The number of measles cases in the country continues to rise, the National Institute for Communicable Diseases (NICD) warned yesterday.

By December 17, 227 cases of laboratory-confirmed measles outbreak cases have been reported across all provinces since October 3, says the NICD.

According to the World Health Organisation (WHO), measles is one of the most contagious diseases humans have ever faced.

The NICD says that before the development of a safe and effective vaccine in 1963, measles infection was nearly universal during childhood and was responsible for an estimated 2.6 million deaths each year.

Between early April and October 2, a deadly national measles outbreak killed more than 750 children in Zimbabwe and global health experts have been warning that the world is at risk of a measles resurgence, mainly because of the sharp drop in the vaccination rate as a result of Covid. Large measles outbreaks have occurred in other sub-Saharan African countries this year.

In July, official data published by WHO and Unicef showed that the largest sustained decline in childhood vaccinations in around 30 years had been recorded.

The spread of the disease across SA

In early October, an outbreak of measles was declared in Limpopo.

The WHO defines a measles outbreak as three cases reported in a single district in one month and warns that measles outbreaks can result in epidemics that cause many deaths.

By October 27, there had been 11 measles outbreak cases in the Greater Sekhukhune district of Limpopo. By November 10, cases were reported in other districts in the province and soon after, cases were confirmed in Mpumalanga. By November 16, 57 cases had been reported in Limpopo and Mpumalanga.

• Between September 1 and November 22, 60 cases were confirmed in Limpopo and 11 in Mpumalanga.
• By November 30, there were 99 laboratory-confirmed cases in Limpopo and Mpumalanga.
• On December 2, an outbreak was declared in the North West.
• Four days later, on December 6, an outbreak was declared in Gauteng. In total, there were 137 confirmed cases in these four provinces.
• By December 17, 227 cases had been reported across all provinces since October 3. Of these, 216 cases were reported from five provinces with a declared measles outbreak, namely Limpopo (110 cases), Mpumalanga (64 cases), North West (27 cases), Gauteng (10 cases), and Free State (5 cases).

The festive season brings with it increased travel and thus greater risk for further cases.

The last large outbreak of measles in South Africa was in 2009, with over 18 000 confirmed cases.

Medical personnel must remain alert

“Clinicians across the country are urged to be on the lookout for measles cases. It is understood that the health departments in the respective provinces have commenced with or are planning immunisation campaigns,” says NICD senior communications manager Sinenhlanhla Jimoh.

Symptoms include fever and a rash (small, red, flat spots over the body). The rash does not form blisters, nor is it itchy or painful. The NICD says other signs include cough, conjunctivitis (red eyes) and a runny nose.

It says that complications can include diarrhoea, dehydration, brain infection (encephalitis), blindness and death. Complications are more serious in those who catch measles as young infants (under two) and in children who are malnourished.

Measles is spread by contact with saliva or mucus droplets from the mouth or nose of an infected person when they breathe, cough, or sneeze. The NICD says these droplets can remain airborne for up to two hours in enclosed areas.

Age of infected people

The NICD says the age of laboratory-confirmed cases across the country ranges from two months to 42 years, with the majority of cases (43%) affecting children between five and nine years of age.

Get vaccinated

While the measles vaccine is routinely administered at six months and 12 months of age, it is never too late to get vaccinated.

In June, the Department of Health (DoH) told the National Assembly that measles vaccination rates had not yet returned to pre-Covid levels.

And even before the pandemic, the vaccination rate was only 79% (2019), with Limpopo at a low 73.6% (for first-dose measles only).

Vaccinated individuals are protected from severe symptoms of measles, mostly for the rest of their life. Communities become vulnerable to outbreaks of measles when more than 5% of persons are not vaccinated, says the NICD.

Of the 216 cases in South Africa, the vaccination status of 158 is unknown, 36 infected people have not been vaccinated and 22 had received the jab.