1. What is the GERMS-SA Annual Surveillance Review about?

This is our annual review of the laboratory-based surveillance programme of pathogens of public health importance for the National Institute for Communicable Diseases. It is our report of the previous year’s case numbers, epidemiology data and clinical data from our enhanced surveillance sites of all the National Health Laboratory Service case numbers from the surveillance data warehouse as well as numbers reported by the private sector.

2. Why does this matter?

It gives us an estimate of disease burden trends of specific bacterial and fungal infections, the impact of vaccines on certain diseases, trends in antimicrobial resistance, and outbreak-related diseases. It also estimates the impact of antiretroviral therapy and programmatic interventions on AIDS-related opportunistic infections.

3. How did the surveillance come about?

It all started in August 1999 with a letter published in the South African Medical Journal, written by renowned experts in the field of public health and infectious diseases, which indicated the need for a laboratory-based surveillance system to measure the impact of the introduction of the Haemophilus influenzae type b vaccine into the Expanded Programme on Immunisation (EPI). They believed an ongoing surveillance programme would be able to measure the impact of the Hib vaccine in preventing invasive disease in infants to justify expenditure on the vaccine, identify vaccine/programme failures, determine whether a booster dose was needed, and potentially to establish a surveillance system for other pathogens which might be included in the EPI in future. Therefore, surveillance of invasive pneumococcal disease, meningococcal disease and enteric disease was included and, in 2003, GERMS-SA was created to achieve these purposes.

4. What was your role in the study?

I was the first medical officer hired in 2003 to set up enhanced surveillance sites, throughout the country, to collect clinical data from patients with diseases that we were tracking in the laboratory-based surveillance. Our GERMS-SA programme is based on the Centers for Disease Control and Prevention’s (CDC) Active Bacterial Core surveillance (ABCs) system.

5. Why should people read this article?

This article provides insight into South Africa’s infectious disease trends, some clinical insights into the clinical presentation of patients with these diseases at public sector hospitals and antimicrobial resistance patterns of our pathogens under surveillance.

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

Because surveillance is long term, it allows us to look at trends over time. Already, we have impacted vaccines for EPI, changes in treatment guidelines for pneumonia, cryptococcal meningitis and monitoring antimicrobial resistance. With the changes in EPI vaccines, particularly of pneumococcal vaccine from PCV13 to PCV10-Cipla, it is important to continue monitoring invasive pneumococcal disease to see how this lower valency vaccine impacts disease. We have seen that poor coverage of vaccines in the EPI leads to outbreaks of disease and urge all healthcare workers and caregivers to get their children immunised.

Dr Vanessa Quan is the head of the GERMS-SA programme, which is part of the Division of Public Health Surveillance and Response.

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