Measles cases in South Africa had climbed to more than 600 by last week, fuelled by the disruption to routine childhood vaccination programmes caused by the pandemic, said the National Institute for Communicable Diseases (NICD).
Government is carrying out a nationwide vaccination campaign to tackle what’s being described as the worst outbreak in more than a decade.
However, said specialist pathologist Kerrigan McCarthy, many of the cases are among older children and young teenagers, indicating gaps in SA’s immunisation coverage before Covid-19 struck.
Five- to nine-year-olds account for 41% of the laboratory confirmed cases, one- to four-year-olds account for 26%, and children from 10-14 years old for 19%, according to the latest NICD report, to 18 February. Business Day reports that it has recorded 619 cases since Limpopo reported SA’s first outbreak in October 2022.
Vaccination usually confers lifelong protection, but if children do not receive all their doses, or are immunised with vaccines that are not properly stored, they may not have adequate protection against the disease, said McCarthy. The government is therefore offering measles vaccines to all children from six months to 14 years in an attempt to cover these gaps.
The NICD does not have data on the vaccination status of most measles cases, but of the 114 cases for which these data are available, 47 were vaccinated, suggesting these children either do not have all of their shots or were unwittingly provided with below-par jabs.
Public clinics offer measles vaccinations at nine months and 18 months, while private sector clinics offer measles vaccination at nine months, followed by a combined measles, mumps and rubella shot at 18 months and six years.
SA has intermittent measles outbreaks every five or six years, but has not had a severe outbreak since 2009/2010, when there were more than 18 000 laboratory-confirmed cases.
Health Minister Joe Phaahla said the government had procured 10.1m measles doses to supplement the stock on hand for the routine childhood immunisation programme, and that the target was 16.3m children.
Since the outbreak began, more than 4.74m measles doses had been administered – Limpopo was the first province to declare an outbreak, in October 2022.
The Departments of Health and Basic Education are collaborating to offer measles vaccinations in state schools and giving free shots at public clinics and to private health facilities.
The national childhood vaccination coverage rate in the country had recovered to pre-pandemic levels by the end of 2021, but immunisation rates remained below pre-Covid-19 levels in Limpopo (62.4% in 2021 compared with 66.2% in 2019) and the North West (60% in 2021 compared with 64.2% in 2019), the two provinces that now have the highest measles burden relative to the size of their population.
Meanwhile, almost 20 000 suspected cases were recorded in the Democratic Republic of the Congo (DRC) last month, a continuation of last year’s outbreak that saw 148 600 cases and 1 800 deaths reported, says Doctors Without Borders (MSF).
The acute viral respiratory illness has become endemic in the DRC with outbreaks every two to three years, reports News24, the biggest outbreak being from 2018 to 2020. During that time, it affected close to 460 000 children, 8 000 of whom died.
Dr Louis Massing, MSF medical director in the DRC, said despite having emergency teams in affected areas, there were constant flare-ups in other parts of the country.
“We have five emergency teams mobilised almost around the clock to respond to the outbreaks, but as soon as we put out a fire here, it flares up on the other side.”
MSF said it was vital to organise the mass catch-up vaccination campaigns that had been planned since the end of 2022.
“The fight against measles is like a chain around the virus: if one link is broken, the virus can escape,” Massing said.
“Unfortunately, many elements of that chain are weak in DRC, and this situation is aggravated by security constraints, geographic challenges to reach many areas, and the high birth rate, with more than two million babies born annually who need to be protected from the disease.”
The World Health Organisation said in 2021, only 55% of children were covered by one inoculation of the two-dose measles vaccine cycle, a far cry from the recommended 95% full vaccination.
Business Day article – SA confronts worst measles outbreak in more than a decade (Restricted access)
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Measles detected in Western Cape
Gauteng scales up measles vaccines as infections increase
Measles cases continue to rise in SA
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WHO, CDC issue global measles warning
Africa: Benefits of childhood vaccination programmes far outweigh risks of COVID-19 transmission