The number of positive tests in South Africa for measles is decreasing, even though the number of cases continues to rise, the National Institute for Communicable Diseases (NICD) said in its latest update on Thursday.

Only seven new cases were reported in the first week of 2023 — in Gauteng and North West. The NICD said vigilance was needed as schools are set to reopen.

“We need vigilance to identify and respond rapidly to cases in school or crèche environments. Planned vaccination campaigns should continue with the same urgency, despite the decrease in cases in recent weeks,” read the NICD statement.

“Prevention and control of measles outbreaks can only be achieved through vaccination. Caregivers and parents are advised to review their child’s vaccination records and confirm that they have received the measles vaccine. 

“It is never too late to vaccinate — children who have not been vaccinated may receive the measles vaccine at any age over six months, free of charge at primary health services.”

The NICD also called on doctors to be on the lookout for measles cases.

A measles outbreak was declared in five provinces between October and December 2022: Limpopo, Mpumalanga, Gauteng, the Free State and North West.

The World Health Organization (WHO) classifies a measles outbreak as three or more cases reported within 30 days in a defined district. There were isolated cases in other provinces, but these did not comply with the WHO classification of an outbreak.

According to the latest epidemiological report issued for the measles outbreak, cases in Limpopo are declining. The outbreak was first declared there in October. So far, 140 cases have been reported in the Greater Sekhukhune, Mopani and Waterberg districts. 

Of the 140 measles cases in Limpopo, 114 (81%) had an unknown vaccination status.

In Mpumalanga, 75 cases of laboratory-confirmed measles have been reported since an outbreak was declared there in November 2022. Of those infected, no vaccine history was known for 65% of patients, and 22% were unvaccinated.

In North West, where an outbreak was declared in December 2022, 114 cases were reported. Only five of the patients were vaccinated; the rest either did not know their vaccination status or were not vaccinated.

In Gauteng, 16 laboratory-confirmed measles cases have been reported, and an outbreak was declared on 6 December 2022. Fifteen of the cases did not have a vaccination history, and one was vaccinated.

In Free State, 12 cases of measles have been confirmed, and an outbreak was declared on 20 December 2022. Eight of the cases were from Bethlehem. Nine patients did not have a known vaccination status, and only one patient was vaccinated.

‘A matter of life or death’

“Ensuring that children are vaccinated against measles and other preventable childhood diseases is a matter of life or death,” said Muriel Mafico, South Africa’s deputy representative at the United Nations Children’s Fund (Unicef).

“We call on all parents and caregivers to check the status of their children’s immunisation coverage and to get up to date as quickly as possible,” said Mafico.

Measles is a vaccine-preventable disease but can be deadly, particularly for children who have missed routine childhood immunisations.

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“The current [global] outbreak has been attributed to consistently lower than optimal vaccine coverage of routine measles doses, increasing the risk of infection and spreading the disease. Covid-19 further interrupted childhood vaccinations in South Africa, but catch-up campaigns in late 2020 and 2021 helped to recover levels to near pre-Covid levels,” said Unicef.

“Frontline health and social workers, community, faith, and civil society leaders, as well as educators and early childhood development practitioners, are advised to be on high alert for anyone showing symptoms and to report this to the nearest health facility as soon as possible. 

“Unicef South Africa calls for additional national and provincial government funding to be allocated to the measles response. These resources would strengthen vaccine administration and related services, as well as risk communication and community engagement to highlight the importance of routine immunisation and to provide resources on how and where to access services.”

Unicef received financial support from Japan and Germany to support and strengthen South Africa’s vaccine cold chain, management, risk communication, and community engagement work.

What are the symptoms of a measles infection?

Measles is a highly contagious disease caused by a virus. Symptoms include fever and a rash that looks like small, flat, red spots all over the body, a cough, conjunctivitis and a runny nose.

The virus can cause severe complications, including an infection in the brain, blindness and diarrhoea. Infants under the age of two are most at risk.

Measles vaccines are given routinely at six and 12 months of age. Unvaccinated children older than six months can receive free vaccinations at any state clinic.

The measles vaccine used in South Africa must be stored in a freezer, and the reconstituted vaccine must be kept between 2℃ and 8℃ and used within six hours. Maintaining the cold chain is very important. DM/MC