What is this study about?

The study summarises the 2023 results from the syndromic respiratory illness surveillance programmes in South Africa.

Why does this matter?

It matters because it provides a summary of the trends of respiratory pathogens causing respiratory illness in South Africa and the return to “normal” circulation patterns following the decline in transmission of respiratory pathogens and changes in seasonality during the COVID-19 pandemic. It also highlights the most common respiratory virus causing hospitalisation in young children (respiratory syncytial virus (RSV)), for which new interventions have become available recently (vaccines for pregnant women and a long-acting antibody injection which protects young babies). It is important to increase access to these products in South Africa.

How did the surveillance come about?

It’s an ongoing surveillance programme, initially established for influenza surveillance. Over the years, it expanded to include other respiratory pathogens in order to describe the trends of respiratory illness by syndrome and by pathogen, define the seasonality, and estimate the burden of respiratory illness in South Africa. An established surveillance platform is important for pandemic preparedness and is used to provide data for policy and vaccine decision-making.

What was your role in the study?

I am the principal investigator on the protocols and grants for surveillance programmes and oversee the team that is responsible for collecting and analysing the data. I was part of the team that developed the concept for the study and contributed to the drafting and the review of the report.

Why should people read this article?

To gain insight on the trends of respiratory pathogens causing mild and severe respiratory illness in South Africa following the decline in circulation of respiratory pathogens during the COVID-19 pandemic. The report includes the description of the timing and severity of the influenza and RSV seasons, year-round low circulation of SARS-CoV-2 with no seasonality, and continued increase in pertussis transmission during the first half of the year. The report also highlights the groups who are more affected by respiratory illness who should be prioritised for interventions. Moreover, it highlights the most important viral causes of respiratory hospitalisation in children (RSV) and in adults (influenza), both of which are vaccine-preventable diseases.

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

The report highlights the evolving epidemiology of respiratory pathogens and highlights the importance of ongoing year-round surveillance. Highlighting that the RSV burden remains high in children, this should encourage a concerted effort by policymakers to explore the introduction of the newly available RSV prevention measures like maternal vaccines and long-acting monoclonal antibodies. In addition, pertussis continues to cause outbreaks in children and adults despite the availability of vaccination; the results of the study should encourage strengthening of the expanded programme on immunisation and increased uptake of the newly introduced pertussis vaccine for pregnant women. These data contribute to disease burden estimates, evaluation of vaccine effectiveness, and providing evidence for policymakers and stakeholders in developing and monitoring prevention strategies.

Dr Sibongile Walaza is the Head of Epidemiology at the Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases.

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