In total, 297 cases of laboratory-confirmed measles cases have been reported in South Africa for specimens collected from epidemiological week 40 (ending 8 October 2022) to epidemiological week 51 (ending 24 December 2022) across all provinces (Table 1). From epidemiological week 40 to mid-week 51, 2022, a total of 285 laboratory-confirmed cases were reported from five provinces with declared measles outbreaks in Limpopo (128 cases), Mpumalanga (68 cases), North West (69 cases), Gauteng (13 cases), and Free State (7 cases) (Table 1). The geographical distribution of cases across South Africa from week 40 until mid-week 51 is shown in Figure 1he number of cases continues to increase daily as blood and throat swabs are submitted to the NICD for measles serology and PCR testing.
Table 1. Cases of laboratory-confirmed measles tested by the NICD from all provinces in South Africa from epidemiological week 40 to 51, 2022. Outbreak-associated cases are contained within the red bordered cells* (EC=Eastern Cape; FS=Free State; GP=Gauteng; KZN=KwaZulu-Natal; LP=Limpopo; MP=Mpumalanga NW=North West; NC=Northern Cape). * A measles outbreak is classified as three or more confirmed laboratory measles cases reported within 30 days of the onset of disease, in a district.
| Epi Week | EC | FS | GP | KZN | LP | MP | NW | NC | WC | Total |
| 40 | 1 | 2 | 3 | |||||||
| 41 | 5 | 5 | ||||||||
| 42 | 1 | 4 | 1 | 1 | 7 | |||||
| 43 | 1 | 11 | 12 | |||||||
| 44 | 1 | 19 | 2 | 22 | ||||||
| 45 | 1 | 1 | 12 | 3 | 1 | 1 | 1 | 20 | ||
| 46 | 1 | 1 | 9 | 8 | 19 | |||||
| 47 | 1 | 2 | 18 | 15 | 4 | 1 | 1 | 42 | ||
| 48 | 1 | 18 | 17 | 3 | 39 | |||||
| 49 | 3 | 2 | 3 | 10 | 14 | 18 | 1 | 51 | ||
| 50 | 3 | 16 | 5 | 29 | 53 | |||||
| 51 | 2 | 1 | 4 | 4 | 13 | 24 | ||||
| Total | 1 | 7 | 13 | 5 | 128 | 68 | 69 | 3 | 3 | 297 |
Figure 2. The epidemiological curve showing the number of laboratory-confirmed measles cases in South Africa from week 40 to mid-week 51 (ending August 07 – ending December 24), 2022 by specimen collection dates and by province, indicating the weeks in which outbreaks were declared in Limpopo, Mpumalanga, North West, Gauteng, and Free State provinces
The age of laboratory-confirmed cases across the five provinces ranges from two months to 42 years (Table 2). The majority of cases 118, (41%) were in the 5-9 year age group, followed by 80 (28%) in the 1-4 year age group and 42 (15%) in the 10-14 year age group. Of the 285 cases, the vaccination status of 84 (29%) was known, of whom 33 (39%) were vaccinated (Table 3). Whilst the NICD is presently not able to provide data on hospital admission rates nor on measles mortality rates, Table 4 reflects the number and proportion of laboratory-confirmed measles cases that originate from hospitals as opposed to primary healthcare facilities. Whilst cases that are seen at hospitals may not necessarily be admitted, this figure gives us an indication of the severity of illness, as patients consulted tertiary care facilities. The number of admitted patients will be a subset of these cases.
Table 2. Age distribution of laboratory-confirmed measles cases from epidemiological week 40 to week 51, 2022, in provinces with a declared measles outbreak
| Age group | FS | GP | LP | MP | NW | Total |
| <1 year | 0 | 3 | 12 | 2 | 2 | 19 |
| 1-4 years | 5 | 2 | 36 | 17 | 20 | 80 |
| 5-9 years | 2 | 6 | 47 | 27 | 36 | 118 |
| 10-14 years | 0 | 1 | 20 | 15 | 6 | 42 |
| ≥15 years | 0 | 1 | 13 | 6 | 4 | 24 |
| Unknown | 0 | 0 | 0 | 1 | 1 | 2 |
| Total | 7 | 13 | 128 | 68 | 69 | 285 |
FS= Free State; GP= Gauteng; KZN=KwaZulu-Natal; LP=Limpopo; NW=North West
Table 3. Vaccination status for laboratory-confirmed measles cases from epidemiological week 40 to 51, 2022 in provinces with a declared measles outbreak.
| Vaccination status | FS | GP | LP | MP | NW | Total |
| Not vaccinated | 2 | 0 | 15 | 17 | 17 | 51 |
| Vaccinated | 0 | 2 | 13 | 9 | 9 | 33 |
| Unknown | 5 | 11 | 100 | 42 | 43 | 201 |
| Total | 7 | 13 | 128 | 68 | 69 | 285 |
Table 4. The facility type where laboratory-confirmed measles cases have been identified, for epidemiological week 40 to week 51, 2022, South Africa. Submission of a specimen from a hospital may suggest (but is not firm evidence) that the patient was admitted.
| Reporting Health Facility | <1 year | 1-4 years | 5-9 years | 10-14 years | ≥15 years | Total |
| From PHC/CHC/other | 10 | 59 | 81 | 33 | 20 | 203 |
| From a hospital (%) | 9 (47) | 21 (26) | 37 (31) | 9 (21) | 4 (17) | 80 (28) |
| Total | 19 | 80 | 118 | 42 | 24 | 283* |
*It was not possible to determine the age of two cases that were tested at a centralised laboratory from a private laboratory group.
