The workshop, which brings together around 25 scientists, industry developers, regulators, and international partners, builds on progress that South Africa has made in developing the sterile insect technique (SIT), in which male mosquitoes are reared in the laboratory, sterilised and released by the thousands to mate with wild females, whose eggs then will never hatch. Since the first sterile male releases in Jozini, KwaZulu-Natal, in 2021, the South African SIT programme has advanced the technology. The lessons learned along the way, from mass-rearing to long-distance transportation to community engagement, are proving to be the foundation for adaptation to other new innovative tools such as gene drive technology.

The gene drive technology – in contrast to SIT, which makes male mosquitoes unable to father offspring – provides a genetic change a head start: instead of being inherited by only half of a mosquito’s offspring as normal genes are, a gene drive is passed on to nearly all of them. Released in small numbers, it can spread through a wild population over generations, offering a self-sustaining tool that needs far fewer repeat releases than SIT. “The two technologies share the same starting point,” explains Dr Givemore Munhenga, Principal Medical Scientist in the Vector Control Reference Laboratory at NICD’s Centre for Emerging Zoonotic and Parasitic Diseases. “Before any genetically modified mosquito can help fight malaria, someone still has to rear it by the hundreds of thousands, package it safely, transport it, and release it in the field. That is exactly where our SIT experience becomes so valuable.”

The workshop, jointly convened with the USA Foundation for the National Institutes of Health (FNIH) and supported by the Bill & Melinda Gates Foundation, focuses on three practical questions: What are the biggest technical challenges in mass-rearing, handling, transporting and releasing genetically modified mosquitoes? Which of these steps can realistically be automated? And should production happen locally, country by country, or regionally, with mosquitoes shipped across borders to where they are needed? Delegates included gene drive researchers, companies developing mosquito-rearing automation, and oversight bodies such as the International Atomic Energy Agency and New Partnership for Africa’s Development. “Gene drives have shown enormous promise in caged trials, but very few groups have grappled with what it actually takes to move from the laboratory to the field,” emphasised Dr Munhenga. “That is our expertise. This workshop lets us share it, learn from others working on the same problem, and make sure that when these tools are ready, Africa is ready to deploy them.”

By the end of the week, the workshop aims to produce an understanding of technical needs and knowledge gaps, new collaborations between NICD and gene drive developers and implementers, and a refined roadmap for the Institute’s own upscaling of the SIT project, another step towards putting a self-sustaining tool in the hands of malaria control programmes in South Africa and across the continent.

The workshop launches alongside a new three-year NICD project to upscale the deployment of genetic control approaches against Anopheles, South Africa’s primary malaria-carrying mosquito. The project will refine mass-rearing and sexing automation, test long-distance chilled transport, trial both ground and drone-based releases, and strengthen the regulatory pathways needed before any gene-drive mosquito can be released in the field.

In early 2026, several southern African countries, including Eswatini, Mozambique, South Africa, Zambia, and Zimbabwe, experienced significantly higher rainfall than normal. Some areas reported a year’s worth of rainfall in a matter of days.

These extreme rainfall events ruined essential infrastructure, displaced local communities, many of whom were already vulnerable, threatened food security, and placed added pressure on overburdened, fragile health systems.

Gains have been slipping 

Even before the recent heavy rains, the Southern African Development Community’s (SADC) malaria elimination aspirations were under immense threat. There had been reports of significant malaria upsurges in several SADC countries, aggravated by unforeseen, drastic cuts to international donor funding that supported routine malaria control activities in many of these countries. The recent heavy rains and associated flooding further exacerbated the situation in several countries, many of which were still recovering from the 2025 upsurges.

Over the first four weeks of 2026, Namibia reported 8 760 cases, an increase of 68% compared to the same period in 2025, while Zimbabwe reported 1 725 cases and four malaria-related deaths in the first week of January 2026. Mozambique, one of the countries most affected by the recent flooding, saw a 55% increase in case numbers over the first six weeks of 2026, reporting 49 deaths and over 1.35 million cases.

