In total, 227 cases of laboratory-confirmed measles outbreak cases have been reported in South Africa for specimens collected from epidemiological week 40 (ending 8 October 2022) to epidemiological week 50 (ending 17 December 2022) across all provinces (Table 1).
From epidemiological week 40 to 50, 2022, a total of 216 laboratory-confirmed cases were reported from five provinces with a declared measles outbreak, namely Limpopo (110 cases), Mpumalanga (64 cases), North West (27 cases), Gauteng (10 cases), and Free State (5 cases) (Table 1). The geographical distribution of cases across South Africa from week 40 until week 50 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.
The age of laboratory-confirmed cases across the country ranges from 2 months to 42 years (Table 2). The majority of cases (92, (43%) were in the 5-9-year age group, followed by 64 (30%) in the 1-4 year age group and 31 (14%) in the 10-14-year age group. Of the 216 cases, the vaccination status of 58(27%) was known, of whom 22 (38%) were vaccinated (Table 3).
An overview of the outbreak in the Limpopo Province
In total, 110 cases of laboratory-confirmed measles were reported between epidemiological weeks 40 to 50, 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 of 2022 in Limpopo province. Greater Sekhukhune and Mopani reported 30 and 38 cases respectively, while Waterberg district reported 34 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 110 measles cases, 88 (80%) had an unknown vaccination status, 10 (9%) were vaccinated, and 12 (11%) were unvaccinated (Table 3). In the Waterberg district, 21 cases of 34 have been reported from Witpoort Hospital in Lephalale.
In total, 64 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, 2022, with Ehlanzeni and Gert Sibande reporting the majority of cases, 37 and 25, respectively. Dwarsloop clinic reported 15 of the 37 cases from the Ehlanzeni district, while Edundonald clinic reported 11 out of the 25 cases from the Ehlanzeni 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 64 cases, 38 had an unknown vaccination status, nine were vaccinated and 17 were unvaccinated (Table 3).
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 27 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). Seven of the 27 cases were not vaccinated and 18 had unknown vaccination statuses (Table 3). Of these 27 cases, the majority (18) were reported from the Ngaka Modiri Moleme district, with 12 from a single clinic, Lonely Park Clinic.
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 10 laboratory-confirmed cases from epidemiological week 40 to 50, 2022, five of which originated in the Ekurhuleni district and two each in the City of Johannesburg and Tshwane. Nine of these cases have unknown vaccination status while one case has been vaccinated (Table 3).
On December 20, 2022, an outbreak was declared in Free State province after three laboratory-confirmed cases were reported in the Thabo Mofutsanyana district. There are currently five laboratory-confirmed cases in this province since epidemiological week 40, 2022, three from the Thabo Mofutsanyana district and one each from the Fezile Dabi and Xhariep districts, and all from different health facilities. The vaccination status of all five cases is unknown (Table 3).
The number of measles cases in the country continues to rise. Prevention and control of measles outbreaks can only be achieved through vaccination. 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/.