DISEASE SURVEILLANCE BULLETIN
January – June 2002 (as on 4/07/2002)

AFP Surveillance in South Africa

The world is eagerly waiting to be declared polio-free by 2005. According to the 21 June 2002 press release EURO 12/02, the European region has recently been certified polio free.

This is a challenge to African region, which still has some countries with polio circulating.

South Africa has not achieved the detection rate of 1 AFP case per 100 000 children under the age of 15 years, with 80% stool adequacy in 2002(80% stool adequacy has never been achieved since 1997,see table 1 and 2).

The quality of surveillance in South Africa has a major impact to the performance of the Southern block as a whole, because it is responsible for 27% of the expected AFP cases of the block. Provinces are urgently requested to increase effort to ensure that AFP cases are detected and investigated and that 2 stool specimens with minimum of 24 hours apart are collected within 14 days of onset of paralysis.

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

35 AFP cases for 2002 were classified by PEC as discarded, 3 compatible and 1 pending 60 day follow up.

On April 2002, the Minister of Health has launched the National Certification Committee (NCC) and a countdown to a polio-free South Africa.

Measles surveillance in South Africa, January-JUNE 2002

South Africa has set a goal to eliminate the indigenous transmission of measles by the end of 2002. Case based surveillance with active laboratory involvement has been introduced in 1998.

Blood and urine for laboratory tests of measles and rubella are collected from every case, which present at the health facility with rash and fever and either cough or coryza or conjunctivitis.

Measles cases have decreased from 19193 in 1980 to 8 in 2001. 356 suspected measles cases with only 4 confirmed measles cases were reported in 2002.

The data quality of Kwazulu Natal, Mpumalanga, North West and Western Cape is very good. Provinces are encouraged to detect, investigate (including completing a case investigation form) and report the cases to the national EPI.

Each province should demonstrate readiness to deal with importations and contain the transmission. The WHO bulletin reported an ongoing measles outbreak in Namibia that has started in 2001 and 94 laboratory confirmed cases were reported.

Suspected measles outbreak news.

On 30 May 2002, the Outwest Mobile Clinic conducted an outbreak response in St Joseph Primary School (Ladysmith, Kwazulu Natal). Blood specimens were collected from 5 scholars (age range=6 -10 years, date of onset = 29 – 31 May 2002) and sent to the laboratory.

The blood test results were negative for measles in all 5 suspected measles cases and the viral isolation from the urine was also negative. None were tested for rubella.

Maternal Neonatal tetanus elimination

World Health Organization (WHO), UNICEF and Department of Health (national and provincial) conducted a Maternal Neonatal Tetanus elimination validation process from 21^st to 26 June 2002.

Clean delivery rate, TT coverage, Antenatal Care first visits rate and DTP3 coverage were indicators used during elimination validation.

Seven provinces were declared to have eliminated MNT. Six districts from Kwazulu Natal (which are Zululand DM, Uthungulu DM and Umkhanyakude DM) and Eastern Cape (Alfred Nzo DC44, Amatole DC12 and O Tambo DC15) are still to be visited by both WHO and UNICEF, to establish elimination status.

Limpopo/Northern Province is being considered for field visit because of the NNT and Tetanus cases that were detected during the facility visit by National Department of Health.

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.zaAND Christa van den Bergh at 012 312 0095 or berghc@health.gov.za.