South Africa is stepping up its response to mpox after a rapid increase in confirmed infections, with Cape Town and the wider Western Cape accounting for the vast majority of cases.
As of 22 September, the country had recorded 22 laboratory-confirmed cases since the beginning of 2026. Eighteen were in the Western Cape, three in Gauteng and one in KwaZulu-Natal, according to the National Institute for Communicable Diseases (NICD) and the Department of Health.
The increase has been particularly noticeable in recent weeks. Thirteen of the Western Cape’s 18 cases were confirmed from mid-August onwards, with health authorities identifying two clusters of close contacts and continuing their investigations. Preliminary analysis indicates that Clade Ib mpox virus is involved in both clusters.
Cape Town at the centre of the outbreak
The Western Cape has become the country’s main focus of surveillance.
When the Department of Health issued its first warning about the recent increase on 18 September, 15 confirmed cases had already been reported in the province, most of them in Cape Town. Authorities subsequently confirmed four additional national cases, bringing the total to 22.
Health officials are working with the NICD and the World Health Organization to strengthen surveillance, contact tracing and the response to new infections.
Vaccination is also being made available according to individual risk and exposure, while health authorities are encouraging people to recognise symptoms and seek medical attention early.
What is mpox?
Mpox is a viral infection caused by the mpox virus. It can spread through close physical contact with an infected person, including contact with lesions, bodily fluids or respiratory secretions during prolonged close contact. Contaminated materials can also play a role in transmission.
Symptoms can include fever, headache, muscle aches, back pain, fatigue and swollen lymph nodes, followed by a rash or lesions. These can appear on the face, hands and feet, as well as in the mouth or genital area.
Importantly, mpox can affect anyone. South Africa’s Department of Health has specifically stressed that transmission is not restricted by gender, sexual orientation or any other demographic characteristic.
That remains an important distinction in LGBTQ+ health coverage. Mpox became strongly associated with gay and bisexual men during the global outbreak that began in 2022, but the virus itself is not an LGBTQ+ disease.
Why LGBTQ+ communities are still part of the conversation
Although sexual orientation is not given for the South African cases, the international experience of mpox means sexual health services and LGBTQ+ communities remain an important part of public-health communication.
The virus can spread through intimate skin-to-skin contact, including during sex, regardless of the genders or sexual orientations of the people involved.
For anyone who develops an unexplained rash, sores or lesions particularly after close contact with someone who may have mpox health authorities recommend avoiding close physical contact and seeking medical advice.
The NICD also advises healthcare professionals to consider mpox when patients present with an unexplained acute vesicular or pustular rash or oral ulcers accompanied by symptoms such as fever, headache, muscle aches, swollen lymph nodes or fatigue.
A reminder that mpox has not disappeared
The South African increase comes against a much broader backdrop of mpox transmission in Africa.
According to the NICD, citing the World Health Organization’s September 2026 situation report, 35 African countries reported more than 52,000 laboratory-confirmed cases and 238 deaths between January 2025 and August 2026. During the six weeks to 16 August, 11 African countries reported active transmission.
The South African outbreak is therefore part of a wider regional picture rather than an isolated development.
For now, authorities are concentrating on identifying cases quickly, tracing contacts and limiting further transmission.
With most of South Africa’s confirmed cases currently concentrated in the Western Cape, the coming weeks will show whether the country’s intensified response can contain the clusters around Cape Town.
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