South African Measles Outbreak Update 2023 ( 23 FEBRUARY )


  • The NICD has tested 4019 serum samples for measles since epidemiological week 40, 2022, of which 615 (15.3%) were confirmed positive. In outbreak-affected provinces, 586 cases have been reported since week 40, 2022. In the past weeks (week 06 up until mid-week 07, 2023), there have been 77 laboratory-confirmed measles cases detected across the country of which 72 are from outbreak-affected provinces.
  • The percentage of samples testing positive (PTP) decreased slightly from 21% of 258 samples tested in week 05 to 19% of the 290 samples tested in week 06
  • An outbreak has been declared in the Western Cape Province following the detection of four laboratory-confirmed measles in the City of Cape Town between 24 January 2023 to 17 February 2023. All cases are epidemiologically unlinked; however, two cases aged 2 and 4 years, are from the Southern Subdistrict and presented at facilities only 4km from each other (Grassy Park and Sea Winds CHC). The third case (10 years old) is from Khayelitsha and the fourth is likely a sporadic case in a 58-year-old commercial pilot. The Western Cape commenced with their vaccination campaign targeting 0-15 year-olds on 6th February 2023. These cases are not reflected in this sitrep as they have occurred outside the reporting interval for this week.
  • In provinces where an outbreak has been declared, the most affected age groups are still the 5-9 year-olds (41%) with a considerable proportion of cases reported among the 1-4 (26%) and 10-14 age groups (19%). Vaccination campaigns should therefore also include children aged 10 to 14
  • The majority of cases (72%) were reported from primary healthcare facilities, and the highest proportion of cases reported from hospitals (50%) 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 mid-week 07, 2023 (ending 18 February 2023) the NICD has tested 4019 serum samples for measles of which 615 (15.3%) 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 07 of 2023, 586 laboratory-confirmed cases were reported from five provinces with declared measles outbreaks; Limpopo (209 cases), Mpumalanga (96 cases), North West (182 cases), Gauteng (75 cases), and Free State (24 cases) (Table 1). The geographical distribution of cases across South Africa from week 40 of 2022 until week 07 of 2023 is shown in Figure 2he number of measles cases continues to increase in blood samples and throat swabs submitted to the NICD for measles serology and PCR testing.

Figure 1. The number of serum samples submitted to the NICD for measles, week 40 2022, until week 07, 2023 and the number (dark green) and % tested positive (red line), by epidemiological week using the date the specimen was collected. *Data from week 07 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 the colour of blue indicates the total number of cases by sub-district), from week 40 to week 07, 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 07, 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 07 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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