In total, 169 cases of laboratory-confirmed measles outbreak cases have been reported from 11 October to 07 December 2022 across 4 provinces: North West, Mpumalanga, Limpopo, and Gauteng (Figure 1). From epidemiological week 40 to week 49, laboratory-confirmed measles cases increased in Limpopo and Mpumalanga to 98 and 50 cases, respectively (Figure 2). A measles outbreak was declared in the Ngaka Molema district in North West province on 02 December 2022 and in Ekurhuleni district in Gauteng province on 06 December 2022. 13 laboratory-confirmed measles cases have been reported in North West province and 8 in Gauteng province.
The age of cases across the country ranges from 2 months to 42 years (Table 1). 44% of cases were in the 5-9 years age group and 28% in the 1-4 years age group. Of the 169 cases, 125 had an unknown vaccination status, 18 were vaccinated and 26 were unvaccinated (Table 2).
Limpopo
In total, 98 cases of laboratory-confirmed measles were reported from 11 October to 07 December 2022, with the majority of the measles cases reported in the Greater Sekhukhune and Mopani districts. Figure 3 displays an epidemiological curve from week 40 of 2022 in Limpopo province, Greater Sekhukhune and Mopani reported 30 and 35 cases, while Waterberg district reported 25 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 1). Of the 98 measles cases, 76 had an unknown vaccination status, 10 were vaccinated, and 12 were unvaccinated (Table 2).
Mpumalanga
In total, 50 cases of laboratory-confirmed measles have been reported since the measles outbreak was declared in Mpumalanga province on 11 November to 07 December 2022. Figure 4 displays an epidemiological curve from week 44, 2022 for Mpumalanga province with Ehlanzeni and Gert Sibande reporting 31 and 18 cases, respectively.
The age of cases across Mpumalanga ranged from 4 months to 18 years. The most affected age group by the measles outbreak is 5-9 years (Table 1). Of the 50 cases, 31 had an unknown vaccination status, 8 were vaccinated and 11 were unvaccinated.
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 13 cases have been reported in North West since week 40. Laboratory-confirmed cases fall into the 1-4 and 5-9 year age groups (Table 1). Three cases were not vaccinated and 10 had unknown vaccination statuses (Table 2).
Gauteng
An outbreak was declared in Gauteng province on 06 December 2022 after three laboratory-confirmed cases were reported at a single health facility in Ekurhuleni district. These three cases fell into the 5-9 year age group (Table 1). All three cases had an unknown vaccination status (Table 2). A case was reported in early October in Ekurhuleni district in a different area that was not epidemiologically linked to the other three cases. In total 8 cases have been reported since week 40, all with unknown vaccination statuses.
Conclusion
The number of measles cases in the country is rising. Four of our nine provinces have outbreaks. It is imperative to know the signs and symptoms. Measles patients present with fever, rash, and one or more of these symptoms, cough, red eyes, and runny nose. Complications of measles include pneumonia, diarrhoea, dehydration, encephalitis, blindness and death. Measles complications are severe in malnourished children and young infants under 2 years of age. Clinicians and caregivers should be on alert for anyone presenting with the aforementioned signs and symptoms.
Persons of any age who are not vaccinated can be infected and develop the disease. Our current measles vaccination coverage is between 75-85%, below the required coverage of 95% to stop transmission. Road-to-health booklets should be checked to ensure measles vaccinations are up-to-date. Measles vaccines are given routinely at 6 and 12 months of age. It is never too late to vaccinate against measles.
In response to the measles outbreak, affected districts follow up on laboratory-confirmed measles cases and vaccinate the contacts. The public health response to the measles outbreak in provinces should target improving measles immunity in all affected provinces. Routine immunization should be reinforced as the outbreak is an opportunity to identify and correct vaccination programme weaknesses.
Provinces are currently conducting vaccination campaigns in the affected areas, please contact individual provinces for more details.
