Report & Analysis Summary | Infectious Disease & Vaccines
New Report Shows Surge in Meningococcal Disease Cases in South Africa: A 2024 Alert for Clinicians
Time to read: 04:52
Time to listen: 08:52
Originally Published: November 2024
Type of article: Summary of Report
MedED Catalogue Reference: MNCS006
Category: Infectious Diseases
Cross-reference: Paediatrics & Neonatology
Keywords: invasive meningococcal disease (IMD), Neisseria meningitidis, vaccines, GERM-3
Originally Published in Public Health Bulletin, a National Institute for Communicable Diseases publication. This is a summary of the original report and in no way represents the original research. Access Content Disclaimer
Key Take Aways
1. There has been an increase in the incidence of invasive meningococcal disease episodes from 2023
2. Serogroup B remains the most common cause of IMD in 2024 (21 cases), followed by serogroups W (13), Y (13), and C (9)
3. Clinicians should suspect IMD in patients with fever, malaise, and rapid deterioration, with or without a petechial rash
4. In suspected cases, blood or cerebrospinal fluid should be sent for culture before starting antibiotics, though treatment should not be delayed.
Overview | Report Purpose | Methods | Findings | High-level Recommendations | Conclusion | Original Research |
Meningococcal disease, caused by Neisseria meningitidis, is endemic in South Africa. Year-round invasive meningococcal disease (IMD) episodes peak in winter and spring. Despite advances in antimicrobial treatments, conjugate vaccines, and improved critical care, meningococcal disease remains a serious public health concern globally.
In 2019, bacterial meningitis (BM), including meningococcal disease, caused an estimated 236,000 deaths worldwide, with nearly one-fifth of survivors experiencing long-term complications.3
The burden of meningococcal disease in South Africa is significant, with an annual incidence of 4 per 100,000 in the general population and 40 per 100,000 among infants. This burden is exacerbated by the high prevalence of HIV and tuberculosis, which influence disease presentation and outcomes in adults.3
IMD has a case fatality rate of 17%, and 20% of survivors develop long-term sequelae, including neurological and cognitive impairments. Most IMD cases in South Africa are sporadic, although clusters occasionally occur. 1,2
Historically, the disease incidence follows a 10–15-year waxing and waning pattern. Key events influencing its epidemiology in South Africa include a nationwide surge in cases caused by serogroup W from 2005–2010, and a sharp decline during the COVID-19 pandemic, when containment measures curbed respiratory pathogen transmission. However, since 2022, cases have been returning to pre-pandemic levels, underscoring the need for heightened awareness.1,2
According to this report, the causative bacterium N. meningitidis has 12 identified serogroups, seven of which (A, B, C, W, X, Y, and Z) are pathogenic.
Transmission occurs through respiratory droplets, with disease progression often starting with nonspecific symptoms such as fever, malaise, and vomiting. Advanced symptoms, including the classic purpuric rash, indicate severe septicaemia and require immediate medical attention.
Locally, GERMS-SA performs national, population-based surveillance for laboratory-confirmed bacterial and fungal infections of public health importance in South Africa. Surveillance through the GERMS-SA programme has provided critical insights into the pathogen’s dynamics, especially in the post-pandemic years. 2
This report, released in November 2024, contains feedback on the surveillance findings of laboratory-confirmed IMD in South Africa from the start of the GERMS-SA programme in 2003 through September 2024, with a focus on the trends noted in the post-COVID-19 pandemic years (2021-2024).
Back to top
The GERMS-SA programme has collected data on laboratory-confirmed invasive meningococcal disease (IMD) in South Africa since 2003. Data through March 2024 were included in the latest report, as a June 2024 NHLS IT security breach disrupted access to the Surveillance Data Warehouse.
The GERMS-SA surveillance programme reported higher numbers of laboratory-confirmed invasive meningococcal disease episodes from January to May 2024 compared to 2023.
However, these numbers declined after June 2024, resulting from failures in automated reporting systems for public-sector cases. Of concern, by week 38 of 2024, 99 cases were confirmed, compared to 107 for the entirety of 2023, indicating a sharp increase in cases.
Serogroup B remains the most common cause of IMD in 2024 (21 cases), followed by serogroups W (13), Y (13), and C (9). This aligns with a trend observed since 2016, where serogroup B overtook serogroup Was the leading cause of disease. All IMD episodes in 2024 were sporadic, with no significant epidemiological links identified between cases.