South Africa, with a reduction in annual case numbers in 2025, appeared to be on track to meet its elimination target. However, Mpumalanga province, one of the country’s three malaria-endemic provinces, experienced a fourfold increase in cases in January 2026, reporting 314 cases compared to 69  reported in January 2025, placing the country’s elimination agenda at risk.

Higher disease risk 

Crucially, disruptions associated with these extreme flooding events also increased the risk of disease transmission. Waterborne illnesses such as cholera pose an immediate threat. But diseases like malaria, which are associated with stagnant water, emerge as threats weeks later.

Flooding often alters the environment to favour malaria transmission in malaria-endemic areas.

As flood waters subside, they leave behind microhabitats such as small pools of stagnant water, waterlogged fields, and blocked drains/sewers. All these serve as ideal breeding sites for malaria mosquitoes.

Flood-related damage to critical infrastructure, like roads and healthcare facilities, disrupts the timely delivery of essential services such as malaria testing and treatment and vector control interventions to the affected communities. Collectively, they contribute to increased malaria transmission.

Communities must be part of the solution

Local communities and governments must actively work together to build resilience to extreme weather events and malaria. Governments, local communities, and technical experts should work together to generate up-to-date maps of flood-risk areas. These evidence-informed flood-risk maps can then be used to guide the development of infrastructure such as housing, safely away from flood-risk areas, potentially reducing the exposure to malaria.

Local, often vulnerable, populations must play their part by not building homes near rivers that regularly burst their banks or in low-lying flood-prone areas.

Additionally, these communities must support and accept routine, effective vector control interventions such as indoor residual spraying and larviciding.

Working with local government structures, affected local communities should actively reduce potential breeding sites by draining stagnant pools, ensuring water storage containers are sealed, and unclogging and covering drains and sewers.

Need for urgent action

An increased availability of suitable breeding sites in areas where malaria mosquitoes are abundant is generally associated with significant increases in transmission intensity – a trend observed in several SADC countries following the recent extreme rainfall events.

Malaria is an unforgiving disease, rapidly progressing to severe disease if not promptly diagnosed and effectively treated with antimalarials. A high index of suspicion for malaria is therefore essential among all flood-affected communities residing in malaria-endemic areas.

This strong malaria awareness must be supported by ready access to malaria testing and treatment. Mitigation and system-strengthening strategies must be developed and actioned to allow healthcare facilities to offer essential basic malaria services in the wake of flood-related disruptions.

The southern Africa region will experience more regular extreme weather events, which will inevitably impact malaria. It is therefore critical that sustainably funded, integrated, effective, climate-sensitive malaria control strategies are implemented and supported by strong, resilient health systems.

Affected communities must be adequately capacitated and resourced to respond to extreme events and protect themselves from malaria. Together, these will support the SADC region in achieving its ambitious goal of malaria elimination.

Dr Jaishree Raman is a Principal Medical Scientist and the head of the Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research at South Africa’s National Institute for Communicable Diseases.

This article is republished under a Creative Commons license.

The 2026 RSV season also started in week 11 (week starting 9 March 2026), when the RSV detection rate in children aged <5 years from inpatient pneumonia surveillance in public hospitals exceeded the seasonal threshold and was sustained for two consecutive weeks (Figure 1B). The influenza and RSV seasons both starting in the same week is an unusual event. Clinicians should be on the alert for a potential high burden of patients with respiratory illness in medical facilities in the coming weeks.

Influenza
The 2026 season marks the earliest start to the influenza season recorded since 2010, based on pneumonia surveillance data. The A(H1N1)pdm09 subtype was the most prevalent among influenza A cases in the pneumonia surveillance programme and public clinics but influenza A(H3N2) is most prevalent in outpatient surveillance in private general practitioner practices (Figure 2). Out of 6 influenza A(H1N1)pdm09 samples sequenced to date 5 were subclade D.3.1 and one was subclade D.3.1.1. Of 11 influenza A(H3N2) samples sequenced to date all were subclade K (J2.4.1). Of 7 influenza B Victoria samples sequenced to date 6 were C.5.6 and one was C.5.1.

