Cholera, which was unknown in Africa south of the Sahara, became an identifiable disease in South Africa in 1919. In the 1970's, 5 cases were diagnosed in people coming into South Africa from countries to the north. Instructions regarding Cholera surveillance were circulated in 1979 following an outbreak in Maputo. There was no evidence of any case of cholera acquired in South Africa before September 1980. Within 12 days, there were 23 proven cases of Vibrio cholera, El Tor biotype, among Africans who obtained drinking water from an irrigation canal off the Crocodile River midway between Nelspruit and Kaapmuiden. Five hundred forty-six cases had been identified by the end of February 1981 and more are expected.

On 13 October 1980, a team of health officials collected at Nelspruit to coordinate measures to contain the epidemic. They included chlorination of the irrigation canal, water surveillance of local rivers by sampling or leaving Moore pads in situ, increasing the number of staff and strengthening equipment at local laboratories, educating local medical and nursing staff in patient management and providing adequate stocks of intravenous fluids and tetracycline. Patients' contacts were traced, their homes inspected, their water supply sources and means of sewage disposal checked and the public educated in cholera prevention. There were regular press statements, radio talks, television programs and the broadcasting of educational leaflets to warn the population to take precautions. It was decided not to hold a mass immunization campaign nor to administer preventive antibiotics.