TAP-WES is a regional initiative that positions the NICD as a technical and training hub for wastewater and environmental surveillance in Africa. The programme supports countries to design, implement, and scale sustainable WES systems by providing technical assistance, training, mentoring, and opportunities for peer learning. It adopts a pathogen-agnostic approach while supporting surveillance of priority pathogens identified by the World Health Organization (WHO).

The programme also shares South Africa’s experience in integrating wastewater surveillance into routine public health surveillance. Through this work, the NICD supports countries in developing policies, designing surveillance systems, strengthening laboratory capacity, improving data analysis, and integrating wastewater surveillance with clinical surveillance and pandemic preparedness.

The two-week training combines classroom learning with practical, hands-on experience. During the first week, participants undertook a field sampling exercise and received laboratory training in sample concentration, nucleic acid extraction, and pathogen detection using both digital and real-time PCR platforms. The second week focuses on data management, epidemiological analysis, reporting, and introductory bioinformatics, with specialised bioinformatics sessions delivered in collaboration with the Scripps Research Institute in the United States.

By building technical expertise and fostering collaboration between African public health institutions, TAP-WES aims to strengthen regional capacity to detect and respond to infectious disease threats through wastewater surveillance. The programme contributes to a more coordinated and resilient public health surveillance network across the continent.

The TAP-WES programme is funded by the Gates Foundation and is implemented in partnership with WHO-AFRO, with technical collaboration from the Scripps Research Institute.

Influenza A(H1N1) pdm09 is now recognised globally as one of the regular seasonal influenza strains that circulate each year and management is the same as for other seasonal influenza strains. For healthy individuals, the illness is mild to moderate and can be safely managed at home with rest, fluids, and over-the-counter medication.

Common symptoms of influenza may include fever, cough, sore throat, headache, muscle and body aches, fatigue and runny or blocked nose. Many people recover fully within a few days to a week without requiring hospitalisation or antiviral treatment. However, certain groups are at higher risk of severe illness or complications. These include pregnant women, older persons, young children, and individuals with underlying medical conditions such as HIV, TB, diabetes, heart disease, asthma, or chronic lung disease.

People in these high-risk groups are encouraged to seek medical attention early if they develop flu symptoms, particularly if they experience difficulty breathing, chest pain, dehydration, persistent fever, or worsening illness.

The NICD continues to strongly recommend annual influenza vaccination as the most effective way to reduce the risk of severe disease and hospitalisation. Vaccination is especially important for vulnerable groups and healthcare workers.

The public can also help reduce the spread of influenza by practising simple everyday prevention measures such as:

• Wash hands regularly with soap and water
• Cover coughs and sneezes with a tissue or bent elbow
• Stay home when sick to avoid infecting others
• Avoid close contact with people who are unwell
• Ensure indoor spaces are well ventilated where possible

The Department and the NICD will continue to monitor influenza trends through national surveillance systems.

Weekly updates on influenza and other circulating respiratory viruses such as RSV, COVID-19, and pertussis are available from the NICD. Click here to visit the page.

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While the ship was travelling past South African shores, some of the passengers experienced serious health complications arising from what was initially considered severe acute respiratory infections.

The ship, carrying about 147 individuals (88 passengers from various countries, and 59 crew members) had departed Ushuaia, Southern Argentina, for Canary Islands on 1 Apr 2026. Enroute to its destination, the ship went past several islands, including mainland Antarctica, Falklands, South Georgia, Nightingale Island, Tristan, St Helena, and Ascension

In terms of medical cases, the first patient was a 70-year-old male passenger who suddenly became ill in the ship enroute from Ushuaia to St Helena Island, and presented with fever, headache, abdominal pain, and diarrhoea. Unfortunately, he passed away on arrival at St Helena Island. His mortal remains are in St Helena, awaiting repatriation to the Netherlands.

