South African Measles Outbreak Update 2023 ( 16 March )


  • The NICD has tested 4830 serum samples for measles since epidemiological week 40, 2022, of which 772 (16%) were confirmed positive. In outbreak-affected provinces, 766 cases have been reported since week 40, 2022. In the past weeks (week 09 up until week 10, 07/03/2023) there have been 66 laboratory-confirmed measles cases detected across the country all of which were from the outbreak-affected provinces.
  • The percentage of samples testing positive (PTP) increased slightly from 18% of 289 samples tested in week 08 to 19% of the 298 samples tested in week 09.
  • Measles outbreak has now been declared in all the provinces in South Africa except for the Eastern Cape.
  • The measles strain detected in Limpopo province and North West province is genotype D8 which is similar to the strain in Zimbabwe in the 2022 outbreak.
  • In the provinces where an outbreak has been declared, the most affected age groups are still the 5–9-year-olds (42%) with a considerable proportion of cases reported among the 1-4 (25%) and 10-14 age groups (19%). Vaccination campaigns should therefore also include children aged 10 to 14.
  • The majority of cases (70%) were reported from primary healthcare facilities, and the highest proportion of cases reported from hospitals (57%) was reported in children under the age of one.
  • Members of the public are urged to ensure their children are vaccinated against measles.

 Outbreak overview

From epidemiological week 40, 2022 (ending 8 October 2022) to week 10, 2023 (ending 11 March 2023) the NICD has tested 4830 serum samples for measles of which 772 (16%) were confirmed measles cases. The number of samples submitted, and the percentage of laboratory-confirmed measles-positive cases are shown in Figure 1.  From epidemiological week 40 of 2022 to week 10 of 2023, 766 laboratory-confirmed cases were reported from eight provinces with declared measles outbreaks; Limpopo (275 cases), Mpumalanga (106 cases), North West (198 cases), Gauteng (124 cases), Free State (28 cases), Western Cape (11), KwaZulu-Natal (17) and Northern Cape (7) (Table 1). The geographical distribution of cases across South Africa from week 40 of 2022 until week 10 of 2023 is shown in Figure 2The number of blood samples and throat swabs submitted to the NICD for measles serology and PCR testing has decreased compared to previous weeks (Figure 3).

Figure 1. The number of serum samples submitted to the NICD for measles, week 40 2022, until week 10, 2023, and the number (dark green) and % tested positive (red line), by epidemiological week using the date the specimen was collected. *Data from week 09 represent partial data and will be updated in next week’s situation report when complete data from samples collected that week becomes available.

Figure 2. Distribution of laboratory-confirmed measles cases by the testing site (red dots – the size of the dot indicates the number of cases from that facility) and district of South Africa (deepening colour of blue indicates the total number of cases by sub-district), from week 40 to week 10, 2023.

Table 1. Cases of laboratory-confirmed measles tested by the NICD from all provinces in South Africa from epidemiological week 40, 2022 to week 10, 2023. 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. *Data from week 09 represent partial data and will be updated in next week’s situation report when complete data from samples collected that week becomes available.


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