Since 2020 South Africa has seen a steady increase in vaccine-preventable diseases, illnesses related to advanced HIV, opportunistic infections and waterborne sickness, despite strides in healthcare provision.
The findings of the Germs-SA Annual Surveillance Review for 2023 have sparked concern by the National Institute for Communicable Diseases (NICD) and prompted a call for “collaboration among health authorities, healthcare workers and the public”.
Germs-SA is a national, population-based laboratory surveillance programme for bacterial and fungal infections. The programme is a collaboration between the NICD, a division of the National Health Laboratory Service, participating South African clinical microbiology laboratories — public and private — and selected public hospitals.
Germs-SA systematically collects, collates and analyses data on diseases of public health importance to provide accurate, quality-controlled strategic surveillance information to clinical managers and public health policymakers.
“A total of 14,138 surveillance cases were detected by Germs-SA in 2023, showing different trends in pathogen incidence and age groups,” the report states.
“Respiratory-transmitted pathogens affected by Covid-19 non-pharmaceutical practices have returned to their pre-Covid-19 levels. The highest burden was found in the Western Cape for many pathogens, possibly related to health-seeking behaviour, better laboratory capacity and specimen-taking practices.”
When it came to opportunistic infections, the report found the number of cryptococcal disease episodes remained stable from 2022 to 2023, “indicating a continued significant healthcare burden, with many patients requiring hospitalisation ...
“The in-hospital mortality rate remained high, especially among those who did not receive flucytosine-based induction therapy, despite treatment guidelines recommending its use.”
Cryptococcal meningitis is a fungal infection of the brain and spinal cord that's caused by breathing in airborne spores of the Cryptococcus fungus. It's a leading cause of death for people with HIV/Aids.
Among the other key findings of the report was a rise in respiratory-transmitted diseases, of which many are vaccine-preventable.
Symptoms of cryptococcal meningitis include:
- headache;
- fever;
- neck pain;
- sensitivity to light;
- confusion or altered behaviour;
- nausea and vomiting;
- stiff neck; and
- hallucinations.
Among the other key findings of the report was a rise in respiratory-transmitted diseases, of which many are vaccine-preventable.
In children under one year, haemophilus influenza disease (incidence rate of 7.59 episodes per 100,000 population) and invasive pneumococcal disease (incidence rate of 14.90 episodes per 100,000 population) still cause substantial disease.
The World Health Organization (WHO) describes haemophilus influenza as “bacteria commonly found in the upper respiratory tract, which are transmitted by droplets from people who are infected (but not necessarily symptomatic) to those who are susceptible.
“If these bacteria enter the bloodstream, becoming ‘invasive’, they can cause pneumonia, meningitis, sepsis or other serious diseases. If the bacteria spread to the sinuses or the middle ear, this can lead to sinusitis or otitis media, a painful type of ear infection.”
The report also found in 2023 there was a 53% increase in invasive meningococcal disease (IMD) episodes, caused by the bacteria Neisseria meningitidis, reported through the programme, compared with 2022. IMD is a major cause of meningitis and septicaemia. The disease often has a rapid progression, with an 8% to 15% case fatality ratio.
The highest incidence occurs in young children, with a second disease peak among adolescents and young adults. IMD increased from 0.12 (per 100,000 people) in 2022 to 0.18 (per 100,000) in 2023, with serogroup B disease dominating.
The report also showed most E coli cases were concentrated in Gauteng and KwaZulu-Natal, with more than half originating from the bloodstream.
“Most (96%) cholera cases were from Gauteng, particularly affecting adults aged 35-44. After the first confirmed case in three years, an outbreak was declared in February 2023, initially linked to imported cases from Malawi. The local spread primarily affected the City of Tshwane from May to July.”
A total of 83 cases of the foodborne disease listeriosis were reported for 2023 — mostly from the Western Cape, Gauteng and KwaZulu-Natal and primarily affected those aged between 15-49.
“The number of cases was lower than expected. Distribution patterns mirrored the previous year.”
Between 2017 and 2018, a listeriosis outbreak saw 1,060 laboratory-confirmed cases reported by the NICD and 218 deaths. The NICD identified Tiger Brands’ Enterprise Foods factory in Polokwane as the source of the outbreak in 2018. A class-action lawsuit was launched against Tiger Brands that year. The case is still before court.
The NICD urged healthcare workers to promote the Expanded Programme on Immunisation vaccinations and encouraged caregivers to take their children for immunisation, including catch-up vaccines.
“We encourage members of the public to get tested for HIV and commit to lifelong antiretroviral treatment to control the infection and prevent the development of opportunistic infections,” it said.
“The Germs-SA surveillance report further highlighted waterborne diseases are prevalent and this can be improved only through better hygiene and sanitation.
“Most of these diseases are manageable and all healthcare workers are encouraged to promote testing and treatment for HIV prevention and care.”
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