From epidemiological week 1 to week 46 of 2024, 626 laboratory-confirmed cases of measles and 10137 cases of rubella were reported by the Measles Reference Laboratory at the National Institute for Communicable Diseases in South Africa. Sporadic laboratory-confirmed measles cases were reported from week 1 to week 46 with Gauteng province reporting the highest number of measles cases (285). The challenge with some of the referred measles cases with samples to the NICD from the private laboratories based in Gauteng for testing, is that these from other provinces were incorrectly allocated to the City Of Tshwane or the City of Johannesburg due to missing patient information. A total of 104 laboratory-confirmed measles cases were reported from epidemiological week 41 to week 46 with Gauteng reporting 64 cases. The majority of the reported measles IgM positive specimens were also positive for rubella IgM antibodies which suggests that these are false-positive measles IgM results. Measles and rubella PCR results for these specimens are pending.
With the rubella virus infections of 10137 nationally, rubella circulation has decreased in the Western Cape Province and increased in the North West Province. Other provinces in the country continue to have high rubella positivity rates, including Gauteng Province, KwaZulu-Natal and Northern Cape Province. Gauteng province reported the highest number of rubella cases to date with 2603 cases reported among samples tested up until week 46.
Overall, increasing numbers of blood specimens with or without throat swabs from suspected measles and rubella cases are being submitted to the National Institute for Communicable Diseases for laboratory confirmation from all provinces in the country. As a consequence, measles-rubella testing is delayed, and clinicians are requested to submit specimens from cases only where the rubella virus is not known to be present. For example, in schools or creches where fever-rash cases have been identified, and laboratory confirmation indicates that rubella infection is present, no further laboratory testing should be done.
Highlights
Measles Surveillance
- A total of 626 laboratory-confirmed measles cases were reported between epidemiological week 1 and week 46 of 2024 in South Africa. From epidemiological week 1 to week 46, the majority of laboratory-confirmed measles cases (285) were reported in Gauteng province. Laboratory-confirmed measles cases continue to be reported in Gauteng province in all districts except West Rand district which reported the last measles case in week 41 of 2024.
Rubella Surveillance
- From week 1 to week 45 of 2024, 10137 laboratory-confirmed rubella cases were reported in South Africa through measles and rubella surveillance. Rubella circulation had increased in Gauteng, Kwazulu-Natal and North West in recent epidemiological weeks, with sustained circulation in Mpumalanga, Northern Cape and Eastern Cape. The Western Cape Province has shown a decrease in the number of reported rubella cases.
There has been a marked increase in rubella cases across South Africa, with 10137 cases in 2024. This number exceeds the typical annual number of rubella cases observed since 2015 . A seasonal increase is expected each year, usually between September to December, however the number of cases in 2024 is notably higher than in previous years.
Health awareness is recommended in the areas where rubella cases are circulating to inform the population how to prevent rubella infection risk. Although rubella infections cause mild disease in adults and children, pregnant women in their first trimester of pregnancy who acquire rubella for the first time are at risk of passing rubella onto their foetus, with consequential congenital rubella syndrome.
Routine measles vaccination should be strengthened and measles catch-up doses continue in healthcare facilities for the children who missed their scheduled doses. Vaccinating children with the measles vaccine protects them from severe illness caused by measles virus infection, including severe pneumonia, encephalitis, blindness, deafness, and death. For all measles-positive cases, the public health response should be done as per the EPI(SA) immunisation guideline.
