![]() Large outbreaks, such as those caused by influenza, put a strain on resources necessary for their control. Programmes to improve IP practice and address antimicrobial resistance in African neonatal units are urgently required. Breaches in IP practice are commonly implicated with outbreak source confirmed in <50%. Outbreaks in hospitalised African neonates are frequent but underreported, with high mortality and predominance of Gram-negative bacteria. From the African neonatal literature we identified 20 outbreaks affecting 524 babies (177 deaths 34% mortality) 50% of outbreaks were caused by extended-spectrum B-lactamase producing Klebsiella pneumoniae. Stringent transmission-based precautions, staff/parent education and change of clinical practices contained the outbreaks. Although the infection source was seldom identified, most outbreaks were associated with breaches in IP practices. We documented 13 outbreaks affecting 148 babies (11 deaths 7% mortality) over 8 years with pathogens including rotavirus, influenza, measles and multi-drug resistant bacteria (Serratia marcescens, Acinetobacter baumannii, methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci). We reviewed neonatal outbreaks from Africa (1 January 1996 - 1 January 2016) to contextualise our experience within published literature from the region. We describe neonatal outbreaks attended by the Paediatric Infectious Diseases and Infection Prevention (IP) teams at Tygerberg Children's Hospital, Cape Town ( - 30 April 2016) reporting pathogens, outbreak size, mortality, source and outbreak control measures. African neonatal units are at high risk of outbreaks owing to overcrowding, understaffing and shared equipment. Hospitalized neonates are vulnerable to infection, with pathogen exposures occurring in utero, intrapartum and postnatally. ![]() Despite stringent lockdown measures, the second month following importation was characterised by community transmission and increasing disease burden in more populous provinces. ![]() The first eight weeks following COVID-19 importation were characterised by early predominance of imported cases and relatively low mortality and transmission rates. The national initial Rt was 2.08 (95% confidence interval (CI): 1.71–2.51). 53%) and resident in a more populous province (98% vs. Cases diagnosed in April compared with March were younger (median age, 37 vs. Amongst 2,819 cases with data, 489/2819 (17.3%) travelled internationally within 14 days prior to diagnosis, mostly during March 2020 (466 (95%)). Hospitalization records were found for 1,271 patients (692 females (54%)) of whom 186 (14.6%) died. ![]() Of these, 7,892 (2.9%) persons tested positive (median age 37 years (interquartile range 28–49 years), 4,568 (58%) male, cumulative incidence of 13.4 cases/100,000 persons). ![]() Using national surveillance data including demographics, laboratory test data, clinical presentation, risk exposures (travel history, contacts and occupation) and outcomes of persons undergoing COVID-19 testing or hospitalised with COVID-19 at sentinel surveillance sites, we generated and interpreted descriptive statistics, epidemic curves, and initial reproductive numbers (Rt).įrom 4 March to 30 April 2020, 271,670 SARS-CoV-2 PCR tests were performed (462 tests/100,000 persons). We describe the epidemiology of COVID-19 in South Africa following importation and during implementation of stringent lockdown measures. ![]()
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