What are the Emerging Trends in Bacterial and Fungal Infections?
Bacterial and fungal infections are illnesses caused by harmful bacteria and fungi invading the body, leading to a range of health issues. These infections can be mild or severe and can affect various parts of the body. For example, Streptococcus pneumoniae causes pneumonia, a serious lung infection, while Mycobacterium tuberculosis is responsible for tuberculosis, a highly infectious respiratory disease. Understanding these infections is crucial for public health efforts, as it allows for targeted interventions, appropriate use of antimicrobial treatments, and the development of effective vaccines.
GERMS-SA plays a pivotal role in safeguarding public health in South Africa through its comprehensive, national laboratory surveillance of bacterial and fungal infections. This vital program is a collaborative effort between the National Institute for Communicable Diseases (NICD), the National Health Laboratory Service (NHLS), clinical microbiology laboratories, and selected public hospitals. GERMS-SA operates on two levels: documenting laboratory-confirmed cases of specific pathogens and conducting enhanced sentinel site surveillance to collect detailed clinical data. This robust system ensures a thorough understanding of infectious disease patterns across the country.
Since its inception in the early 2000s, GERMS-SA has evolved from multiple surveillance projects into a cohesive and enduring program. Its longevity has allowed for the accumulation of critical data, revealing trends in pathogens of public health significance, including those that are vaccine-preventable, epidemic-prone, or associated with healthcare settings and HIV.
The GERMS-SA: Annual Surveillance Review for 2022 highlights key findings, providing essential insights that help shape public health policies and clinical practices in South Africa.
Materials and Methods
In 2022, the GERMS-SA surveillance program involved about 222 South African clinical microbiology laboratories from public, private, military, and mining sectors across all provinces. Laboratories reported cases to the NICD using standard forms and sent isolates for further analysis. Diseases under surveillance included HIV-associated opportunistic infections, epidemic-prone diseases, vaccine-preventable diseases, and healthcare-associated bloodstream infections. Thirty enhanced surveillance sites, chosen for convenience within the public health sector, used REDCap for data collection on tablets.
Data management was centralized at the NICD, with demographic and clinical data recorded in a Microsoft Access database. Incidence rates were calculated using mid-year population estimates and the Thembisa model, and data quality was maintained through regular training and audits. Results were disseminated through annual reviews, conferences, and publications.
Results
Cholera cases were reported but didn’t warrant public health responses, while Campylobacter cases were mainly non-invasive and more common in children. Enteric fever cases surged, primarily in children. Genetic clustering in Gauteng suggested local outbreaks. Invasive meningococcal disease doubled in 2022, with infants at highest risk. Serogroup circulation increased, warranting further analysis.
Cryptococcosis incidence risk declined to 60 per 100,000 HIV-infected persons, attributed to early ART initiation and reflex CrAg programs. However, new cases remained stable, impacting healthcare systems. Flucytosine-based therapy decreased, affecting in-hospital fatality rates. Shigella infections rose significantly, with specific serotypes dominating, while Listeria cases decreased, particularly in neonates.
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