The Public Health Surveillance and Response Division was established incorporating GERMS-SA, Outbreak Response and Travel Health.
The division facilitates communication and data sharing between the national and provincial health departments and the NICD, and provide epidemiological input to other NICD units through collaborative projects and support of surveillance and epidemiological activities and outbreak responses.
The Division of Public Health Surveillance and Response (DPHSR) includes the GERMS-SA surveillance programme, the Epidemiology Support Unit (responsible for provincial epidemiology support and the national notifiable medical conditions) and the Outbreak Response Unit (ORU), responsible for the Emergency Operations Centre (EOC). Together, these three Units contribute significantly to national communicable disease surveillance and response efforts. Furthermore, these activities undergird and support the surveillance and research activities of the NICD centres.
Globally, there is increasing pressure from the World Health Assembly that member states adhere to the International Health Regulations (IHR, 2005). Signatory countries have been requested to host a ‘Joint External Evaluation’ of adherence to requirements of the IHR, which include activities to support prevention, detection and response to communicable disease, chemical and radiation events. The NICD contribution included capacity for communicable disease diagnostics, disease surveillance and technical support for response activities fulfil and support many of the requirements of the IHR. The EOC supported by the ORU is able to provide coordination and management of public health events of national and regional concern through the use of an incident management system and dedicated staff. Further, on account of these capacities, the NICD is a key role-player in national, regional and international responses to public health threats. The DPHSR collaborates and co-operates with the National Department of Health, the National Disaster Management Centre, the National Joint Operations Committee in support of the IHR. Disease intelligence emanating from NICD surveillance activities is reported regularly through the Multinational Outbreak Response Team, and to other government structures as the need arises
At a national level, the technical expertise of the NICD is made available to provinces and districts within South Africa through multiple arms of the DPHSR:
- Provincial epidemiologists are based in the provinces and support analysis of routine TB and HIV data, outbreak investigation and interpretation of communicable disease data;
- NMC alerts triggered by the NHLS laboratory information system and clinicians in public sector health facilities ensure that district and provincial communicable disease staff are timeously informed about the presence of disease;
- Outbreak Response Unit staff provide support for appropriate public health interventions on request and in response to NMC alerts; and
- The 24-hour hotline staffed by NICD pathologists and doctors and co-ordinated by DPHSR provides a forum for rapid alert and notification of disease of public health importance, as well as provision of technical advice for a range of infectious conditions.
The GERMS-SA programme, established in 2003, is a nationwide surveillance programme coordinated by the Division of Public Health Surveillance and Response at the NICD. Following the amalgamation of multiple, laboratory-based surveillance projects in 2012 and 2013, the name was modified to GERMS-SA.
Its main objective is to provide strategic information regarding trends in the pathogens of public health importance, e.g. vaccine-preventable diseases to measure the impact of vaccines, epidemic-prone diseases to monitor and respond to outbreaks, healthcare-associated bloodstream infections with the trend of antibiotics resistance and the burden of HIV-associated opportunistic infections (OI). Annually, approximately 200 clinical microbiology laboratories send isolates meeting GERMS-SA case definitions to NICD reference laboratories for phenotypic and genotypic characterisation; the data generated is disseminated to participants and stakeholders via numerous reports and publications.
- To deliver accurate, quality-controlled strategic surveillance information on selected organisms to participants and stakeholders, e.g. Department of Health;
- To improve laboratory participation in the surveillance programme;
- To improve clinical case data collection at enhanced surveillance sites;
- To improve and maintain surveillance data management procedures;
- To facilitate improved laboratory diagnosis of diseases under surveillance;
- To provide support to similar laboratory-based surveillance efforts by neighbouring African countries; and
- To undertake special research studies nested within the surveillance programme.
NICD has historically supported the National Department of Health (NDoH) in its roles of responding to priority diseases such as HIV and TB and to outbreaks of infectious diseases. Support to provincial DoH has primarily been from teams based at the NICD until 2014 when the NICD set up a provincial epidemiology team (PET) comprising of one senior epidemiologist based at the NICD and nine provincial field epidemiologists; one in each of the nine provincial DoH offices.
Currently, there are five provincial epidemiologists in KwaZulu-Natal, Mpumalanga, Free State, Eastern Cape and North West provinces. The process of filling the vacant positions is underway. Having an NICD epidemiologist in each province ensures that epidemiology, public health, diagnostic and clinical expertise within the NICD is available to provinces in a timely manner to effectively support communicable disease surveillance, prevention and control, epidemiology research, training and outbreak response at provincial and district level.