An overview of the outbreak in the Limpopo Province
In total, 128 cases of laboratory-confirmed measles were reported between epidemiological week 40 to mid-week 51, 2022 with the majority of the measles cases reported in the Greater Sekhukhune, Mopani, and Waterberg districts. An outbreak of measles was declared in Limpopo on the 11th of October 2022 (epidemiological week 41, 2022). Figure 3 displays an epidemiological curve from week 40 to week 51 of 2022 in Limpopo province. Mopani and Waterberg each reported 44 cases, while the Greater Sekhukhune district reported 30 cases. The age of measles cases across Limpopo ranged from 4 months to 42 years. Measles virus infection affected mostly the age group 5-9 years (Table 2). Of the 128 measles cases, 100 (78%) had an unknown vaccination status, 13 (10%) were vaccinated, and 15 (12%) were unvaccinated (Table 3). In the Waterberg district, 25 cases of 44 have been reported from Witpoort Hospital in Lephalale.
Figure 3. The epidemiological curve showing the number of measles cases by districts of Limpopo Province from epidemiological week 40 to mid-week 51, 2022 (02 October – ending 24 December), 2022 by specimen collection date
Mpumalanga
In total, 68 cases of laboratory-confirmed measles have been reported since epidemiological week 40, 2022. The measles outbreak was declared in Mpumalanga province on 11 November 2022 (epidemiological week 45, 2022). Figure 4 shows an epidemiological curve for Mpumalanga province from week 44 to week 51, 2022, with Ehlanzeni and Gert Sibande reporting the majority of cases, 38 and 29, respectively. Dwarsloop clinic reported 16 of the 38 cases from the Ehlanzeni district, while Dundonald clinic reported 12 out of the 29 cases from the Gert Sibande district.
The age of cases across Mpumalanga ranged from 4 months to 28 years. The most affected age group by the measles outbreak is 5-9 years (Table 2). Of the 68 cases, 42 had an unknown vaccination status, 9 were vaccinated and 17 were unvaccinated (Table 3).
Figure 4. The epidemiological curve shows the number of measles cases by the district of Mpumalanga Province from epidemiological week 44 to mid-week 51, 2022 by specimen collection date.
North West
An outbreak was declared in North West province on 02 December 2022 after three laboratory-confirmed cases were reported in Ngaka Modiri Molema district. A total of 69 cases have been reported in North West since epidemiological week 40, 2022. Most of the laboratory-confirmed cases are among children aged 5-to-9 years, followed by those aged 1-to-4 years (Table 2). Nine of the 69 cases were vaccinated and 43 had unknown vaccination status (Table 3). Of these 69 cases, 57 were reported from the Ngaka Modiri Molema district, with 33 cases reported from a single clinic, Lonely Park Clinic in Mahikeng.
Figure 5. The epidemiological curve shows the number of measles cases by the district of North West Province from epidemiological week 42 to mid-week 51, 2022 by specimen collection date.
Gauteng
An outbreak was declared in Gauteng province on 06 December 2022 after three laboratory-confirmed cases were reported at a single health facility, Ethafeni clinic in the City of Ekurhuleni Metropolitan Municipality. There are currently 13 laboratory-confirmed cases from epidemiological week 40 to 51, 2022, five of which originated in the Ekurhuleni district and five from the City of Tshwane. Amongst these cases, 11 have unknown vaccination status while two were vaccinated (Table 3).
Free State
On December 20, 2022, an outbreak was declared in Free State province after three laboratory-confirmed cases were reported in Thabo Mofutsanyana district. There are currently seven laboratory-confirmed cases in this province since epidemiological week 40, 2022, five from the Thabo Mofutsanyana district and one each from the Fezile Dabi and Xhariep districts. Three of the five cases reported from Thabo Mafutsanyana district were reported by Bethlehem clinic. The vaccination status of five cases is unknown and the other two cases were not vaccinated (Table 3).
Conclusion
The number of measles cases in the country continues to rise. 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 6 months, and free of charge at primary health services. 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. For more information about measles, case definition, notification, investigation, and guidelines for measles management including vaccination, please refer to our website: https://www.nicd.ac.za/diseases-a-z-index/measles/.
