According to South Africa’s Ministry of Health and the National Institute for Communicable Diseases (NICD), more than 350 cases of pertussis have been reported since July 2025. From January to October 2025, a total of 483 confirmed cases were reported nationally, representing a 2-fold increase over average incidence. The outbreak has yet to peak and primarily affects children under 5 years of age.
Most affected provinces:
- Western Cape: 162 cases (34% of all cases)
- Gauteng: 111 cases (23% of all cases)
- Additional cases in Free State and Northern Cape
Age distribution:
- Over half (273/483, 56%) of cases are children under 5 years
- Approximately one in four (128/483, 26%) cases are infants 6 months or younger
- Infants under 3 months face highest risk for severe complications
Keep in Mind:
- Many pertussis cases go unrecognized and unreported, meaning actual infections in South Africa likely exceed the 483 confirmed cases
- One confirmed case often represents multiple undetected infections in the community
- Pertussis is highly contagious—an infected person can spread it to 12-17 other unvaccinated individuals
- About 90% of unvaccinated people exposed to pertussis will become infected
- Symptoms begin like a common cold but progress to severe, prolonged coughing fits lasting weeks or months (the “100-day cough”)
- Infants may not cough at all but can stop breathing (apnea)
- About 1 in 5 unvaccinated people with pertussis is hospitalized
- Complications include pneumonia (1 in 20 children), seizures, brain damage, and death (1-3 per 1,000 children)
- The outbreak has yet to peak, meaning case numbers are expected to continue rising
Global Outlook on Pertussis
South Africa’s outbreak is part of a significant global pertussis resurgence in 2025. According to the Pan American Health Organization (PAHO), World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC), multiple countries worldwide are reporting substantial increases:
- Americas Region: 7 countries reporting outbreaks with 14,201 cases and 93 deaths (Brazil, Colombia, Ecuador, United States, Mexico, Paraguay, Peru)
- United States: 10,062 cases including 5 deaths through mid-May 2025
- Argentina: 180+ cases since mid-July 2025
Declining vaccination coverage is a major factor—in South Africa and globally, coverage for pertussis-containing vaccines dropped during the COVID-19 pandemic and has not fully recovered.
Vaccination and Prevention for Travelers to South Africa
All adult travelers to South Africa should receive 1 dose of Tdap (adult acellular pertussis-containing vaccine) every 10 years, assuming they previously received an adequate primary series.
Booster considerations:
- A booster dose should be considered if it has been at least 3 years since the last acellular pertussis-containing vaccine (e.g., Tdap) dose for persons aged > 65 years or those with immunocompromising conditions or underlying lung disease (off-label use)
- Those who received Td or TT for their most recent dose should receive an immediate dose of Tdap, regardless of the interval since the last tetanus dose
For families traveling to South Africa with infants:
- Parents of infants who have not yet completed a 3-dose series of a pertussis-containing vaccine may want to consider postponing travel to South Africa until the infant has received the third dose
- Infants receive DTaP vaccines at 2, 4, and 6 months of age, with boosters at 15-18 months and 4-6 years
- Infants under 6 months are at greatest risk and have the highest hospitalization and death rates
Pregnant travelers to South Africa:
- Maternal vaccination during pregnancy is highly effective at protecting newborns
- Pregnant women should receive Tdap vaccination during the third trimester (27-36 weeks) of each pregnancy
- Vaccination during pregnancy provides passive immunity to infants during the first weeks of life before they can be vaccinated
- Babies born to vaccinated mothers have a 90% decreased risk of getting pertussis in the first 3 months of life
Healthcare workers and caregivers traveling to or working in South Africa:
- Should ensure they are up-to-date on Tdap vaccination to prevent transmission to vulnerable patients and infants
- Vaccination of close contacts of pregnant women and newborns is essential
Travelers to Western Cape and Gauteng provinces should be especially vigilant, as these areas account for 57% of all confirmed cases.
Learn more about travel health risks on our website.
Learn more about the TDAP vaccine.
Schedule a pre-travel consult before your trip.
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