The Centre for Respiratory Diseases and Meningitis (CRDM) is a resource of surveillance, diagnostics, expertise and research in the field of communicable respiratory diseases and meningitis for South Africa and the African continent.
The centre generates data and provides expertise related to respiratory diseases and meningitis of public health importance to the South African National Department of Health, health care providers, regional and international collaborators, to assist with the planning of public health policies and programmes, and response to respiratory disease and meningitis outbreaks. CRDM is also a source of capacity building and formal training within South Africa and the African region.
The objectives of CRDM are:
- To conduct surveillance for communicable respiratory diseases and meningitis within South Africa in order to provide data on the burden, severity and seasonality;
- To characterise (phenotypically and genotypically) pathogens contributing to respiratory diseases and meningitis in order to understand strain relatedness (molecular epidemiology) and guide vaccine development, treatment and prevention policy;
- To monitor trends in antiviral and antibacterial drug resistance in respiratory and meningeal pathogens in order to inform empiric treatment guidelines;
- To monitor the impact and effectiveness of interventions to reduce respiratory diseases and meningitis;
- To provide reference laboratory functions for specialised organism characterisation and identification related to respiratory communicable diseases and pathogens causing meningitis nationally and regionally;
- To identify and characterise novel respiratory and meningeal pathogens with potential to cause outbreaks and to assist with response to respiratory disease outbreaks;
- To be a source of local and regional expertise on respiratory diseases and meningitis;
- To engage in directed and relevant research to answer questions related to regional communicable respiratory disease and meningitis disease problems and their surveillance and management; and
- To build local and regional capacity in epidemiology and laboratory diagnostics for respiratory disease and meningitis.
CRDM coordinates the following syndromic surveillance programmes: pneumonia surveillance, influenza-like illness (ILI) (2 programmes: systematic ILI at public health clinics and viral watch) and the respiratory morbidity surveillance system.
Pneumonia is a leading cause of hospitalisation and death in children and adults in South Africa. The National Pneumonia Surveillance Programme, started in 2009, it includes sentinel syndromic surveillance for severe respiratory illness irrespective of duration of symptoms and testing for core pathogens of public health importance, namely, influenza, respiratory syncytial virus (RSV) and Bordetella pertussis. Surveillance is operational in five provinces. In addition, at three of the surveillance sites, surveillance for Streptococcus pneumoniae is included. Data from this surveillance programme provides policy makers, clinicians and the general medical community with regular updates on seasonality, trends and the burden of pathogens associated with pneumonia. It also provides strategic information to support planning and monitoring of pneumonia prevention and control activities.
Influenza-like illness surveillance
Surveillance for influenza-like illness (ILI) is ongoing at outpatient clinics at three provinces, with plans to expand to cover all provinces with existing pneumonia surveillance sites. In addition, CRDM has a long- standing ILI programme (since 1984), The Viral Watch sentinel surveillance programme. The surveillance programmes provide data to describe the timing and severity of the influenza and RSV seasons, characterisation of circulating influenza virus strains to guide decisions around Southern Hemisphere influenza vaccine composition, annual estimates of influenza vaccine effectiveness and detect outbreaks caused by the pathogens included as part of surveillance.
Respiratory morbidity surveillance system tracks trends in the number of pneumonia and influenza hospitalisations, using anonymised data from a private hospital group.
CRDM houses a World Health Organization (WHO)-designated National Influenza Centre (NIC). This is 1 of 142 NICs in 113 countries that form part of the WHO’s Global Influenza Surveillance and Response System (GISRS). The South African NIC works closely with the stakeholders from the National Department of Health and the WHO Collaborating Centres to monitor the emergence of novel, emerging or resistant influenza virus strains through surveillance activities. The NIC also performs preliminary genotypic and phenotypic characterisation of influenza virus specimens circulating in South Africa and ships representative clinical specimens and isolated viruses to WHO Collaborating Centres for advanced antigenic and genetic analysis. The results form the basis for WHO recommendations on the composition of the Northern and Southern hemisphere influenza vaccine each year.
Since 1999, CRDM has conducted national laboratory-based, population-based active surveillance for invasive disease caused by S. pneumoniae, H. influenzae and N. meningitidis. Enhanced surveillance occurs at 26 hospital sites (at least one in every South African province) where additional clinical data are collected on each patient with invasive disease. Surveillance data contribute to the evaluation and understanding of the impact of both the pneumococcal conjugate vaccine (PCV) and the Haemophilus influenzae serotype b conjugate vaccine (Hib CV). CRDM also contribute data on numbers and serogroups of Neisseria meningitidis and support diagnostic testing and outbreak response for suspected cases of meningococcal meningitis. The data allow for descriptive epidemiology of invasive disease and emergence of resistance in these three pathogens.
CRDM serves as a regional reference laboratory (RRL) for the WHO Regional Office (WHO/AFRO), Immunization and Vaccine Development Cluster, which is part of the WHO/AFRO (VP-IBD) surveillance network. Cerebrospinal fluid samples are submitted from 12 Southern and East African countries for molecular detection and serotyping/grouping of S. pneumoniae, H. influenzae and N. meningitidis. Data are reported back to countries and WHO AFRO. Training and site assessments are also provided to improve surveillance capacity in these 12 countries.
CRDM partners with the Outbreak Response Unit (Public Health Surveillance and Response Division/NICD). They are tasked with providing technical support for all aspects of communicable disease outbreak investigation and control in the nine provinces of South Africa, with special emphasis on optimising the role of laboratory services during these events. The Unit ensures constant communication with stakeholders such as the Department of Health, medical practitioners, media and the general public.
CRDM partners with the national Notifiable Medical Conditions (NMC) surveillance system, which is tasked with providing timely, accurate data of diseases that are of public health importance. These diseases may pose significant public health risks that can result in disease outbreaks or epidemics with high case fatality rates both nationally and internationally. Know more about NMC by clicking the link below.
LEADERSHIP AND TEAM
Cheryl Cohen is an Associate Professor in epidemiology at the University of the Witwatersrand and head of the Centre for Respiratory Diseases and Meningitis. She qualified as a medical doctor at the University of the Witwatersrand and is a Fellow of the College of Pathologists of South Africa in the discipline of Microbiology.
She obtained an MSc in Epidemiology from the London School of Hygiene and Tropical Medicine, United Kingdom and a PhD from the University of the Witwatersrand. In her position at the NICD, she works closely with the South African Department of Health to generate evidence to guide policy with regard to the control and management of respiratory diseases. She led the establishment of a national surveillance programme for severe acute respiratory infections in South Africa in 2009 and is the epidemiology lead for national surveillance for pneumonia and invasive bacterial infections causing pneumonia. She heads up a team with an active research agenda in the field of respiratory diseases with a focus on the burden of disease and risk groups for severe illness, as well as assessment of the impact and effectiveness of interventions to reduce respiratory disease burden. She is a member of several national advisory committees as well as several international World Health Organization working groups, mainly related to influenza and other respiratory viruses.