Even though South Africa has made great strides in healthcare provision, which has led to better health outcomes for its population, there is still a need for vigilance against vaccine-preventable diseases, illnesses related to advanced HIV, cryptococcal meningitis, invasive meningococcal and water-borne diseases.
The National Institute for Communicable Diseases (NICD) GERMS-SA Annual Surveillance Review for 2023 has shown a steady rise in the number of disease episodes since 2020, which is a cause for concern and requires collaboration amongst health authorities, healthcare workers and the public.
GERMS-SA is a national, population-based laboratory surveillance programme in South Africa for bacterial and fungal infections. The programme is a collaboration between the NICD, a division of the National Health Laboratory Service, participating South African clinical microbiology laboratories (both public and private), and selected public hospitals. GERMS-SA systematically collect, collates, and analyses data on diseases of public health importance to provide accurate, quality-controlled strategic surveillance information to clinical managers and public health policymakers.
A total of 14 138 surveillance cases were detected by GERMS-SA in 2023, showing different trends in pathogen incidence and age groups. Respiratory-transmitted pathogens affected by COVID-19 non-pharmaceutical practices have returned to their pre-COVID-19 levels. The highest burden was found in the Western Cape Province for many pathogens, possibly related to health-seeking behaviour, better laboratory capacity, and specimen-taking practices.
Amongst the key findings of the GERMS-SA surveillance report was a rise in respiratory-transmitted diseases, of which many are vaccine-preventable. In children under one year, Haemophilus influenzae disease (incidence 7.59 episodes per 100 000 population) and invasive pneumococcal disease (incidence 14.90 episodes per 100 000 population) still cause substantial disease.
We encourage healthcare workers to promote Expanded Programme on Immunisation (EPI) vaccinations and urge caregivers to take their children for immunisation, including catch-up vaccines. In 2023, there was a 53% increase in invasive Neisseria meningitidis disease (IMD) episodes reported through the GERMS-SA surveillance programme compared to 2022 (107 vs. 70). IMD increased from 0.12 per 100 000 persons in 2022 to 0.18 per 100 000 in 2023, with serogroup B disease dominating. The incidence of opportunistic infections such as cryptococcosis amongst persons living with HIV remained stable in comparison to 2022. However, it showed high mortality, particularly among those not receiving flucytosine-based induction therapy as directed by the South African cryptococcal treatment guidelines. Patients with cryptococcosis typically present late to healthcare facilities and have multiple morbidities.
We encourage members of the public to get tested for HIV and commit to lifelong antiretroviral treatment to control the infection and prevent the development of opportunistic infections. The GERMS-SA surveillance report further highlighted that water-borne diseases are prevalent, and this can be improved only through better hygiene and sanitation.
Most of these diseases are manageable, and all healthcare workers are encouraged to promote testing and treatment for HIV prevention and care. We thank all participating South African clinical microbiology laboratories (public and private) and selected public hospitals. We encourage all clinical microbiology laboratories to continue to submit isolates to the GERMS-SA for surveillance. For the full GERMS-SA report, click here.
For enquiries and interview requests, please contact: Media@nicd.ac.za