The second affected passenger was a 69-year-old female, the spouse to the first patient, who collapsed at the OR Tambo International Airport while trying to connect a flight to her home country of the Netherlands. She was taken to a nearby health facility around Kempton Park for medical attention and unfortunately passed away. Her laboratory test result was positive for Hantavirus.

The third patient, a British national, also became ill while the ship was travelling from St Helena to Ascension. Despite medical treatment provided to him at Ascension, his condition did not improve and necessitated his medical evacuation to a South African private health facility in Sandton for further medical management. His laboratory test results came back positive for Hantavirus – a rare but potentially deadly virus transmitted primarily by rodents. The patient is still in critical condition in isolation, but receiving medical attention.

The Department is working with the NICD and Gauteng Health Department authorities to conduct contact tracing to stop potential spread of the virus by identifying and monitoring individuals who may have been exposed to the infected persons.

In our view, there is no need for the public to panic because only two patients from the cruise ship have been within our borders. The World Health Organization is coordinating a multi-country response with all affected islands and countries to contain further spread of the disease.

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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.

In the first three months of 2026, Gauteng recorded 414 confirmed malaria cases and 11 deaths. While these figures are concerning and require increased public awareness and prompt healthcare action, most of these cases are imported. This means the infections were acquired in the malaria-endemic regions of Limpopo, Mpumalanga, and KwaZulu-Natal provinces, or through international travel to malaria-endemic locations, and diagnosed after individuals returned to the Gauteng province.

In South Africa, malaria transmission is mainly confined to the low-altitude areas of KwaZulu-Natal, Limpopo, and Mpumalanga, where malaria-transmitting mosquitoes occur and environmental conditions support ongoing transmission. Provinces such as Gauteng are not considered malaria-endemic, but imported malaria cases are frequently identified, particularly among travellers returning from affected areas within South Africa and elsewhere. In areas like Gauteng, where malaria-transmitting mosquitoes do not occur, people infected with malaria cannot transmit malaria to others.

Recent heavy rains and flooding across the region have increased malaria risk in endemic provinces in South Africa. For example, Mpumalanga alone reported more than 300 cases in January 2026, while neighbouring malaria-endemic countries have also seen a rise in infections. These conditions highlight the importance of heightened awareness, especially during and after the rainy season.

Malaria is both preventable and treatable, but it can progress rapidly to severe illness and death if diagnosis and treatment are delayed. Travellers to malaria-endemic areas should take preventive measures seriously, including the use of appropriate malaria chemoprophylaxis for moderate- to high-risk destinations. Anyone who develops flu-like symptoms such as fever, chills, headache, body aches, or fatigue after recent travel to a malaria-endemic area – whether within South Africa or elsewhere in Africa – should seek medical attention immediately and request a malaria test. This applies even to those who have taken preventive medication, as no prophylactic is 100% effective. Early diagnosis and prompt treatment save lives.

For additional guidance on malaria prevention, symptoms, and treatment, click here.

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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).

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The 2026 respiratory syncytial virus (RSV) season also started in the week of 9 March 2026. The fact that both the flu and RSV seasons are starting at the same time means clinicians could potentially see a high burden of patients with respiratory illness in medical facilities in the coming weeks.

Influenza A(H3N2), A(H1N1)pdm09 and influenza B are common seasonal influenza strains in humans. The majority of people with influenza present with mild illness, which usually resolves within three to seven days. However, influenza may cause severe illness, leading to hospitalisation or possibly death, especially among those at risk of severe illness or complications.

Influenza vaccination is recommended to protect against infection and severe illness. Ideally, the influenza vaccine should be administered prior to the start of the influenza season as it takes about two weeks for an adequate immune response to develop following vaccination. However, it is not too late to vaccinate once the season has begun. The influenza vaccine will be available in pharmacies from the first week of April. The early start to the season means that this year, the vaccine is only becoming available as the season is getting started, so members of the public who fall into groups at high risk for severe influenza are urged to get their vaccines as soon as possible.