Respiratory syncytial virus (RSV)
Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and lower respiratory tract infections (LRTI) in young children and can lead to severe illness in infants. It is highly contagious, primarily spreading through respiratory droplets, and re-infections can occur. Over the past decade (excluding pandemic years 2020 and 2021), the RSV season typically begin in mid-February (week 7), with the onset ranging from late-January to late-February, usually preceding the influenza season. Compared to historical data (excluding the SARS-CoV-2 pandemic period), the start of the 2026 RSV season is approximately 4 weeks later than the average, but similar to 2025 when the season also started late (Figure 1B). Among cases with RSV subgroup available in South Africa in 2026, the RSV-A subgroup has accounted for a majority of cases, followed by a smaller proportion of RSV-B subgroup viruses (Figure 3).

READ THE FULL UPDATE HERE

One of the key benefits of PrEP is that it can be safely used by HIV-negative partners in sero-different relationships (where one partner is HIV-positive and the other HIV-negative) to support safe conception and breastfeeding without transmitting the virus to their babies.

According to the 2021 South African PrEP provision guidelines, PrEP is “the use of antiretroviral drugs by HIV-negative people before potential exposure to HIV to prevent the acquisition of HIV.” Both oral and injectable PrEP are safe to use during pregnancy and breastfeeding.

In sero-different relationships, PrEP is recommended as a safe conception strategy to protect the HIV-negative partner and prevent transmission to the child. PrEP can be applied in two main scenarios:

Scenario one: An HIV-negative female with an HIV-positive male partner takes PrEP for safe conception and continues during pregnancy and breastfeeding while she remains at risk of HIV exposure.

This aligns with pillar 1 of the Vertical Transmission Prevention (VTP) guidelines, which focus on the primary prevention of HIV transmission among women of childbearing age.

Scenario two: An HIV-negative male with an HIV-positive female partner takes PrEP for safe conception, while the HIV-positive female continues on antiretroviral therapy (ART) during pregnancy and breastfeeding to prevent vertical transmission. This aligns with pillar 3 of the VTP guidelines, which focuses on preventing vertical transmission.

PrEP can also be used by couples who are both HIV-negative but are at high risk of contracting HIV.

The introduction of Lenacapavir, a six-monthly injectable, supports the recommendations of the 2022 National Antenatal Care (ANC) HIV Sentinel Surveillance, which highlighted the need to strengthen HIV prevention efforts among HIV-negative women attending antenatal care.

The surveillance study, conducted by the National Institute for Communicable Diseases (NICD), monitored HIV prevalence and estimated PrEP coverage among pregnant women (aged 15–49) attending 1,595 public antenatal clinics between February and April 2022.

Secondary analysis of the 2022 ANC survey revealed that 31% of HIV-negative pregnant women were at substantial risk of HIV acquisition. Among them, 4% reported having an HIV-positive partner, while 68% did not know their partner’s HIV status.

PrEP remains an essential HIV-prevention tool for women with HIV-positive partners or those who don’t know the HIV status of their partners.

The study also examined factors associated with PrEP uptake before and during pregnancy. PrEP uptake prior to pregnancy was six times higher among women with HIV-positive partners compared to those with HIV-negative partners. Similarly, during pregnancy, those with HIV-positive partners were eight times more likely to use PrEP.

Although these findings indicate that PrEP is being used as a safe conception strategy in the public sector, overall uptake remains low at 3.6% prior to pregnancy and 6.5% during pregnancy.

This is concerning, as oral PrEP (taken as one tablet daily) is freely available in public health facilities for HIV-negative individuals. PrEP is also available in the private sector in other forms, such as the 28-day silicone vaginal ring and the two-monthly cabotegravir injectable.

Despite SA’s high HIV burden – 7.8-million people living with HIV in 2024, 81% on ART, and 170,000 new infections – the advances in HIV treatment and prevention are commendable.

To effectively combat the epidemic, prevention efforts must be strengthened alongside the expansion of ART, particularly for the prevention of mother-to-child transmission.

