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Cholera in SA: what you need to know and look out for

Picture Cindy Waxa/Reporter ANA

Picture Cindy Waxa/Reporter ANA

Published Mar 3, 2023


This week, the National Health Department confirmed a sixth person's death from cholera.

In a media statement, the department said the deceased was a 19-year-old woman living in the Emandleni informal settlement in Benoni, Ekurhuleni District in Gauteng.

"The patient was identified by the Outbreak Response Team during contact tracing and social mobilisation activities, where over 1160 people were reached. She was one of the two people who exhibited signs and symptoms of cholera who were referred to hospital for testing. Her test results came back positive, and she was given treatment and recovering well," the department's Foster Mohale said.

Mohale said although there is no need for the public to panic, the department is concerned about the rising number of cholera cases and urges all people who experience Cholera symptoms, with or without local or international travel history, to visit their nearest health facility.

The National Institute for Communicable Diseases explained that the first three cases were imported or import-related cases following travel to Malawi.

The NICD said cases four and five acquired infection locally; they had not travelled, had no links to imported cases or to each other, and don’t reside or work in the same area.

“These two are classified as indigenous cases. The sixth case is newly reported and under investigation,” the institute said.

The NICD has also issued an alert on what communities should be aware of and signs and symptoms to look out for.

How does cholera affect a person?

The incubation period (the period from when the person ingests cholera-contaminated water/food to when they first become ill) ranges from a few hours to five days (usually 2 - 3 days). Most persons infected with cholera will have very mild illnesses or not feel ill at all. Mild cholera presents as a diarrhoeal illness which can’t easily be distinguished from other common causes of diarrhoea. In its severe form, cholera typically presents as follows:

• sudden onset of illness;

• diarrhoea which is profuse, painless and watery, with flecks of mucus in the stool ("rice water" stools);

• vomiting may occur, usually early in the illness;

• most persons don’t have fever, although children may develop a fever;

• dehydration occurs rapidly and if untreated, can be fatal,

How is cholera spread?

Water contaminated with human faeces is the most important means of cholera transmission, either directly (through drinking contaminated water) or indirectly (through eating contaminated food).

• Water can be contaminated at its source, during storage or during use.

• Food can become contaminated when it comes into contact with contaminated water. Vegetables that have been fertilised with human excreta (nightsoil) or "freshened" with contaminated water also become contaminated. Fish (particularly shellfish) sourced from contaminated water and eaten raw or insufficiently cooked may also cause infection.

• Soiled hands can also contaminate clean drinking water and food

What precautions should people take?

The community should be informed about sources of contamination and ways to avoid infection. Hand washing is vital in all community and health facility settings. Attention to sanitation can markedly reduce the risk of transmission of cholera as well as other diarrhoeal diseases.

This is especially true where the lack of improved sanitation may lead to the contamination of water sources. High priority should be given to observing the basic principles of sanitary human waste disposal and particularly the protection of water sources from faecal contamination.

• Use safe water. If people are concerned about the quality of water they use for drinking and cooking, it is recommended to treat the water first by boiling it (place water in a clean container and bring it to a boil for one minute) or treating it with household bleach (add one teaspoon of household bleach (containing 3 to 5% chlorine concentration) to 20 litres of water, mix well and leave it to stand for at least 30 minutes before use). Water should be stored and covered in clean containers.

• Because contaminated food may also be a source of cholera infection, attention to food safety is an essential preventive measure in order to prevent faecal contamination of food by food handlers. Street vendors and communal food sources will require particular attention through health education, since they pose a special risk.

Picture: NICD

Picture: NICD

Picture: NICD