Cluster: Health Information, Epidemiology, Evaluation & Research

PANDEMIC INFLUENZA A, H1N1 UPDATE SOUTH AFRICA, 12 JUNE TO 29 SEPTEMBER 2009

1. DISTRIBUTION OF CASES:

On overall 11 729 H1N1 cases were recorded in South Africa 29 September 2009.

Gauteng Province recorded greatest number of H1N1 cases (n=5 318) accounting for 45%

of all the cases reported, followed by KwaZulu Natal and Western Cape Provinces with 17

% (n=2 008 and 1 963 respectively), Figure 1. The national case fatality rate (CFR) was

0.7, with a provincial range of 0 to 3.1; Northern Cape Province recorded the greatest CFR

of 3.1% (Table 1).

Table 1: Number of pandemic H1N1 2009 by province (31 August Update)

Province of residence*

Laboratory Confirmed Cases

Percentage of Laboratory

Confirmed Cases

Deaths CFR (%)

Eastern Cape 682 6 10 1.5

Free State 300 3 2 0.7Gauteng 5 318 45 12 0.2

KwaZulu Natal 2 008 17 16 0.8Limpopo 429 4 0 0

Mpumalanga 437 4 1 0.2

Northern Cape 98 1 3 3.1

Northwest 449 4 2 0.4

Western Cape 1 963 17 38 1.9Unknown 45 0South Africa 11 729 100 84 0.7

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OUTBREAKS REPORT IN SOUTH AFRICA

Figure 1: Distribution of H1N1 Cases in South Africa

DISTRIBUTION OF CASES BY VARIOUS VARIABLES

Cases mainly peaked in the age group 10-14 years with 19% (Figure 2). The age group

5-19 years accounted for 54% of the cases. On the other hand, deaths peaked in the age group 25-29 years with 7 cases (Table 2).

Epidemiology and Surveillance Directorate

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Table 2: Demonstrate distribution of Cases and Deaths by Age Group

Age Group Number of cases % Number of Death

<1 216 2 11-4 933 8 15-9 1,957 17 210-14 2,272 19 315-19 2,094 18 820-24 1,172 10 725-29 700 6 1230-34 503 4 935-39 536 5 9 40-44 402 3 845-49 330 3 650-54 276 2 1055-59 119 1 260-64 53 0 265+ 57 0 3Ukn 109 1 1SA 11 729 100 84

H1N1 weekly update (29 September)

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Figure 2: Distribution of Cases by Age Category

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The distribution of H1N1 cases by reporting date shows that cases peaked on the 12

August 2009 with 531 cases, however it should be noted that number of cases on this day

differed from report to report thought the peak day remained consistent from the previous

reports, this maybe as a result of data validation process. Cases substantially declined

from 10 September to the 29 September 2009.

Table 3: Recording Date

Collection date  

15-Jun-09 124-Jun-09 625-Jun-09 126-Jun-09 128-Jun-09 101-Jul-09 203-Jul-09 604-Jul-09 1405-Jul-09 306-Jul-09 907-Jul-09 1108-Jul-09 910-Jul-09 1411-Jul-09 412-Jul-09 913-Jul-09 2014-Jul-09 1515-Jul-09 816-Jul-09 1917-Jul-09 918-Jul-09 319-Jul-09 1120-Jul-09 2521-Jul-09 3022-Jul-09 2423-Jul-09 4724-Jul-09 5525-Jul-09 3026-Jul-09 2727-Jul-09 11028-Jul-09 11929-Jul-09 13330-Jul-09 20331-Jul-09 214

01-Aug-09 12902-Aug-09 7603-Aug-09 24304-Aug-09 44705-Aug-09 34506-Aug-09 43407-Aug-09 366