With the introduction of Lenacapavir, expected to be accessible in some public sector facilities by early 2026, we anticipate improved PrEP uptake — not only among pregnant women but also among all individuals at high risk of HIV infection.

We need to continue strengthening and promoting early ANC attendance. Maintaining viral load monitoring and returning results to pregnant women living with HIV to ensure women are virally suppressed and that both low-level and high-level viraemia are responded to timeously.

We need to also promote male circumcision and condom use as strategies for the primary prevention of sexually transmitted infections. These warrant a further focus on their inclusion in existing prevention strategies.

This article is republished from Sowetan newspaper under a Creative Commons license. Read the original article.

This is where sanitation becomes essential. Safely managed sanitation means having a toilet that treats or safely disposes of waste on site, stores it securely for emptying and treatment elsewhere, or connects to a functioning sewer system and treatment plant. Yet an estimated 3.4 billion people still lack these services — nearly half of the world’s population. Raising awareness and advocating for consistent local and national investment in sanitation is crucial, especially as communities face emergencies, climate-related threats and rapid urban growth.

The Centre for Enteric Diseases at the National Institute for Communicable Diseases, a division of the National Health Laboratory Service, monitors illnesses such as cholera, typhoid and other diarrhoeal pathogens that emerge when sanitation systems break down. While we cannot repair infrastructure ourselves, we can raise the alarm when cases rise, help trace sources of infection and support clinicians, authorities and the public with treatment guidelines, prevention strategies and mitigation measures.

Against this backdrop, the 2025 World Toilet Day campaign shone a light on the global sanitation crisis and called for faster action toward Sustainable Development Goal 6: ensuring water and sanitation for all by 2030. By encouraging people to decorate their toilets, the campaign invited reflection on this essential yet often overlooked human right — and reminded us that sanitation is fundamental to health, dignity and resilience.

We thank all the participants of the campaign and congratulate the following winners:

Category 1 – Best Dressed Toilet

Winner: Anthony Smith

Category 2 –  Most Wacky Toilet

Winner: Sandrama Nadan

Category 3 –  Most Educational Toilet

Winner: Lisa Sun

In early October 2025, the National Institute for Communicable Diseases (NICD) was notified of three malaria cases in the Free State, a non-endemic province, involving three family members with no recent travel to a malaria-endemic area. Preliminary investigations suggest these are odyssean malaria cases.

Odyssean malaria in South Africa

High volumes of people, goods and vehicles regularly entering Gauteng from malaria‐endemic areas increases the likelihood of infected mosquitoes being inadvertently transported (via road, rail, air, or freight) into the province; hence, most odyssean malaria cases have been detected in this province. According to the Public Health Bulletin South Africa report  “Odyssean Malaria in South Africa, 2014 – 2023”, 82 of the 99 (97 laboratory-confirmed and two probable) odyssean malaria cases reported and investigated between 2014 and 2023 were from Gauteng. However, these cases can occur anywhere, as demonstrated by the recent cluster in the Free State. Although odyssean malaria cases are sporadic and relatively uncommon, awareness and prompt responses are critical, as odyssean malaria is associated with an unacceptably high fatality rate.

What should healthcare workers do?

Delayed diagnosis and treatment of malaria can lead to severe illness or death. Healthcare workers should maintain a high index of suspicion for malaria in any patient presenting with fever or unexplained illness, even when there is no travel history to a malaria-endemic area. Although odyssean malaria cases are rare, malaria should always be included as a differential diagnosis in patients with unexplained fever and thrombocytopenia. A multidisciplinary approach – involving clinicians, laboratories, entomologists, and public-health teams is essential to investigate, confirm and respond effectively to odyssean malaria cases.

Malaria endemic areas in South Africa

Malaria transmission in South Africa generally occurs in the low-altitude regions of northern KwaZulu-Natal, Limpopo, and Mpumalanga provinces, bordering Mozambique, Eswatini, Botswana, and Zimbabwe. All countries neighbouring South Africa, except Lesotho, are malaria-endemic. The high transmission malaria season in South Africa generally runs from September to May, coinciding with the hot, rainy summer months, when the breeding conditions for malaria mosquitoes are optimal.

