Alarm bells as South Africa's measles inoculation drive falls short

The national health department has acknowledged South Africa faces a measles outbreak as vaccination drives against the childhood virus are lagging.

The uptake of childhood vaccines dipped during the pandemic.

“Immunisation rates remain suboptimal and this places the country at risk of outbreaks. This applies especially to measles, a very contagious disease. High coverage rates of at least 95% are required to prevent outbreaks,” said Foster Mohale, spokesperson for the department.

Measles, one of the most contagious human viruses, is largely preventable through vaccination.

Mohale said the surveillance of vaccine preventable diseases was weakened during the pandemic as officials responsible “were required to focus on Covid-19 surveillance resulting in neglect of other surveillance activities”.

“This places the country at risk of delays in identifying outbreaks across the country.”

This week the World Health Organisation (WHO) warned countries to brace for global measles outbreaks due to a steady decline in childhood vaccination during the pandemic.

WHO reported that in 2021 a record high of nearly 40-million children missed at least one measles vaccine dose. About 25-million children missed their first dose and an additional 14.7-million missed their second dose. The world body warned this decline “is a significant setback in global progress towards achieving and maintaining measles elimination and leaves millions of children susceptible to infection”.

In 2021, there were an estimated 9-million cases and 128,000 deaths from measles worldwide, and 22 countries experienced large and disruptive outbreaks.

“The paradox of the pandemic is that while vaccines against Covid-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunisation programmes were badly disrupted, and millions of children missed out on life-saving vaccinations against deadly diseases like measles,” said WHO director-general Dr Tedros Adhanom Ghebreyesus.

“Getting immunisation programmes back on track is absolutely critical. Behind every statistic in this report is a child at risk of a preventable disease.”

Limpopo and Mpumalanga are experiencing measles outbreaks.

On Thursday the National Institute for Communicable Diseases confirmed 71 cases were recorded in the country between September 1 and November. All were from the two provinces.

The institute said Limpopo had 60 cases affecting four districts. Capricorn, Greater Sekhukhune, Mopani, and Waterberg were declared measles outbreak areas.

Vhembe, with two laboratory–confirmed measles cases, did not meet the outbreak criteria.

On October 28, the Ehlanzeni district in Mpumalanga, which shares a border with Greater Sekhukhune and Mopani districts in Limpopo, was declared a measles outbreak area.

The institute said 11 laboratory-confirmed measles cases were reported in Mpumalanga, with nine from the Ehlanzeni district, one from Gert Sibande district and one from the Nkangala district.

According to the latest statistics from the health department, the coverage of first vaccination doses was 88.5% in April while the second dose coverage was 84%. Only 85% of children are fully vaccinated, which is 10% lower than the 95% coverage required to prevent outbreaks.

Mohale said while immunisation rates had dropped during the hard lockdown, the inoculation programme did show significant resilience due to a catch-up campaign in late 2020 and early 2021.

“Immunisation rates quickly returned to levels above those reported prior to the pandemic. Catch-up plans for missed doses is an ongoing practice in health facilities.”

To raise population immunity to a level that ensures prevention of disease outbreaks, the department will conduct a national measles vaccination campaign from February 6 to 17 2023.

“This was planned before the current outbreaks, although we are working closely with the affected provinces to respond to the outbreaks. This will include administration of additional measles doses to all children under five years old regardless of their previous history of measles vaccination.”

Western Cape health department spokesperson Byron la Hoe said the province had  maintained an average cover of 80% or above for the first and second doses of the measles-only vaccine.

“Active surveillance is an important pillar in the province’s strategy to stop the spread of measles and other notifiable communicable diseases. This entails reporting all suspected measles cases, investigation and specific actions to prevent the spread of measles. Contacts are traced and measles vaccine boosters offered to the contacts of laboratory-confirmed cases,” he said.

“To encourage parents to visit clinics for vaccination, appointment systems were used to minimise time parents spend at a healthcare facility and alleviate fear of contracting disease. SMSes and telephone calls are used to recall clients who have missed their follow-up appointments, and catch-up outreaches are being done continuously to ensure optimal cover.”

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