Enteric Diseases

Mission: To provide specialized diagnostics, relevant data and expertise in diarrhoeal diseases

Working Groups:

Bacteriology Division
The bacteriology division was established in 1997 and is the reference centre in South Africa for human infections involving bacterial enteric pathogens including diarrhoeagenic Escherichia coli, Salmonella species, Shigella species and Vibrio cholerae. The division participates in national laboratory-based surveillance for enteric bacterial pathogens. Isolates are voluntarily submitted to the bacterial division from ~200 clinical microbiology laboratories and data is collected on patients presenting throughout South Africa with both invasive and non-invasive disease. In order to make these data representative and reflective of disease burden in each province, all diagnostic laboratories are actively motivated to voluntarily submit limited demographic details and isolates. In exchange, the bacterial division offers serogrouping and serotyping results free of charge, regular feedback (quarterly reports by province sent to every laboratory participating) and aggregated pathogens numbers, published in the NICD Bulletin. In addition, E-tests are used to determine the minimum inhibitory concentration (MIC) of each isolate to antimicrobial agents, according to CLSI guidelines. The division routinely performs genotypic characterization (DNA fingerprinting) on all outbreak/epidemic-prone pathogens including Salmonella Typhi, Shigella dysenteriae type 1, V. cholerae O1 and Shiga-toxin producing E. coli (including the  enterohaemorrhagic E. coli). The division actively assist in outbreak investigations and performs genotyping and strain characterization of any enteric bacterial pathogens involved.

Virology Division
The virology division was established in May 2006 to expand the range of diarrhoeal pathogens under investigation to include viruses associated with gastroenteritis. The division participates in a sentinel surveillance program at five sites around South Africa to monitor rotavirus epidemiology, genotype distribution and the impact of the rotavirus vaccine introduced into the expanded program on immunization (EPI) in August 2009. The division is also involved in investigating methods to improve vaccine safety and efficacy in developing countries. Furthermore, the division monitors the incidence, seasonality and molecular character of additional enteric viruses including, but not limited to, norovirus, sapovirus, adenovirus, astrovirus, bocavirus in children less than five years of age. The division also provides diagnostic support to the outbreak investigation unit.

Centre Leadership Team

Dr Karen Keddy

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Dr Keddy qualified as a medical microbiologist in 1996 and was tasked with setting up a national reference centre for bacterial enteric pathogens, the Centre for Enteric Diseases (CED) of the National Institute for Communicable Diseases, South Africa. She initiated laboratory-based surveillance for enteric pathogens through the GERMS-SA programme, including non-typhoidal Salmonella and Shigella, diarrhoeagenic Escherichia coli, typhoid fever and cholera and is involved in sentinel surveillance for diarrhoea in children aged < five years. Recently she introduced surveillance for Campylobacter and Listeria. Through Dr Keddy’s initiative, CED hosts the PulseNet Africa database contributing to global knowledge on the molecular epidemiology of enteric pathogens. Dr Keddy was a member of Global Foodborne Diseases Network (WHO), and is a member Global Task Force on Cholera Control (GTFCC) and other expert committees on matters relating to waterborne and foodborne disease, she has consulted on antimicrobial resistance in enteric pathogens and has run numerous training programmes for enteric pathogens on behalf of WHO, been a reviewer for FAO on whole genome sequencing and consulted to various NGOs over the last 12 years. She is an ad hoc attendee of the annual European Centers for Disease Control Food and Waterborne Diseases meeting. Dr Keddy has published on both epidemiological and microbiological aspects of the enteric bacteria in South Africa and globally.

Dr Nicola Page

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Nicola Page completed a four year BSc (Agric) in Microbiology at the University of Pretoria (UP), obtaining the degree with distinction in 1995. After a year in the United Kingdom, she came back to South Africa in 1997 and completed a BSc (Agric) Honours, continuing the Microbiology specialization. During 1998, she met Prof Duncan Steele and began studying towards an MSc (Med) in Medical Virology in his laboratory at the Medical University of South Africa (MEDUNSA). She remained in Prof Steele’s laboratory for seven years, achieving an MSc (Med) in Medical Virology and PhD. Her early work concentrated on the molecular epidemiology of rotavirus, techniques to amplify dsRNA viruses and next generation sequencing of rotavirus strains. During this time, she was also heavily involved in the African Rotavirus Network, training African scientists in rotavirus analysis techniques. Nicola moved to the National Institute for Communicable Diseases in May 2006 and set up the Virology Division of the Centre for Enteric Diseases. In 2011, the institute was restructures and she became co-head of the Center for Enteric Diseases with Dr Karen Keddy. In 2014, she embarked on an MPH in Field Epidemiology at UP, obtaining the degree with distinction in 2016, and was appointed an extraordinary professor at the Department of Medical Virology (UP). Her current research projects include diarrhoeal surveillance in South Africa, the development of molecular techniques for the detection and characterization of other pathogens associated with diarrhoea and the monitoring of rotavirus vaccine effectiveness.

Bacteriology Division

Tel: +27 11 386 6269

Virology Division

Tel: +27 11 555 0370