Historically, IMD incidence in South Africa peaked in 2006 at 1.4 cases per 100,000 people.
The incidence reached its lowest point in 2021, at 0.05 per 100,000, but gradually rose to 0.18 per 100,000 by 2023. While these numbers reflect a return to pre-COVID-19 trends, levels remain below those seen before the pandemic.
The highest incidence continues to be among infants, recorded at 1.6 per 100,000 in 2023, with a smaller increase in adolescents and young adults (0.22 per 100,000).
Among infants, serogroup B has consistently been the predominant strain, responsible for over half of all cases since 2019.
Geographically, coastal provinces, especially the Western Cape, report higher IMD rates, with an incidence of 0.61 per 100,000 in 2023—double that of other provinces.
While all regions show an upward trend since 2021, rates remain within the range of early pre-pandemic years.
High-level Recommendations
The World Health Organization’s roadmap for defeating meningitis by 2030 includes targets for the elimination of BM epidemics, the reduction of vaccine-preventable deaths, and improved quality of life for survivors.3
Based on the findings of this report, the researchers recommended the following:
Clinical Interventions
Clinicians should suspect IMD in patients with fever, malaise, and rapid deterioration, with or without a petechial rash.
Blood or cerebrospinal fluid should be sent for culture before starting antibiotics, though treatment should not be delayed.
All suspected IMD cases should be reported to the NMC system within 24 hours.
Clinicians should offer chemoprophylaxis to close contacts of IMD cases to prevent further infections.
Laboratory
Laboratory staff should send invasive meningococcal isolates to NICD for serogrouping and further characterisation.
Culture-negative specimens should be sent to NICD for molecular detection of pathogens.
Vaccinations
High-risk individuals (e.g., those with asplenia, complement deficiency, and haematological malignancies) should receive the quadrivalent meningococcal vaccine (A, C, W, Y).
Vaccinations should be considered for young infants, adolescents in hostels, mine workers, and laboratory staff who have been in direct contact with meningococcal isolates.
Finally, all suspected cases of IMD must be reported to the NMC programme, and isolates must be submitted to GERMS-SA for surveillance and outbreak monitoring.
Meningococcal disease in South Africa has increased over the past three years, with trends consistent with historical patterns and seasonal variation. Serogroup B remains the predominant cause of invasive meningococcal disease (IMD), affecting all age groups but with the highest incidence in infants and a smaller peak in young adults.
The Western Cape Province consistently reports a higher incidence of disease compared to other regions. However, the distribution of serogroups and seasonal patterns aligns with provinces like Gauteng and the Eastern Cape. This geographic and demographic variability highlights the ongoing need for targeted surveillance and public health interventions.
Based on the report findings, the ongoing increase in case numbers in 2023 and 2024 is cause for concern and clinicians are urged to be on the alert for meningococcal cases, especially during the meningococcal season.
Access the original Report
Meiring, S., de Gouveia, L., & Quan, V., et al. (2024). Increase in meningococcal disease in South Africa continues into 2024: Clinicians urged to be on alert. Public Health Bureau of South Africa Retrieved from https://www.phbsa.ac.za/wp-content/uploads/2024/11/Increase-in-Meningococcal-Disease-in-South-Africa-Report.pdf.
Additional References
2. Meiring, S., Cohen, C., & de Gouveia, L., et al. (2022). Case-fatality and sequelae following acute bacterial meningitis in South Africa, 2016 through 2020. *International Journal of Infectious Diseases, 122*, 1056–1066. https://doi.org/10.1016/j.ijid.2022.07.068
Disclaimer
This article is in no way presented as an original work. Every effort has been made to attribute quotes and content correctly. Where possible, all information has been independently verified. The Medical Education Network bears no responsibility for any inaccuracies which may occur from the use of third-party sources. If you have any queries regarding this article contact us
Fact-checking Policy
The Medical Education Network makes every effort to review and fact-check the articles used as source material in our summaries and original material. We have strict guidelines in relation to the publications we use as our source data, favouring peer-reviewed research wherever possible. Every effort is made to ensure that the information contained here accurately reflects the original material. Should you find inaccuracies or out-of-date content or have any additional issues with our articles, please make use of the Contact Us form to notify us.
