What do the latest GERMS-SA surveillance findings reveal about disease trends in South Africa?
Infectious diseases caused by bacterial, fungal, and parasitic pathogens remain a major public health concern. Surveillance systems that rely on laboratory-confirmed cases provide critical insights into disease burden and epidemiology, but can be affected by disruptions in diagnostic and reporting capacity.
GERMS-SA is a national, population-based laboratory surveillance programme led by the National Institute for Communicable Diseases, monitoring bacterial, fungal, and parasitic infections across South Africa through a network of laboratories and sentinel hospital sites.
In 2024, marking over two decades of surveillance, findings showed that opportunistic infections, particularly cryptococcosis, remained major contributors to severe disease and mortality, while vaccine-preventable diseases continued to present a persistent burden with evolving epidemiology.
Additionally, the programme was also expanded surveillance to include neglected tropical diseases, specifically schistosomiasis and soil-transmitted helminth infections in Limpopo and Mpumalanga.
The following review summarises key findings from the GERMS-SA 2024 Annual Surveillance Review, highlighting trends across major infectious disease categories and reflecting on the role of long-standing surveillance systems in informing public health policy, vaccine strategies, and outbreak response in South Africa.
Materials and Methods
In essence, public and private microbiology laboratories nationally submit culture-positive isolates on Dorset transport media, in line with GERMS-SA case definitions, to the NICD, where reference laboratories confirm the organism, perform antimicrobial susceptibility testing, and conduct serogrouping/serotyping on viable isolates (or on PCR-confirmed, culture-negative specimens), as well as molecular characterisation.
Laboratories also submit case reports to the NICD using standardised case definitions and laboratory case report forms containing patient demographics, specimen type, and laboratory test results.
Results
A total of 12 657 surveillance cases were detected in 2024 (including audit cases). Opportunistic infections, particularly cryptococcosis, remained major contributors to severe disease and mortality across all age groups.
Vaccine-preventable and epidemic-prone diseases showed ongoing burden and shifting epidemiology, including increased meningococcal disease and persistent pneumococcal and enteric fever patterns.
Neglected tropical disease surveillance in Limpopo and Mpumalanga showed high confirmation rates but highlighted under-submission of specimens and provincial variability.
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