Weekly updates on influenza and other circulating respiratory viruses such as RSV, COVID-19, and pertussis are available from the NICD. Click here to visit the page.

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A global resurgence of chikungunya virus (CHIKV) disease was observed in 2025. Major outbreaks have been documented across multiple World Health Organization (WHO) regions, including the African, South-East Asia, and the Region of the Americas. For the first time, sustained local transmission has been reported in countries within the European region, as well as in China, in the Western Pacific region.

Approximately 502,264 CHIKV disease cases (suspected and laboratory-confirmed) and 186 deaths were reported globally from 41 countries and territories between 1 January to 10 December 2025. The most severely affected region was the region of the Americas, accounting for the highest number of reported cases and deaths, while substantial outbreaks were also reported in the European region, driven largely by transmission in French overseas territories, particularly La Réunion Island.

Chikungunya virus disease

Chikungunya is a vector-borne viral disease caused by CHIKV, a ribonucleic acid (RNA) virus in the genus Alphavirus, and the Togaviridae family. The natural reservoir of the CHIKV includes mosquito vectors Aedes aegypti and Aedes albopictus, which can carry the virus and transmit it to humans. Human infection occurs through the bite of infected female mosquitoes, which bite predominantly during daylight hours. Once a human is infected, the virus can be transmitted to other mosquitoes that bite the infected individual during the viremic period, perpetuating transmission cycles. These same mosquito species also transmit dengue and Zika viruses.

The illness begins after an incubation period of 3-7 days (range 2-12 days), with early symptoms such as sudden high fever (often above 38.5 °C), severe polyarthralgia affecting multiple joints bilaterally and symmetrically, headache, myalgia, and maculopapular rash. In severe cases, patients may experience persistent arthralgia for months to years. Case fatality rates remain low overall, but deaths can occur particularly in vulnerable populations, including neonates exposed during the peripartum period, adults over 65 years, and persons with underlying medical conditions such as hypertension, diabetes, or cardiovascular disease.

Currently, there is no specific antiviral treatment. Clinical case management is supportive and includes rest, adequate hydration and analgesic therapy with paracetamol for fever and pain relief.

Current risk assessment and travel advice

As of 17 December 2025, the WHO conducted a risk assessment based on available information on the chikungunya outbreaks globally. The risk assessment considered the public health risk to be high at the national level (within affected countries) due to factors such as the reported number of deaths; large immunologically-naive populations in newly affected temperate regions, which pose a greater risk of community transmission; as well as widespread presence of Aedes mosquito vectors and conducive environmental conditions. Global risk is assessed as moderate given the unprecedented scale and geographic distribution of the 2025 outbreaks and potential for infected travelers to introduce the virus into receptive areas.

No travel or trade restrictions have been recommended. Travelers are advised to take precautions such as using insect repellent, wearing long-sleeved clothing, staying in accommodations with air conditioning or screens, and avoiding outdoor activity during peak mosquito hours. Travelers should monitor themselves for symptoms for 12 days following any potential exposure. Anyone who develops symptoms such as sudden high fever, severe joint pain, headache, muscle pain, rash, or conjunctivitis should seek medical care, inform healthcare providers of travel history, and avoid further mosquito bites for at least one week to prevent local transmission.

Situation in South Africa

In South Africa, no autochthonous transmission has been documented in association with the current global outbreaks. The presence of Aedes aegypti mosquitoes in South Africa’s urban areas creates potential for local transmission should there be an imported case during periods of high vector density. These mosquitoes are particularly abundant along the eastern seaboard, with established populations documented in the coastal provinces such as KwaZulu-Natal and the Eastern Cape, as well as in the inland Gauteng province.

The risk of importation of chikungunya cases into South Africa exists due to international travel networks (direct flights) between South Africa and affected regions, particularly the Indian Ocean Islands. Vigilance is vital given ongoing outbreaks in the region. Healthcare workers should consider chikungunya in any patient presenting with unexplained acute febrile illness accompanied by severe arthralgia who has recently traveled to an affected area or had potential mosquito exposure. Rapid action is essential, which includes isolation of suspected cases, safe specimen collection and immediate reporting to the relevant public health authority to initiate rapid response and to the National Institute for Communicable Diseases (NICD) for laboratory testing.

