South Africans need to be vigilant against vaccine-preventable diseases, illnesses related to advanced HIV, cryptococcal meningitis, invasive meningococcal and water-borne diseases.

This is according to the National Institute for Communicable Diseases (NICD), which says cases are rising despite South Africa having made strides in healthcare provision, which has led to better health outcomes.

The rise in cases was revealed in the NICD’s Germs-SA Annual Surveillance Review for 2023, which was released to the media on Wednesday.

The report shows a steady rise in disease cases since 2020, which is a cause for concern and requires collaboration among health authorities, healthcare workers and the public, the NICD said.

Key findings from 2023

Germs-SA detected 14 138 surveillance cases in 2023, showing different trends in pathogen incidence and age groups.

According to the report, respiratory-transmitted pathogens affected by Covid-19 non-pharmaceutical practices have returned to pre-Covid-19 levels.

The highest burden for many pathogens was found in the Western Cape, possibly related to health-seeking behaviour, better laboratory capacity and specimen-taking practices.

Also among the report’s key findings is 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.

According to the World Health Organisation (WHO), Haemophilus influenza is caused by bacteria commonly found in the upper respiratory tract, which are transmitted by droplets from people who are infected (but not necessarily symptomatic) to those who are susceptible.

From infection to the appearance of symptoms is two to 10 days.

“If these bacteria enter the bloodstream, becoming ‘invasive’, they can cause pneumonia, meningitis, sepsis or other serious diseases. If the bacteria spread to the sinuses or the middle ear, this can lead to sinusitis or otitis media, a painful type of ear infection.

“Antibiotic resistance is a growing challenge, with antibiotic-resistant strains now found in all regions of the world.”

The NICD has thus encouraged healthcare workers to promote the Expanded Programme on Immunisation vaccinations and caregivers to take their children for immunisation, including catch-up vaccines.

Invasive Neisseria meningitidis disease

In 2023, there was a 53% increase in invasive Neisseria meningitidis disease (IMD) episodes reported through the programme, compared with 2022. IMD increased from 0.12 (per 100 000 people) in 2022 to 0.18 (per 100 000) in 2023, with serogroup B disease dominating.

IMD can refer to any illness caused by a type of bacteria called Neisseria meningitidis, also known as meningococcus. These illnesses are often severe and can be deadly. They include infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia).

These bacteria spread through the exchange of respiratory and throat secretions, such as saliva. Doctors treat meningococcal disease with antibiotics, but quick medical attention is important.

Keeping up to date with recommended vaccines is the best defence against meningococcal disease.

Meningitis signs and symptoms

Clinical features of patients with meningitis vary depending on the cause, disease course, brain involvement and systemic complications.

Common symptoms of meningitis are:

• neck stiffness
• fever
• confusion or altered mental status
• headaches
• nausea and vomiting.

Less frequent symptoms are:

• seizures
• coma
• neurological deficits (for example, hearing or vision loss, cognitive impairment or weakness of the limbs).

Sepsis signs and symptoms

Sepsis is a medical emergency. It can cause different signs and symptoms at different times. People who think they may have sepsis should seek immediate medical care.

Common signs and symptoms include:

• fever or low temperature and shivering
• confusion
• difficulty breathing
• clammy and sweaty skin
• extreme body pain or discomfort
• high heart rate, weak pulse or low blood pressure
• low urine output.

Symptoms in children include:

• fast breathing
• convulsions
• pale skin
• lethargy
• difficulty waking up
• feeling cold to the touch.

Opportunistic infections remain stable

The incidence of opportunistic infections, such as cryptococcosis, among people living with HIV remained stable in comparison with 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,” the NICD said.

Cryptococcal disease is caused by the fungus Cryptococcus, which is found worldwide in places such as decaying organic matter, trees, soil and bird droppings.

People inhale the fungus from the air in the form of fungal spores. The fungus may remain inactive until the person’s immune system is weakened, such as in transplant recipients or persons with untreated HIV. People with intact immune systems can sometimes also get the disease, although these cases are less common.

When the fungus is active, it can spread to the brain and sometimes other organs through the bloodstream. Meningitis is the most common form of disease caused by this fungus. Cryptococcal meningitis is a major cause of death in people living with HIV worldwide (second only to TB), despite the now widespread use of antiretroviral therapy.

The NICD encourages the public to get tested for HIV and commit to lifelong antiretroviral treatment to control the infection and prevent the development of opportunistic infections.

Water-borne diseases are prevalent

The surveillance report further highlighted that water-borne diseases are prevalent.

“This can only be improved through better hygiene and sanitation.”

The national, population-based laboratory surveillance programme for bacterial and fungal infections is a collaboration between the NICD, a division of the National Health Laboratory Service; participating South African clinical microbiology laboratories (public and private); and selected public hospitals.

The surveillance programme systematically collects, 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.

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