AFP Surveillance in South Africa, January-May 2002

DISEASE SURVEILLANCE BULLETIN
January - July 2002(as on 05/08/2002)

AFP Surveillance in South Africa

Due to the fact that most of the provinces did not reach the detection rate of 1 Acute Flaccid Paralysis (AFP) case per 100,000 children <15 years and 80% stool adequacy, the National EPI decided to conduct Hospital visits.

The first provinces to be visited were

Gauteng (Tembisa Hospital was used as a training site for hospital visits), Northern Province and Mpumalanga. The findings are as follows:

Lack of awareness and knowledge about AFP surveillance was evident in some of the hospitals. Some of the doctors mentioned that they were not told by their Management to look for AFP cases only hear nurses talking about it, hence they are not supportive.
Lack of effective AFP surveillance system in Limpopo Province. District coordinators are requested to do more in improving the surveillance system, which will allow the provincial coordinator to monitor surveillance, and other EPI related activities.

South Africa has achieved the detection rate of 1 AND 55% stool adequacy, which is below 80% in 2002(Jan-August). We would like to encourage provinces to improve stool adequacy and also detection rate.

The above graph shows the number of AFP cases expected by the end of August 2002 in each province.

Table 1. Current status of AFP surveillance in South Africa per province (as on 05/08/2002)

PROVINCE	2002(as on 05/ 08/02)
PROVINCE	Estimated	Detected	Detection Rate	Stool adequacy	% Stool adequacy
Eastern Cape	29	11	*0.7*	5	45
Free State	9	3	*0.6*	0	0
Gauteng	22	11	*0.9*	9	82
Kwazulu Natal	33	25	*1.3*	19	76
Mpumalanga	11	6	*0.9*	2	33
Northern Cape	4	1	*0.4*	1	100
Northern Province	25	15	1.0	4	27
North West	10	4	*0.7*	3	75
Western Cape	13	16	*2.1*	8	50
South Africa	156	92	1.0	51	55

Measles case based surveillance in South Africa, Jan-July 2002.

South Africa has set a goal to eliminate indigenous transmission of measles by the end of 2002.

Measles elimination occurs when endemic transmission has stopped AND secondary spread from importations ends without intervention.

For South Africa to claim measles elimination status, these three Measles Elimination Criteria should be met (adopted during the April 2001 EPI Managers meeting in Harare).

The rate of confirmed measles cases should be less than 1 per 100,000 in a total population.
For all outbreaks with greater of equal to 5 confirmed measles cases, the percentage of outbreaks with with greater of equal to 25 cases should be less than 30%.
For all outbreaks with with greater of equal to 5 confirmed measles cases, the percentage of outbreaks with with greater of equal to 100 cases should be less than 5%.

Table 2. Number of measles and rubella cases per province in South Africa, 2002(as on 05/08/2002)

Province	Suspected Measles cases	Confirmed Measles cases	Confirmed Rubella cases
Eastern Cape	7	0	0
Free State	43	1	15
Gauteng	154	1	11
Kwazulu Natal	59	0	0
Mpumalanga	83	0	11
Northern Cape	20	1	5
Limpopo Province	12	1	0
North West	14	0	2
Western Cape	49	2 Imported	0
Unknown	11	0	2
SOUTH AFRICA	452	6	46

The proportion of confirmed measles cases has decreased from 9% in 1998 to 1.4% in 2002(i.e. January to July 2002).

Data quality for Free State, Gauteng, Limpopo Province and Northern Cape is poor. We therefore would like to encourage provinces to improve disease surveillance and collect epidemiological information on all the cases.

Suspected measles outbreak news.

Two children from Bellville aged 7 months and 3 years respectively were admitted in Tygerberg Hospital. Their date of rash onset was 03/07/2002 and 20/07/2002.

But the investigation indicated that they were from Somalia and the 3-year-old child just came from Somalia.

Blood was taken and sent to the laboratory for measles serological tests. The blood test results were positive for measles. The epidemiological investigation is not yet complete and still waiting for a report on the outbreak response.

We would like to congratulate Western Cape for showing readiness in dealing with importations.

Maternal Neonatal Tetanus Elimination

South Africa has a great challenge to maintain Maternal Neonatal Tetanus elimination status.

Provinces should monitor the immunization coverage i.e. DTP3 and TT for pregnant women.

Another challenge is to ensure that both clean delivery rate and antenatal first visit rate are increased to more than 80%.

These are major challenges to more rural provinces like Eastern Cape, Kwazulu Natal and Limpopo where home deliveries and the use of substances to the umbilical cords are still common.

Maternal and Child mortality rates are good indicators for the success of health care delivery system in South Africa and other countries.

Infant Mortality Rate in South Africa is 45 deaths per 1,000 live births (South African Demographic and health survey, 1998). In 2000, 940 maternal deaths were reported (3^rd Interim Report on Confidential Enquiries into Maternal Deaths in South Africa, 2000).

CHILDREN ARE THE GREATEST ASSETS OF MANKIND, LETS PROTECT THEM AGAINST VACCINE PREVENTABLE DISEASE. NATIONAL IMMUNIZATION AWARENESS WEEK
4-10 AUGUST 2002.

For more information contact Thomas Dhlamini at 012 312 0033 or dlamit@health.gov.za , Fungisani Matidza at 012 312 0069 or MatidF@health.gov.za AND Christa van den Bergh at 012 312 0095 or berghc@health.gov.za .

EDITED BY DR NJ NGCOBO

DISEASE SURVEILLANCE BULLETIN January - July 2002(as on 05/08/2002)