Clinicians identifying a suspected case of chikungunya should contact the NICD Clinical Hotline (0800 212 552), a 24-hour service for healthcare professionals, to discuss the case’s risk assessment (based on clinical, travel, and exposure history), as well as laboratory testing. Chikungunya is classified as a Category III notifiable medical condition (NMC) in South Africa and must be notified within seven days of laboratory diagnosis through the NMC notification system.

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Hosted by the National Institute for Communicable Diseases (NICD) in collaboration with Wellcome Connecting Science, this second Antimicrobial Resistance (AMR) of Bacterial Pathogens in Africa training course takes place from 6–13 March 2026 at the NICD’s Sandringham campus.

This intensive programme brings together experts and emerging researchers to advance skills in pathogen genomics, surveillance, and data analysis, key tools needed to better understand, track, and respond to the growing threat of antimicrobial resistance across Africa.

AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to the medicines designed to treat them. As resistance increases, common infections become more difficult to treat, leading to prolonged illness, increased healthcare costs, and higher mortality rates. Strengthening technical expertise and surveillance systems is critical to addressing this growing public health threat.

The course provides intensive, hands-on training in antimicrobial susceptibility testing (AST), laboratory diagnostics, whole-genome sequencing (WGS), and bioinformatics analysis. Participants are set to gain practical skills in detecting, characterising and interpreting resistance mechanisms in bacterial pathogens, as well as understanding how genomic data can inform public health action and policy decisions.

By integrating laboratory-based practical sessions with computational analysis, the programme bridges the gap between traditional laboratory science and genomic insights, enabling participants to translate data into meaningful surveillance and response strategies.

The second biannual offering of this training reinforces NICD’s ongoing commitment to sustainable skills development and continental collaboration. The programme fosters cross-country networks, promotes data sharing, and encourages harmonised surveillance approaches aligned with global standards.

This collaboration with Wellcome Connecting Science – an international leader in genomics training – will ensure participants are exposed to global best practices, cutting-edge methodologies, and international expertise. This will certify that African scientists are equipped with world-class knowledge to address region-specific AMR challenges.

Strengthening regional expertise in genomic surveillance is particularly important as countries expand their laboratory and sequencing capabilities. Skilled professionals are essential to ensure that data generated across the continent is accurately analysed, interpreted, and translated into effective public health interventions.

The NICD remains committed to supporting efforts to combat AMR through surveillance, research, training and public awareness. By investing in scientific capacity, we are safeguarding the effectiveness of life-saving antimicrobials for current and future generations.

Click here for more information about the training programme.

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The Ethiopian Ministry of Health (MoH) has declared an end to the country’s first confirmed Marburg Virus Disease (MVD) outbreak. This declaration followed the completion of the World Health Organization (WHO) recommended two consecutive incubation periods (42 days) without reporting a new suspected, confirmed, or death of a suspected MVD case, after the recovery (discharge) or safe burial of the last known case. The last known laboratory confirmed MVD case demised, and a safe burial was conducted on 14 December 2025. The outbreak was first confirmed on 14 November 2025 in Jinka town, South Ethiopia Regional State, following the laboratory detection of the Marburg virus (MARV) by the Ethiopian Public Health Institute (EPHI) National Reference Laboratory in an adult who developed viral haemorrhagic fever (VHF) symptoms on 23 October 2025.

Epidemiological findings

By the end of the outbreak, as of 25 January 2026, 19 cases (14 laboratory-confirmed and five probable cases), including nine deaths (four laboratory-confirmed cases and all five probable cases), have been recorded, with a case fatality rate (CFR) of 64.3%.

