1. What is this study about?

We have been monitoring the trends in enteric virus circulation in five-year-old children who present for the treatment of diarrhoea at selected hospitals and clinics in various provinces across South Africa from 2009 until 2023.

2. Why does this matter?

Diarrhoeal diseases still contribute to morbidity and mortality in South African children post-rotavirus vaccine introduction. Information from longitudinal surveillance provides us with insights on rotavirus vaccine performance and coverage as well as other enteric viruses that might contribute to diarrhoeal disease burden. We need to be aware of the magnitude of the problem so that we can identify suitable interventions and strategies to implement them. This may also include advocating for the development of new enteric vaccines.

3. What drew your interest in this area of research?

There are more interventions available to prevent and treat diarrhoeal diseases than any other condition that we are trying to combat today. These include hand washing with soap, access to safe water and adequate sanitation, rotavirus vaccines, exclusive breastfeeding, the use of oral rehydration solution and zinc for treatment, and improved case management and referral. Knowing what is causing the problem and to whom allows for the implementation of targeted interventions for those that need them most.

4. What was your role in the study?

I currently co-ordinate the diarrhoeal disease surveillance and have been with the programme since the start in 2009. I have worked on all aspects of the programme, from set-up to laboratory analysis to training to data entry and analysis. The programme has been a major part of my research for 15 years, and it has been rewarding to see the information generated.

5. Why should people read this article?

Anyone working in paediatrics or who is interested in diarrhoeal diseases will get a summary of data from the last 14 years, giving them insight into annual trends in enteric virus circulation. The paper should also provide them with epidemic intelligence and assist them with diagnostic differentiation when presented with a sick child. In addition, people working in public health will see the impact of the rotavirus vaccine introduction in South Africa and identify new challenges that require attention going forward.

6. What impact do you hope this study will have on public health policy and access to healthcare?

Vaccines against rotavirus have been a success, despite the lower vaccine effectiveness, and have demonstrated the value of these interventions in reducing childhood mortality. Access to vaccines should be a priority programme in healthcare, ensuring that the most vulnerable have access to these lifesaving interventions.

Prof. Nicola Page is a principal medical scientist who leads the Virology Division and is currently the Acting Head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases (NICD).

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