The first cases of cholera in Gauteng were traced to a bus trip to Malawi back in January, Health Minister Dr Joe Phaahla said

The explanation of the origins of the deadly waterborne disease is unlikely to bring any comfort to the families who lost their loved ones to the outbreak.

On Wednesday, Phaahla held a press briefing at Tshedimosetso House in Pretoria, where he outlined the timeline of what has now come to be known as the Hammanskraal cholera outbreak, which has claimed 23 lives.

As the minister was speaking, the Mpumalanga Health Department reported that a 73-year-old hypertension patient from Phake near Siyabuswa died at Mmametlhake Hospital outside Hammanskraal after testing positive for the disease.

Phaahla said the first two cases involved sisters who travelled together from Diepsloot in Johannesburg to Malawi and returned on January 30. He said the two tested positive for cholera on February 5.

“A husband of one of the women also subsequently tested positive for cholera after developing symptoms. Subsequently, eight more cases were confirmed, six more in Johannesburg, mainly in Diepsloot, and two cases in Ekurhuleni.

“The one case in Ekurhuleni, a child, unfortunately, died from the disease. The last public statement regarding those early cases was by us on 29th March 2023. These cases were linked to travel to an endemic country viz Malawi even though the two in Ekurhuleni could not be directly linked,” said Phaahla.

The minister stated that transmission was limited to close family members and households.

“The public health awareness [campaign] helped to contain them, and there have been no further reports on these,” he said.

According to Phaahla, signs of an outbreak were seen following notification of increased diarrhoea cases in the Free State, including the Ngwathe Local Municipality in the Fezile Dabi District and towns such as Vredefort and Parys.

“A total of 174 patients with diarrhoea were attended to at various clinics and hospitals, mainly Parys and Boitumelo District Hospitals. Unfortunately, due to the fact that some of the patients presented at clinics where conditions were not adequate to take specimens for [the] laboratory, this was not done.

“On May 12, 2023, I received a message from the [Free State] health MEC that eight patients had died from diarrhoea, two at home and three each at Parys and Boitumelo hospitals. [At the time] laboratory tests were outstanding.

“Subsequently, laboratory tests confirmed only one of the eight deaths as cholera. Further tests on other patients who were admitted or treated for diarrhoea confirmed eight more definite cholera cases bringing the total to 9,” said Phaahla.

Phaahla added that there were problems with the testing of water sources in the Free State due to a high content of chloroform.

“The last case to test positive was on 23 May 2023. All measures of health education about water and food safety are being promoted by the district, provincial, national, and World Health Organisation personnel are assisting the district in monitoring and health promotion,” he said.

The South African government has since declared Hammanskraal, in the Tshwane Metro Municipality, the epicentre of the country’s cholera problem.

“The first reported case is of a 56-year-old male originally from Giyani, Limpopo, who resides in Musina. The patient is a police officer, and he is enrolled for a three-week course at the South African Police Service College in Hammanskraal.

“He arrived on 7th May and started [his course] on 8th May. On 12th May he complained of diarrhoea and vomiting and was taken by ambulance to Muelmed Hospital in Pretoria on 15th May 2023. Laboratory tests confirmed cholera on 15th May and it was further confirmed by the National Institute for Communicable Diseases on 18th May,” said the minister, adding that the officer was still in ICU in stable condition.

Phaahla said that a follow-up by the Outbreak Response Team revealed that more students were complaining of gastrointestinal symptoms with a total of 33 seen at various health facilities resulting in eight admissions.

“The National Department of Health and Gauteng Health Outbreak Response Teams were called to Jubilee Hospital on 19th May 2023, where on arrival they were informed of the big number of patients arriving with gastrointestinal symptoms since Monday, 15th May, the same day that the police officer was admitted to Muelmed Hospital.

“By Friday, 19th May the hospital reported that 52 patients had been seen with a mixture of diarrhoea and vomiting and already by then six patients had died. By then only a limited number of five specimens had been taken to the laboratory which is impossible to determine the cause in a majority of the patients,” he said.

This was not the end.

“In the seven days from 17 to 23 May 2023, 163 patients presented at Jubilee with diarrhoea and vomiting, giving an average of 23 patients per day. The number of deaths was 17 in seven days.

“In the subsequent seven days from 24 to 30 May, the number reduced to 30 patients with an average of four patients per day and a total of two deaths,” said Phaahla.

In response to the growing numbers, the Department of Health has since created special cholera and gastroenteritis wards and deployed specialist gastroenteritis physicians to Jubilee.

Results are also being fast-tracked while field hospitals or clinics are receiving additional health personnel.

“The key message is that at this stage the outbreak of cholera is limited to a small area in the Free State, Ngwathe municipality, with no reported new cases since May 23, 2023.

“In the case of Tshwane, we have a total of 99 confirmed cases. Again, there is a significant downward trend and the outbreak remains in Tshwane and we are confident that it will be contained,” Phaahla said.