Cases were reported from the Jinka, Malle, and Dasench woredas (districts), located in the South Ethiopia Region State, as well as from Hawassa, in the Sidama Region. Through contact tracing, epidemiological links were established, including travel history to Jinka town, where the outbreak was first reported. In total, 857 contacts were identified and completed the 21 days of daily symptoms monitoring.

Molecular analysis of the laboratory confirmed cases indicated that the circulating strain in this outbreak is the same as the strain previously detected in MVD outbreaks in other East African countries. Investigations conducted under the One Health approach identified the presence of certain species of fruit bats in the affected areas, which are recognised natural reservoirs of MARV.

Public health response and control measures

In response to the outbreak, the Ethiopian MoH, in collaboration with EPHI, WHO, Africa Centre for Disease Control and Prevention (Africa CDC), and other partners, implemented a comprehensive outbreak response. National and regional emergency coordination mechanisms were activated, and multidisciplinary rapid response teams were deployed to affected areas to support surveillance, case investigation, contact tracing, infection prevention and control (IPC), and case management.

Enhanced laboratory surveillance was implemented, with approximately 3 800 samples tested during the course of the outbreak to support case detection. Designated treatment centres were established, with a team of trained healthcare workers deployed. Risk communication and community engagement activities were intensified to promote early reporting, health care-seeking behaviour, and safe burial practices.¹

Risk assessment

All reported deaths occurred following unsupervised burials, with the latter recognised as a risk factor for further transmission in the community when appropriate infection, prevention, and control measures are not in place. The identification of healthcare workers among the confirmed cases indicates possible occupational exposure within healthcare facilities.

Although no new cases were reported throughout the 42 days following a safe burial of the last known confirmed MVD case on 14 December 2025, there is still a risk of MVD re-emerging after the outbreak has been declared over, due to potential spillovers from contact with the animal reservoir.¹ In addition to monitoring and responding to community feedback and rumours, risk communication and community engagement initiatives are continuing to raise awareness and to dispel stigma against those impacted by the outbreak. Based on the current risk assessment, WHO does not recommend any travel or trade restrictions on Ethiopia.

Public health considerations and recommendations

Although the outbreak has been declared over, the country has entered the recommended 90-day period of enhanced surveillance. The WHO and partners have emphasised the importance of sustained vigilance, particularly in regions with ecological conditions favourable for MARV spillover. Continued strengthening of VHF surveillance, enhanced health facility and laboratory testing capacity, rapid response mechanisms, as well as cross-border collaboration, remains critical for ensuring early detection and containment of future outbreaks. Ongoing community engagement, including raising public awareness and continued health worker trainings are essential to improve preparedness and reduce the risk of delayed detection and response.

The successful containment of this outbreak highlights the value of rapid case detection, coordinated multisectoral response, and strong national and international partnerships in managing the high consequences related to infectious disease threats. To reduce transmission, WHO recommends limiting bat-to-human exposure, particularly in fruit bat-infested mines and caves, as well as improving human-to-human transmission prevention through early isolation of suspected cases, safe and dignified burials, and strict IPC practices in healthcare facilities.

Situation in South Africa

There have been no reports of MVD cases internationally that are linked to this outbreak in Ethiopia, and the risk of MVD importation remains low. However, vigilance is vital given the emergence of MVD outbreaks in the African region. Healthcare workers are encouraged to consider MVD in any patient presenting with unexplained acute febrile illness who has a history of potential exposure from being in the mines or caves known to have fruit bat colonies. The National Institute for Communicable Diseases (NICD) serves as the national reference centre for VHF testing, with laboratory diagnostic capacity, and provides expert guidance.

Clinicians identifying a suspected case of MVD should contact the NICD Clinical Hotline (0800 212 552), a 24-hour service for healthcare professionals, to discuss laboratory testing and provide a detailed clinical, travel, and exposure history. VHF diseases, including MVD, are classified as Category 1 notifiable medical conditions (NMC) in South Africa, and must be reported within 24 hours of clinical suspicion through the NMC notification system.

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