How do provincial differences shape the burden and characteristics of invasive pneumococcal disease in South Africa?
Invasive pneumococcal disease (IPD), caused by Streptococcus pneumoniae, remains a significant public health concern in South Africa, particularly among infants, older adults, and individuals with underlying conditions. While the introduction of pneumococcal conjugate vaccines (PCVs) into the Expanded Programme on Immunisation in 2009 led to substantial declines in disease incidence, IPD has not been eliminated. Ongoing transmission, alongside evolving serotype patterns, continues to shape the burden of disease across populations.
National surveillance systems provide critical insight into overall IPD trends, but they can mask important differences at provincial level. Variations in population structure, healthcare access, HIV prevalence, and local health system capacity influence both disease incidence and clinical outcomes. These differences became more pronounced during and after the COVID-19 pandemic, when non-pharmaceutical interventions temporarily reduced transmission before incidence rebounded toward pre-pandemic levels.
Laboratory-based surveillance offers a robust approach to monitoring IPD by capturing confirmed cases and enabling detailed analysis of incidence, serotype distribution, and patient characteristics.
In this report, we describe the epidemiology of IPD in the Eastern Cape, Northern Cape, and Western Cape provinces from 2019 to 2024, using laboratory-confirmed cases reported through national surveillance.
Materials and Methods
Data were prospectively collected through GERMS-SA, a national infectious disease surveillance platform conducting laboratory-based, population-based, and enhanced surveillance.
For this study, we selected three geographically adjacent provinces in SA (EC, NC, and WC) to provide detailed provincial-level analyses, with data from other provinces reported separately. From 2019 through 2024, all laboratory-confirmed cases of IPD in these provinces were included.
Results
Between January 2019 through to December 2024, 5 108 laboratory-confirmed IPD cases were reported to the GERMS-SA surveillance programme in the three provinces overall; 71% (3 647/5 108) of cases were confirmed on blood culture, ranging from 55% in the EC to 78% in the WC.
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