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08-Aug-09 21609-Aug-09 16110-Aug-09 15811-Aug-09 52212-Aug-09 53113-Aug-09 32414-Aug-09 27715-Aug-09 17216-Aug-09 19417-Aug-09 48018-Aug-09 30319-Aug-09 30920-Aug-09 32321-Aug-09 36022-Aug-09 23523-Aug-09 12824-Aug-09 48525-Aug-09 40426-Aug-09 37227-Aug-09 26228-Aug-09 25929-Aug-09 13230-Aug-09 12231-Aug-09 30901-Sep-09 19002-Sep-09 20703-Sep-09 16904-Sep-09 10505-Sep-09 3006-Sep-09 3707-Sep-09 11608-Sep-09 7610-Sep-09 5111-Sep-09 3512-Sep-09 1613-Sep-09 1314-Sep-09 2915-Sep-09 4016-Sep-09 3717-Sep-09 2718-Sep-09 2319-Sep-09 720-Sep-09 821-Sep-09 1622-Sep-09 923-Sep-09 425-Sep-09 426-Sep-09 5

Unknown 139Total 11,729

Epidemiology and Surveillance Directorate

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Figure 3: Distribution of H1N1 Cases by Day

Cases showed a relatively equal distribution in both males and females, though males

were mainly affected with 50%, Table 4.

Table 4: Distribution of Cases by Gender

Gender Number of cases Percent casesFemale 5,840 49.8Male 5,826 49.7Unknown 63 0.5Total 11,729 100

Large number of cases were reported during week 32, 33 and 34, with 1 983, 1 713 and

1 181 respectively, compared to other weeks (Table 5).

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Table 5: Distribution of Cases by Week

Week Number of cases Percent 24 1 025 1 026 10 0.127 46 0.428 79 0.729 73 0.630 273 2.331 1,010 8.632 2,210 18.833 2,193 18.734 2,145 18.335 2,036 17.436 1,057 9.037 361 3.138 171 1.539 38 0.3

Unknown 25 0.2Total 11,729 100.0

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Figure 4: Distribution of Cases by Week

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Distribution of Cases by Week and Province

Cases peaked in week 32 in nearly all the Provinces, and then started to decrease slightly with a significant mark during week 36.

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Figure 5: Trend Showing Distribution of Cases by Week

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Figure 6: Graph Showing Distribution of Cases by Week

2. Deaths cases review

Epidemiology and Surveillance Directorate

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Death Cases were recorded in approximately 42 hospitals. Tygerberg hospital recorded

greatest cases of 9 followed by Kalafong Hospital with 6 death cases. As a result review of

case management is recommended in this particular hospital.

Table 6: Deaths by facility

Facility_Name Freq.

2 Military Hospital 12 Military Hospital / Tygerberg 13 Military Hospital 1AMPATH-KZN 4Addington Hospital 1Albert Luthuli 1Barberton Hospital 1Beaufort West Hospital 1Cecilia Makiwane Hospital 1Chis Hani Baragwanath Hospital 1City Hospital - Joint Medical Holdings 1De Aar Municipal Clinic 1Dietrich Voigt Mia Inc. 5Dora Nginza hospital 3Durbanville Medi-Clinic 1Eben Donges Hospital 6Eerste River Hospital 1Elizabeth Hospital 1GP Polokwane 1George Hospital 2Helderberg Hospital 1Inkosi Albert Luthuli Central Hosp 1Kalafong hospital 4Karl Bremer Hospital 6Kimberly Hospital 1Kokstad, Egum 1Life Empangeni Garden Clinic 1Life Glynwood Hospital 1Life Robinson Hospital 1Livingstone Hospital 2Lower Umfolozi War Memorial Hospital 1Mafikeng General Hospital 1Mahatma Gandhi 1Mount Edgecombe Medical Centre 1Paed PE 1Paed Springs 1Pelonomi Hospital 1Phys Uitenhage 1Pretoria West / Kalafong Hospital 1Sunninghill Hospital 1Tygerberg Hospital 9

Vergelegen Mediclinic 1WYN 1

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Worcester Hospital 2Wormest Hospital 1Unknown 6Total 84

Forty eight cases were recorded in females accounting for 57% compared to 43% in

males.

Table 7: Number of Deaths by Gender

Gender Number of deaths Percent Female 48 57Male 36 43Total 84 100

48

36FemaleMale

Figure 8: Percentage of Deaths Cases by Gender

Epidemiology and Surveillance Directorate

ACKNOWLEDGEMENT

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National Institute for Communicable Diseases

Communicable Disease control directorate

Epidemiology and Surveillance Directorate

Provinces

World Health Organisation

Stakeholders

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