INFECTIOUS DISEASES

Infections disease outbreaks strain the workplace and public health systems therefore there should always be an efforts to contain the spread of these diseases.

Employers are reminded that Section Eight of the Occupational Health and Safety Act speaks to the general duties of employers to their employees and states that every employer shall provide and maintain, as far as is reasonably practicable, a working environment that is safe, and without risk to the health of his or her employees.

Weekly updates of circulating diseases are available from the National Institute for Communicable Diseases (NICD) at https://www.nicd.ac.za/media/alerts/

Notifiable Medical Conditions (NMC)

Notifiable Medical Conditions are of public health importance and Category 1 notifiable conditions require immediate reporting by the most rapid means available upon diagnosis. A written or electronic notification to the Department of Health is also required within 24 hours of diagnosis by a health care provider, private health laboratory or public health laboratory.

A list of Category 1 notifiable medical conditions can be found on the National Institute for Communicable Diseases Website.

Some examples include:

Acute flaccid paralysis, Acute rheumatic fever, Anthrax, Botulism, Cholera, Diphtheria, Enteric fever (typhoid or paratyphoid fever) Food borne disease outbreaks (two or more cases of a similar foodborne disease), Haemolytic uraemic syndrome (HUS), Listeriosis, Malaria, Measles, Meningococcal disease, Pertussis, Plague, Poliomyelitis, Rabies (human), Respiratory disease caused by a novel respiratory pathogen (including novel influenza A virus and MERS coronavirus), Rift valley fever (human), Smallpox, Viral haemorrhagic fever diseases (including Ebola or Marburg viruses, Lassa virus, Lujo virus, new world arena viruses, Crimean -Congo haemorrhagic fever or other newly identified viruses causing haemorrhagic fever) and Yellow fever.

Respiratory Diphtheria

The NICD has recently warned of an increase of cases of Respiratory Diphtheria which is a potentially life-threatening infection caused by the bacteria Corynebacterium diphtheriae, leading to a buildup of a thick, gray coating in the throat, nose, and tonsils. This coating can block the airway, making breathing and swallowing difficult. The condition is highly contagious and can cause severe complications like myocarditis and neurological problems if left untreated.

The clinical presentation includes the following signs and symptoms:

sore throat
low-grade fever
AND an adherent membrane of the nose, pharynx, tonsils, or larynx – the membrane is greyish-white and firmly adherent to the tissue
AND/OR enlarged glands in the neck (bull neck)
toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Treatment includes antibiotics to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion.

As a Category 1 notifiable conditions it requires immediate reporting to the Department of Health and contact tracing should be started to prevent further spread.

Measles and Rubella (“German measles”)

There were 15 100 rubella cases across South Africa in 2024. This number exceeds the typical annual number of rubella cases observed since 2015. There has been a marked decrease in cases in the first weeks of 2025.

Pregnant women in their first trimester of pregnancy who acquire rubella for the first time are at risk of passing rubella onto their foetus, with consequential congenital rubella syndrome.

Measles virus infection can cause severe illness in children including severe pneumonia, encephalitis, blindness, deafness, and death. For all measles-positive cases, the public health response should be done as per the EPI(SA) immunisation guideline.

A seasonal increase is expected each year, usually between September to December. Health awareness is recommended in the areas where rubella cases are circulating to inform the population how to prevent rubella infection risk.

Measles is a notifiable disease and public health officials must urgently respond to every measles case to prevent outbreaks.

Mpox

The Department of Health urged members of the public to be extra vigilant of mpox symptoms as three laboratory-confirmed cases of the disease were detected in Ekurhuleni, Gauteng province in March 2025. This increased the total cumulative number of positive cases from 28 to 31 cases since the outbreak in May 2024. The number includes six cases recorded since the beginning of this year.

The three detected cases in March 2025 included a 38-year old man who presented to the healthcare facility with symptoms of mpox and the other two confirmed mpox cases who were both contacts of the other patient. None of the patients had recent travel history which suggests there is ongoing local transmission of the virus in the country. This also highlights the necessity of rapid and well-coordinated contact-tracing for early detection and effective management of positive cases.

