South Africa braces for potential public health threats in 2025, with respiratory viruses like influenza, Covid-19, respiratory syncytial virus (RSV), and human metapneumovirus (HMPV) likely to dominate concerns.
Professor Burtram Fielding, Dean of the Science Faculty at Stellenbosch University and an expert in virology, warns that global travel and climate change could lead to unpredictable spikes in infections outside traditional seasons.
“The diseases of concern are typically caused by viruses,” said Fielding.
“Researchers are closely monitoring avian influenza; if this virus mutates to spread more easily between people, we could face a situation far worse than the Covid-19 pandemic.”
He emphasized the importance of vaccines, herd immunity, and lessons learned from the pandemic, including mask-wearing, staying home when ill, and hand hygiene, to mitigate future outbreaks.
Fielding also cautioned about the challenges of distinguishing viral infections based on symptoms alone.
“Symptoms like cough, sore throat, runny or stuffy nose, muscle aches, headaches, and fatigue are common across respiratory viruses. Laboratory confirmation is required to identify the causative pathogen,” he explained, noting that co-infections could worsen outcomes but remain under-tested due to high costs.
Amid these broader concerns, South Africa has been grappling with a range of infectious disease outbreaks, highlighting the resilience and commitment of its public health systems.
In 2024, Mpox re-emerged as a pressing concern. On August 14, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern (PHEIC) for the second time in two years.
A day earlier, the Africa Centres for Disease Control and Prevention (Africa CDC) declared Mpox a Public Health Emergency of Continental Security (PHECS), following the discovery of a new strain, clade Ib, in the Democratic Republic of the Congo (DRC) and its spread.
South Africa recorded 24 cases of Mpox (clade IIb) by August 2024.
In response, the government swiftly implemented enhanced surveillance and contact tracing protocols to contain the virus.
In December 2024, the National Institute for Communicable Diseases (NICD) raised alarms over a sharp increase in Rubella cases.
Over the first 46 weeks of 2024, an extraordinary 10,137 cases of Rubella were reported, predominantly affecting children under 15 years old. Gauteng Province was particularly hard-hit, with 2,603 cases, followed by KwaZulu-Natal, Northern Cape, and North West provinces.
This surge was mirrored by a rise in measles cases. Between weeks 1 and 46, 626 laboratory-confirmed measles cases were reported nationwide, with Gauteng again recording the highest numbers.
These outbreaks underscored gaps in vaccination coverage and the need for improved immunization programs.
Meanwhile, human metapneumovirus (HMPV) emerged as a significant concern globally, with China reporting a sharp surge in cases in 2024.
Often undiagnosed due to its symptoms resembling those of other respiratory viruses, HMPV primarily affects children, the elderly, and immunocompromised individuals.
In China, the surge was linked to increased transmission facilitated by the easing of COVID-19 restrictions, which had previously reduced the circulation of many respiratory viruses.
Experts noted that HMPV spikes could reflect a rebound effect, where population immunity waned during prolonged lockdowns and social distancing measures.
Health Department spokesperson Foster Mohale acknowledged the unpredictability of disease patterns due to climate change but assured that South Africa is prepared to respond to emerging threats.
“The department, working with other stakeholders, has developed Pandemic Preparedness Plans to ensure smooth responses to any disease outbreak. These plans include strengthening critical areas of the public health system such as emergency coordination, collaborative surveillance, community protection, clinical care, and access to medical products,” Mohale said.
As the country moves into 2025, a focus on strengthening immunization programs, enhancing surveillance, and fostering community awareness.