The main focus for the next few years is on HIV/TB and CDC (notifiable disease surveillance), and outbreak response. The PET provides expert technical advice and assistance on the design, maintenance, analysis and interpretation of surveillance databases. Additionally, they support synthesis and analysis of surveillance and routine clinical and DHIS data collected at provincial, district and sub-district levels by both NICD and DoH to determine populations at risk, monitor disease trends and distribution, detect outbreaks and subsequently advise on interventions required to curb morbidity and address public health needs and resource allocation.
Provincial epidemiologists analyse data generated via the NICD centre for TB to describe and report on trends and numbers of patients diagnosed with drug susceptible and drug resistant TB. These reports analysed together with provincial data from electronic TB registers showing the actual number of patients’ initiating TB therapy, are used to identify and address gaps in the TB treatment cascade. The PET is also responsible for the implementation and management of the clinic based surveillance of HIV/TB drug resistance and STIs and provides some supervision to the GERMS surveillance.
The Outbreak Response Team is tasked with providing technical support for all aspects of communicable disease outbreak investigation and control in the nine provinces of South Africa, with particular emphasis on optimising the role of laboratory services during these events. The team aims to be a source of intelligence during outbreaks, and through working in close collaboration with the provincial and national Departments of Health, ensures a comprehensive outbreak response, as well as the development of systems for early detection and improved reporting. Through close partnerships with the NHLS diagnostic laboratories and reference units of the NICD, the team aims to facilitate appropriate laboratory diagnostic services during outbreaks and specialised diagnostics as required.
The Outbreak Response Team plays a crucial role in communications, with stakeholders such as the Department of Health, medical practitioners, media and the general public. The team publishes a monthly Communicable Diseases Communiqué for providing up-to-date information on communicable disease events in South Africa, as well as regularly produce various healthcare worker guidelines, handbooks, fact-sheets, etc., for outbreak-prone communicable diseases of high public health importance. The Team also plays a central role in capacity development by providing in-service training to SA-FELTP residents, public health specialist registrars and secondees from international partner organisations, and routinely provides Epidemic Preparedness and Response Training to the staff of the Department of Health.
The National Emergency Operations Centre (EOC), housed on the upper level of the PRF Training Centre, was created in 2014 in response to the Ebola outbreak in West Africa. The EOC operates under a memorandum of agreement, signed January 2015, with the government of the Republic of South Africa through its National Department of Health (NDoH) to act as a coordination centre for responses to public health emergencies such as the Listeriosis outbreak of 2017/2018, and is seen as a key strategic point for the country’s ability to build a resilient health system.
The EOC aims to collate, organise and deploy resources both internal and external to the NICD required to respond to a major infectious disease incident, outbreak or related event, which has been declared a Public Health Emergency by the Director-General of the NDoH.
During a declared public health emergency, the specific functions of the EOC are to:
- Maintain surveillance, verification and confirmation of the relevant infectious disease in South Africa, the African continent and internationally;
- Perform a coordination role, provide strategic management oversight, gather data on a daily basis and provide Provinces and the NDoH with strategic information to manage the incident;
- Provide a 24-hour hotline for advice and reporting of incidents relating to the declared Public Health Emergency;
- Organise for appropriate samples to be collected, transported to the laboratory and for appropriate diagnostics test to be carried out;
- Liaise with Port Health authorities in the establishment and evaluation of screening systems in at key entry points in South Africa;
- Organise and manage the monitoring of individuals returning from countries with, ongoing outbreaks of high-risk infectious diseases during a Public Health Emergency, with a specific focus on individuals who have been involved in healthcare, those in contact with a known or suspected case of the relevant disease;
- Provide a communications portal during ongoing outbreaks of high-risk infectious diseases during a Public Health Emergency, including updates, health promotion materials and travel advice and a public call centre where communities can obtain information of a particular incident or disease profile;
- When relevant during a Public Health Emergency, liaise with Department of Agriculture, Fisheries and Forestry on Zoonotic diseases that have potential to spread to humans;
- Use every Public Health Emergency as an opportunity to train South African and Southern African Development Countries’ scientists, technologists and epidemiologists in partnership with the NDoH and Provinces;
- Support the Government’s International Health Regulations reporting responsibilities; and
- Ensure that Department of Health Executive Management at National and in Provinces are regularly kept informed on progress in the management of any declared Public Health Emergency.
LEADERSHIP AND TEAM
Acting Centre head: Dr Linda Erasmus
Surveillance Information Management Unit