the college, the officer complained of diarrhoea and vomiting. He was taken by ambulance to Muelmed Hospital where laboratory tests confirmed cholera on May 15. The diagnosis was further confirmed by the NICD on May 18.

Phaahla said the man was in ICU, reportedly in a stable condition.

A follow-up by the Outbreak Response Team revealed that more students were complaining of gastrointestinal symptoms, with 33 seen at various health facilities and of those, eight people were admitted to hospital.

Phaahla said the National Department of Health and Gauteng Health Outbreak Response Teams were called to Jubilee Hospital on May 19, where they were informed of a large number of patients arriving with gastrointestinal symptoms since the day the police officer was admitted to Muelmed Hospital.

By the end of that week, Phaahla said the hospital had reported 52 patients who had a mixture of diarrhoea and vomiting. By then, six patients had died.

In the seven days between May 17 to 23, a total of 163 patients presented at Jubilee Hospital with diarrhoea and vomiting, giving an average of 23 patients.

The number of deaths was 17 patients in seven days.

In the subsequent seven days from May 24 to 30, the number of patients presenting with symptoms reduced to 30. There were two deaths.

“Interventions at health services provision included the creation of special cholera and gastroenteritis wards, the deployment of specialist gastroenteritis physician to Jubilee Hospital, the fast-tracking of laboratory results and the setting up of a field hospital/clinic with deployment of additional health personnel.

“Working with the ward councillor of Kanana community, Health Outreach Teams have been deployed to educate the community about cholera and reinforce messages of prevention through basic hand hygiene, water and food safety.

“Our colleagues in Water Department, both in the City of Tshwane and DWS, are continuing to examine the water sources to determine any contamination.”

He said the outbreak was limited to a small area in the Ngwathe municipality in the Free State, with no new case reported since last Tuesday.

In the case of Tshwane, 99 cases had been confirmed, with seven new cases recorded in the past 24 hours. Three patients were in Jubilee Hospital, one in Military hospital, one in Eugene Marais Life hospital, one in Netcare Montana and one in Odi Hospital.

The first two cases reported by Gauteng on February 5, 2023 was of the two sisters who had travelled together by bus to Malawi in January. The husband of one of the women also subsequently tested positive for cholera after developing symptoms.

After that, eight more cases were confirmed – six in Johannesburg, mainly in Diepsloot, and two in Ekurhuleni. In the one case in Ekurhuleni, a child had died from the disease.

Even though the cases in Ekurhuleni could not be linked to the sisters who travelled to Malawi, the minister said the transmission was limited to close family members and households. Public health awareness had helped contain them as there had been no further reports on more cases.

In the Free State, the first notification of the outbreak was in the Fezile Dabi District in the Ngwathe Local Municipality, in the towns of Vredefort and Parys. A total of 174 patients with diarrhoea were attended at various clinics and hospitals, mainly Parys and Boitumelo District Hospitals, the minister said.

“Unfortunately, due to the fact that some of the patients presented at clinics where conditions were not adequate, specimens for the laboratory could not be taken.

“On the 12th May 2023, I received a message from MEC of Health, that eight patients had died from diarrhoea, two at home and three each at Parys and Boitumelo hospitals and that the laboratory tests were outstanding. Subsequently, laboratory tests confirmed only one of the eight deaths was due to cholera,” Phaahla said.

However, further tests on other patients who were admitted or treated for diarrhoea confirmed eight more cholera cases. This brought the number of confirmed cases in the Free State to nine.

Phaahla said that according to a report from the Free State, the water sources were tested but the tests were deemed non-compliant “as there was too much chlorine in the water”.

He said the department was confident in the measures taken as there was a significant downward trend showing.

“Cholera can be very quick. It may start with abdominal cramps and vomiting but then quickly move to loss of fluids and organ failure. Many of the deaths were due to loss of fluids and organ failure. So, go to the hospital or clinic or field hospital as soon as you show any symptoms such as diarrhoea and vomiting,” Phaahla said

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