Malaria symptoms

The early symptoms of malaria are non-specific and can therefore easily be misdiagnosed with other infections, such as COVID-19, tick bite fever, and pneumonia. Common malaria symptoms include:

• Fever and flu-like illness
• Shivering, chills, and sweating
• Muscle aches and fatigue
• Abdominal discomfort, nausea, vomiting, or diarrhoea
• Loss of appetite, sore throat, or cough

How is malaria managed and treated?

Uncomplicated malaria can be treated effectively with oral antimalarial medication, provided diagnosis and treatment are prompt. If diagnosis and/or treatment are delayed, malaria rapidly progresses to severe disease, particularly in non-immune individuals, increasing the risk of adverse outcomes. The choice of medication depends on the severity of the illness and must be informed by the national malaria treatment guidelines.

What should the public do to prevent malaria?

• Reduce mosquito breeding: Drain standing water and cover containers.
• Use personal protection: Consider the use of non-pharmaceutical (e.g. DEET-based repellents, pyrethroid based plug-ins) and/or pharmaceutical (e.g. doxycycline, atovaquone-proguanil) measures. The effectiveness data of natural remedies like citronella and lemon verbena are limited.
• Dress appropriately: Wear long-sleeved shirts, trousers and socks when outdoors in the evenings.
• Sleep safely: Keep windows and doors shut at night. If available, use window/door screens, air conditioners or bed nets.

Odyssean malaria is uncommon and sporadic, but awareness and early action can save lives. Stay alert, not alarmed – recognising malaria early, wherever you are, makes all the difference. Malaria is preventable, treatable, and curable – let’s stay vigilant and keep South Africa malaria-free.

For more information about malaria, click here.

Briefly explain what NMCs are and why they are important in public health surveillance?
NMCs are diseases of public health importance that pose significant risk to the population based on several reasons, for example, potential to cause outbreaks and high fatality, high burden, diseases targeted for elimination or antimicrobial resistance. Through surveillance, we can collect, analyse, and use epidemiological data systematically to inform public health measures for prevention and response.

What criteria determine whether a disease becomes notifiable in South Africa?
This is based on the International Health Regulation 2005 (IHR) and the National Health Act 61 of 2003.

How do NMCs contribute to the early detection of outbreaks or emerging health issues?
NMCs are grouped into four categories, with Category 1 diseases (such as epidemic-prone or a new virus or disease) legally required to be reported immediately, followed by written or electronic notification within 24 hours of clinical suspicion or laboratory confirmation. This rapid reporting system enables early detection, verification, and response to potential outbreaks or rising health emergencies.

Briefly describe the process of what happens when a healthcare provider reports an NMC?
Once a healthcare provider reports an NMC, alerts are automatically sent to officials at the sub-district, district, provincial, and national levels. Teams verify the alert, and once confirmed, outbreak investigation and response activities commence.

How does the data collected from NMC reporting influence public health decision-making or policy during an outbreak?
The NMC reporting contains epidemiological data on the index case, which assists with outbreak investigation activities. On its own, the NMC data cannot influence policy but provides critical evidence for decision-making on person, place, and severity of illness (hospitalisations and death). These data are used by decision makers for policy.

What are some common challenges faced in the reporting and tracking of NMCs?
A major challenge in the NMC system is the clinical under-reporting of cases. When a healthcare worker sends a sample for testing, it typically indicates sufficient clinical suspicion to report the case, but this step is often missed. Laboratory notifications alone do not include the clinical and personal details needed to verify and investigate a case, resulting in delays in response.

Can you share an example where timely NMC reporting directly led to a successful outbreak intervention or containment?
Each notified case helps achieve timely outbreak intervention and containment, which highlights the importance of prompt reporting.

