South Africa has a routine notification system for reporting notifiable medical conditions. The South African Disease Notification System is a passive surveillance system that collects information on Notifiable Medical Conditions. The National Department of Health (NDOH) manages the Disease Notification System under the auspices of the Directorate: Epidemiology and Surveillance.

The notification of certain medical conditions in South Africa is based on the government’s Health Act, Act No. 61 Of 2003, coupled with regulations on the reporting of specific diseases to the Local, Provincial and/or National Health Department. The Health Act prescribe the diseases in South Africa that need to be notified to the National Department of Health, how soon after diagnosis (presumptive or confirmed) and the information required for each condition. 33 medical conditions are notifiable. Some of these have been sub-divided for practical reasons e.g. Crimean Congo Haemorrhagic Fever has been separated from other haemorrhagic fevers, resulting in more than 40 different conditions, which the notification system covers.

The notification system has several objectives:

• At the national level, it helps the National Department of Health (NDOH) to plan and implement health promotional and intervention strategies.
• It helps the NDOH to monitor disease trends over time. In time this will permit an evaluation of the effectiveness of promotional and intervention strategies.
• At provincial it helps to implement immediate interventions

** Schematic Information flow for notifying a medical condition in SA

National Department of Health

Cluster: Health Information, Evaluation & Research (HIER)
Directorate: Epidemiology & Surveillance
Private Bag X828
Pretoria
001

Tel: 012 – 312 0992 / 0767
Fax: 012 – 312 0815

How do I notify?

The initial notification of a medical condition is done on a case-based form (GW 17/5) with the relevant details, to make tracing as easy as possible, since a disease notification demands action (follow-up) at the peripheral level. Normally it is the health personnel e.g., clinic personnel, infection control nurses, other hospital staff, public or private medical practitioners who makes the initial notification. This form makes provision for the notification of cases as well as deaths. Any person contracting a notifiable disease and then dies from the disease should be notified twice: first as a  “CASE” and then later as a “DEATH”. This will ensure that when estimating the “Case Fatality Rate” (CFR%), all deaths in the numerator are also included in the denominator. Depending on the structural organization of the province, the completed GW 17/5 forms is sent to the relevant local health authority, district health office or the provincial office.

Who should notify?

The first health care professional to come into contact with a patient presenting with one of the prescribed Notifiable Medical Conditions is required by law to notify. This may include clinic personnel, infection control nurses, other hospital staff or private medical practitioners. In the event of deaths (or cases) in the community, a member of the community is obliged to notify the event.

Which diseases are notified?   

Currently 33 broad medical conditions are currently notifiable in South Africa (see List of Notifiable Medical Conditions). Some (e.g. Tuberculosis and Viral hepatitis) have been spilt into various components, resulting in more than 40 notifiable medical conditions

Notifiable medical conditions have been sub-divided into two categories according to type of disease:

a) Category A: these are medical conditions that require immediate notification to the regional/provincial or Department of Health by telephone or fax upon initial diagnosis (presumptive or confirmed) with written notification form (GW17/5) to follow within five days.

Any health care professional identifying even a single case of a disease (presumptive or laboratory confirmed) contained in the Category A should make an immediate notification directly to the designated local health officer through fax or telephonically as rapidly as possible (within 24 hours). The local health officer must report to the Provincial health officer and/or to the National Department of Health. Where it is applicable, laboratory confirmation should be obtained at the earliest opportunity and also reported to the designated health office. After reporting through a telephone/fax, it is still required of the health care provider to send a complete GW17/5 form to the designated local health authority within five days after telephonic reporting.

b) Category B: these are medical conditions that require written notification (GW17/5 form) only, within seven days of diagnosis.

Do I have to wait for laboratory confirmation?

No. The notification system is based on clinical notifications and therefore all suspected cases of a notifiable condition must be immediately notified. This ensures a rapid response to a clinical case and avoids the delays inherent in waiting for laboratory results. Appropriate laboratory tests should be preformed but you do not have to wait for results to notify. Some conditions are only ever based on clinical criteria such as tetanus.

Reporting a Notifiable Disease during an outbreak

During an outbreak of a notifiable disease, all cases must be reported immediately through the phone, email or fax. Daily reporting by health facilities should be maintained through an Outbreak Case Line Listing Form as well through the notification form (GW17/5) to the local health authority that must report to the provincial health officials and the National Department of Health. The purpose of line-list is to summarize time, place and person analysis, epidemiologic curve, and analysis tables for risk factors, such as age group, sex, location, etc. The National Department of Health should then be notified (through GW17/5 form) since the disease is notifiable medical condition.

Priority Reporting of MDR & XDR –TB

  
Tuberculosis (TB) is one of 33 medical conditions, which is notifiable in terms of the National Health Act (Act 61 of 2003). The Directorate: Epidemiology & Surveillance have instituted a priority reporting for MDR and XDR TB. This means that all health care facilities -public and private- including clinics, hospitals, laboratories, general practitioners and private specialist doctors, are required to report all cases of MDR and XDR to the department of health within 24 hours.

More info on XDR -TB

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 For more information and to obtain GW17/5 forms contact:

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List of Notifiable Medical Conditions in South Africa

Figure 1: Schematic of Information flow for notifying a medical condition in South Africa. PDF

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Category A disease: Immediate notification [within 24-hours] after diagnosis by the health care professional through telephone or fax to the designated district or provincial health officer