What is this article about?

This article describes the epidemiology of invasive pneumococcal disease (IPD) in the Free State, KwaZulu-Natal, and Mpumalanga provinces from 2019 to 2024, using laboratory-confirmed cases from the national GERMS-SA laboratory-based surveillance programme. It highlights trends in incidence, serotype distribution, and clinical characteristics across the three provinces.

Why does this matter?

IPD remains an important cause of illness and death, especially among young children, older adults, and people living with HIV. Although pneumococcal conjugate vaccines (PCVs) have reduced disease burden, changing vaccine formulations, including South Africa’s recent switch from 13-valent PCV (PCV13, Pfizer/Wyeth) to 10-valent PCV (PCV10, Serum Institute of India), together with the predominance of non-vaccine serotypes, continue to influence disease patterns. In addition, host factors such as age, HIV status, and comorbidities influence disease risk and presentation. Ongoing surveillance is therefore necessary to guide prevention strategies and inform policy decisions.

How did this article come about?

This article is the second in a three-part series providing provincial-level analyses of IPD epidemiology across all nine provinces in South Africa. Each paper presents detailed data on three provinces and is intended to support provincial and public health planning, rather than interprovincial comparison. While national data are important for overall policy, provincial analyses help identify local variation in disease burden, risk factors, and healthcare needs, which can inform more targeted interventions and resource allocation. Readers are encouraged to look out for the last report in the series, which, together with the other two, will provide coverage for all nine provinces.

What was your role in the development of this article?

I developed the first draft of the article. As Project Manager, I co-ordinated data collection, oversaw data quality assurance and analysis, and contributed to interpretation of findings, under the oversight of the GERMS-SA Principal Investigators. Collaboration with surveillance teams and laboratories ensured accurate reporting of invasive pneumococcal disease trends.

Why should people read this article?

This article provides important provincial-level insights into IPD trends, highlighting high-risk groups such as infants, people living with HIV, and individuals with co-morbidities. It also shows the predominance of non-vaccine serotypes, which is relevant for clinicians, public health practitioners, and policymakers involved in disease prevention and management.

What impact do you hope this article will have on public health policy and healthcare access?

We hope the findings will support evidence-based decision-making by informing vaccination policy, strengthening surveillance systems, and guiding targeted interventions for high-risk populations. The study also emphasises the importance of integrating IPD prevention with HIV care, including early HIV diagnosis and treatment, as well as ongoing efforts to strengthen vaccination programmes and improve PCV uptake, with the potential to reduce morbidity and mortality.

Ms Kate Bishop Jensen (MPH) is a Project Manager at the Division of Public Health Surveillance and Response at the National Institute for Communicable Diseases.

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