Hand Foot and Mouth Disease

Since the beginning of February 2025, hand, foot, and mouth disease (HFMD) cases have been reported in educational institutions in the eThekwini District. These cases have been found in primary schools and daycare centres in the district’s northern region.

Hand, foot, and mouth disease (HFMD) is a viral infection that commonly affects infants and children under 10 years of age. It is caused by a group of viruses known as enteroviruses, which infect millions each year, globally. Small outbreaks often occur in daycare centres or crèches during the summer and autumn.

The condition is generally mild and self-limiting, meaning those affected typically recover within 7 to 10 days. Hand, foot, and mouth disease does not occur in animals and should not be confused with foot and mouth disease (also called hoof-and-mouth disease), which affects animals such as sheep and cattle.

Hand, foot, and mouth disease (HFMD) is transmitted through:

Direct contact – Touching an infected person’s saliva, nasal secretions, or blisters.
Droplets – Coughing or sneezing spreads the virus in the air.
Contaminated surfaces & objects – Shared toys, stationery, and utensils.
Contact with faeces – Poor hand hygiene after using the toilet or changing diapers.

Signs and symptoms usually start 3 to 7 days after infection and last 7 to 10 days. Common signs and symptoms include:

Fever
Sore throat
Fatigue
Loss of appetite
Small blisters on the inside of the mouth, sides of the tongue, palms of the hands, and soles of the feet.

HFMD is usually diagnosed clinically based on symptoms. In severe cases, throat or stool samples may be collected and sent to a laboratory for confirmation and to rule out other diagnoses. There is no specific vaccine or treatment for HFMD. Individual symptoms like fever and pain can be treated with medication. Affected individuals should rest and stay hydrated. The infection is usually self-limiting and resolves in 7 to 10 days without medication.

Educators and parents should encourage good hygiene practices such as regular handwashing and not sharing eating utensils (e.g., cutlery, cups, toothbrushes). Surfaces and other shared items, such as toys and stationery, should be cleaned regularly. Children should avoid direct contact with individuals who are ill. Affected children should not be excluded from school if they are well enough to attend, and there is no indication to close schools or restrict attendance when cases arise.

Malaria

The NICD also warned travellers to be vigilant against Malaria over the Easter Holidays as South Africa usually experiences an uptick in malaria cases after the Easter holidays.

The risk of malaria exists in the regions of KwaZulu-Natal, Mpumalanga, and Limpopo provinces. Additionally, neighbouring countries including Botswana and Namibia, are experiencing malaria outbreaks, with malaria cases being reported in areas not generally associated with ongoing malaria transmission. While Mozambique has not reported any outbreaks, certain areas are regarded as high-risk.

Malaria symptoms are very similar to “flu” symptoms and include headache, fever, chills, fatigue, muscle and joint pain.

All travellers returning from malaria-endemic areas, including very low-risk areas, should immediately report a flu-like illness (headache, fever, chills, fatigue, muscle and joint pain) to the nearest healthcare facility and request a malaria test. Particular care should be taken with young children, as their symptoms are very nonspecific (fever, loss of appetite, vomiting). Malaria rapidly progresses to severe illness, often with severe consequences; therefore, early diagnosis and treatment are critical.

A malaria risk map and further information on prevention are available on the NICD website.

Flu

According to the NICD, the flu season started in the week of 24 March 2025, which is four weeks earlier than last year and marks the earliest start to the flu season since 2010 however this early start doesn’t mean that this year’s flu season will be more severe than in previous years.

For most people, flu symptoms are mild and resolve in a few days. But for some, influenza can lead to severe illness. Those most at risk include:

Pregnant women
People living with HIV
Individuals with chronic conditions like diabetes, lung disease, heart disease, tuberculosis, kidney disease, or obesity
Older adults (65 years and older)
Children younger than 2 years

To reduce the spread of flu, remember to:

Wash your hands often
Cover coughs and sneezes with your elbow or a tissue
Avoid close contact with people who are sick
Stay home if you are feeling unwell

Disclaimer: This article does not intend to provide Medical Advice to the public, it is only intended to share information published by the NICD. For Medical Advice, please consult your Healthcare provider.