Measles outbreak: what to look for

THE National Institute for Communicable Disease (NICD) declared a measles outbreak in all South African provinces, except for the Eastern Cape, last week.

Measles is a highly contagious disease caused by the measles virus. Signs and symptoms include fever, rash, cough, red eyes, and runny nose.

At at the time of going to print, more than 700 laboratory-confirmed cases were reported in the country.

Forty-two percent of the confirmed cases were children aged five to nine, 25% were aged one to four, and 19% were aged 10 to 14, said the NICD.

The eThekwini Municipality said with the Department of Health, the national measles campaign, that started on February 5, took place every five years. The campaign ends on March 31.

Msawakhe Mayisela, spokesperson for the municipality, said 648663 persons had been vaccinated.

“It is recommended all children who are eligible for vaccination as per the Expanded programme on immunization-EPI(SA) schedule, and are not up to date for various reasons, should visit their nearest health care facility to receive a vaccine catch up dose. Parents should bring along the child’s vaccination card (Road to Health booklets).

“Since eTthekwini was declared a measles outbreak (area) on 2 March 2023, there are eight Area Based Outbreak Response Teams who conduct outbreak response to all laboratory confirmed positive measles cases that are reported, they identify all close contacts, and administer measles vaccine catch up dose to all eligible people. All clinics are providing vaccination in accordance with EPI schedule,” he said.

Signs

According to the NICD, patients with measles present with fever and with a rash. The rash looks like small, red, flat spots that start on the face/head and then spread downwards over the body. The rash does not form blisters, nor is it itchy or painful. Other signs include cough, conjunctivitis (red eyes) and coryza (running nose).

The NICD added:

◆ Complications of measles can include diarrhea, dehydration, middle ear infection, brain infection (encephalitis), blindness and death. Complications are more serious in those who catch measles as young infants (under 2 years of age), in children who are malnourished and people who are immunosuppressed.

◆ Any person who is not immune to measles can catch measles from an infected person. Once a person has had measles, they are immune to the virus. Vaccination is another way to become immune to measles. 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.

◆ There is no specific treatment for measles, so treatment is directed at improving symptoms and preventing complications. Vitamin A should be given to all children with measles to prevent eye damage.

◆ According to the vaccination schedule, the measles vaccination is given at six months and a second vaccine at 12 months of age. In addition to routine vaccination, in South Africa, supplementary immunisation activities are conducted every 3 to 4 years to immunise any child who may have missed a measles vaccine, and to increase the efficacy of vaccination and population immunity.

◆ The National Department of Health has decided to conduct a vaccination campaign in response to the current measles outbreak. This campaign targets the age group from 6 months to 15 years of age. These campaigns do not replace routine immunisation. All eligible infants and children should continue to receive their routine measles vaccines at 6 and 12 months of age.

◆ Relatively common adverse reactions, which after vaccination at a rate of less than 1 in 20 persons, include pain at the injection site, fever between 7 and 12 days following the vaccination, morbilliform (macular) rash between 7 and 10 days following vaccination. These side effects are generally mild and are dealt with symptomatically. Very rare but more serious adverse reactions after vaccination include encephalitis (1 in 2 million), febrile seizures (1 in 3000), thrombocytopenia or low platelets (1 in 30000) and anaphylaxis or severe allergic reaction (1 in 1 million).

The risks of serious complications following measles infection are enormously greater than vaccine-related serious adverse reactions and include death, pneumonia with permanent lung damage, and corneal scarring.

Alert

The NICD has also issued an alert about the start of Respiratory Syncytial Virus (RSV) season in South Africa.

RSV is the most common cause of bronchiolitis and lower respiratory tract infection among young children. It is highly contagious with transmission mainly by respiratory droplets.

In its alert, issued last week, the NICD said clinicians and paediatric hospitals/ intensive care units should anticipate an increase in paediatric admissions during the 2023 RSV season, based on trends abroad.

“Reports of increased RSV circulation and increased severe RSV-associated illness (hospitalisation) including among children aged (under) 1 year of age during the northern hemisphere RSV 2022-2023 season (November to February) have been published from the United States of America. It is possible that the RSV season in South Africa will follow a similar trend,” it said.

In South Africa the RSV season usually precedes the influenza season.