What role do healthcare providers and laboratories play in ensuring accurate and timely reporting of NMCs?
Healthcare providers and laboratories play a crucial role in ensuring accurate and timely NMC reporting. By complying with the reporting requirements, cases can be detected and responded to more efficiently.

How can public health authorities improve awareness and compliance among health workers regarding the importance of reporting NMCs?
We offer training to healthcare workers in both public and private facilities to improve awareness and compliance. Laboratory data from the National Health Laboratory Service is automatically reported, and similar systems are being developed for private laboratories. In the meantime, private laboratories report detected NMCs directly to the National Institute for Communicable Diseases.

For more on the NMC system, including resources, tutorial videos, contact details, and more, click here.

WHO Representative in South Africa, Ms Shenaaz El-Halabi, said: “The Global Polio Laboratory Network is dedicated to a singular mission: delivering timely and precise diagnostic results to support the polio programme’s effective response to any poliovirus outbreak. The NICD functions not only as the National Polio Laboratory for South Africa but also serves nine additional countries as the National Polio Lab and as a Sequencing Referral to seven other countries.”

The centre is one of the three designated regional reference laboratories. The NICD plays a pivotal role in supporting other regional laboratories through capacity-building initiatives, enhancement of quality assurance measures, and continuous efforts to broaden sequencing capacity and expertise throughout Africa.

NICD Executive Director, Prof. Adrian Puren, welcomed the opening of the centre and expressed gratitude to the WHO, the Gates Foundation (which funded the centre), and other partners. National Health Laboratory Service CEO, Prof. Koleka Mlisana, and Deputy Director-General at the National Department of Health NDoH, Dr Anban Pillay, echoed these sentiments.

“We call upon the National Department of Health to play a crucial role by facilitating the smooth shipment and clearance of laboratory items, investing in resource mobilisation, and strengthening laboratory operations through capacity building, procurement, and the recruitment and retention of skilled personnel,” Ms El-Halabi concluded.

Highlights:

• Since the last situational report (week 16), the following updates are included in this report:
  o Two new laboratory-confirmed cases of toxigenic respiratory diphtheria, one from Limpopo and one from KwaZulu Natal.
  o No new asymptomatic carriers of toxigenic C. diphtheriae.
  o One additional death has been reported, bringing the total to 11 deaths.
• Appropriate public health responses have been initiated for each case.

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx (Figure 2) – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE

Highlights:

• Since the last situational report (week 15), the following updates are included in this report:
  o Three new laboratory-confirmed cases of toxigenic respiratory diphtheria, one from Mpumalanga and two from Limpopo.
  o No new asymptomatic carriers of toxigenic C. diphtheriae.
  o Two suspected cases awaiting results from the Western Cape.
  o One additional death has been reported, bringing the total to 10 deaths.
• Appropriate public health responses have been initiated for each case.

Information for clinicians

Clinical presentation of respiratory diphtheria

Respiratory diphtheria is a vaccine-preventable illness caused by toxigenic C. diphtheriae (and more rarely C. ulcerans or C. pseudotuberculosis), and can occur in persons of all ages.

The clinical presentation includes the following signs and symptoms:

• sore throat
• low-grade fever
• AND an adherent membrane of the nose, pharynx, tonsils, or larynx (Figure 2) – the membrane is greyish-white and firmly adherent to the tissue
• AND/OR enlarged glands in the neck (bull neck)
• toxin-mediated systemic signs including myocarditis, polyneuropathy and renal damage

Patient management
Treatment includes antibiotics (azithromycin or penicillin) to clear the organism from the throat and prevent onward transmission, and diphtheria anti-toxin (DAT) to neutralise unbound toxin. The dosage of DAT is determined by the duration and severity of illness. Treatment, contact tracing and chemoprophylaxis should be started prior to laboratory confirmation. Early administration of DAT may be life-saving and should not be delayed in cases with a high index of suspicion. Supportive care is primarily aimed at airway management and includes providing oxygen, monitoring with electrocardiogram and intubation or performance of a tracheostomy if necessary.

To access previous diphtheria situational reports, click here.

READ THE FULL UPDATE HERE