Measles is a viral disease that is caused from virus in the paramyxovirus family and is highly transmissible either through direct contact or through air. The virus infects respiratory tract first before causing rashes throughout one’s body over a span of 14 days. It is a life-threatening illness which causes serious complications, and can result in fatalities, particularly in children under five years and people with weakened immune systems.

Measles outbreaks are common in Africa, where vaccination rates are low in some regions, and the disease spreads rapidly due to factors such as poverty, malnutrition, and inadequate healthcare systems. In recent years, there have been several outbreaks of measles in different parts of Africa, including South Africa, Madagascar, Nigeria and the Democratic Republic of the Congo.

As of Saturday (04 March), the South African government confirmed 727 cases of measles across the country. Measles cases have now been declared in all the provinces in South Africa except for the Eastern Cape.

Seasons:

The measles vaccines were first introduced in the year 1963. Prior to that, severe outbreaks occurred at least once every two to three years. In recent times, although the outbreak severity has declined, the disease occurs typically in the late winter and early spring of each year in places with temperate climates. While in tropical regions, measles has irregular associations with rainy seasons, suggesting that climate plays a major role with the spread of virus.

Seasons:

People suffering from Measles generally encounter the following symptoms over a span of 14 days:

Fever, cough and runny nose are mild symptoms which are reported initially and may last for two to three days. Rashes, in the form of small red spots, are severe symptoms which first appears on the face and then spreads over the body. Rashes are often accompanied with high fever of 40-41 degrees Celsius and may last for seven to ten days, as the disease slowly starts to fade.

Complications:

In most cases, the cause of death is mostly attributed to post-disease complications such as:

• Blindness
• Encephalitis (an infection that causes brain swelling)
• Diarrhea and related dehydration
• Ear infections
• Severe respiratory infections such as pneumonia

High Risk Groups:

• Unvaccinated young children, mostly under the age of five
• Unvaccinated pregnant women
• People with weak immune systems
• People diagnosed with HIV/AIDS
• People suffering from cancer

Contagion:

• Measles virus are airborne and can be transmitted through coughing and sneezing.
• Transmission can also happen through close personal contact or direct contact with nasal or throat secretions.
• Touching a contaminated surface can also lead to spread of the disease. For up to two hours the virus can remain active and contagious in air or on surfaces that have been contaminated.
• An infected person can pass on the virus for up to four days before the rash appears and for up to four days after the rash has appeared.

Number of cases in South Africa:

In South Africa, the National Institute for Communicable Diseases (NICD) has tested 4608 serum samples for measles and found 727 (15.8%) laboratoryconfirmed cases as of the first week of March. Eight provinces out of nine have declared measles outbreaks:

On 20 February, four laboratory-confirmed cases of measles in Cape Town City led to the NICD declaring a measles outbreak in the Western Cape Province. As of Thursday (09 March), 10 laboratory-confirmed cases have been reported in the province, and all the cases are from Cape Town.

Treatment:

• People showing symptoms of measles should consult a doctor immediately for early detection and treatment, and to prevent the virus from spreading further.
• South African children are vaccinated with routine Measles vaccination called MeasBio in two doses: first given at six months of age and second administered at 12 months.
• The Center for Disease Control and Prevention (CDC) recommends children to get two doses of Measles, Mumps, and Rubella (MMR) vaccine, starting with the first dose to be registered at 12 through 15 months of age, and the second dose at four through six years of age.
• Good diet, fluid consumption, and WHO-recommended oral dehydration treatment help decrease measles complications.
• Vitamin A supplements should be administered twice a day to measles patients. This recovers low vitamin A levels even in well-nourished youngsters, prevents eye damage and blindness, and reduces measles fatalities.

Risk Level:

The current overall risk is considered high at national level. On 06 February 2023, the National Institute for Communicable Diseases (NICD) started a vaccination programme for Measles for children aged zero to 15 years, since majority of the cases detected are of children, in Western Cape.

The overall regional and global risk is considered low due to minimal crossborder transmission from South Africa to neighboring countries.

Recommendations:

• Mandatory check on routine vaccination of children for measles and mass immunization programmes in areas with high case and death rates.
• Maintaining proper hygiene by using disinfectants on surfaces, washing hands with soap and sanitizers, and keeping one’s environment clean.
• When caring for patients with Measles, further transmission of the disease through person-to-person contacts or nosocomial routes can be avoided by taking preventive precautions against contact with patient.
• Such precautions include wearing protective clothing, such as masks, gloves, gowns, and goggles; using infection control measures, such as complete equipment sterilization; and isolating infected patients from contact with unprotected persons until the disease has run its course.
• Workers at risk of exposure to measles can be encouraged to get the Measles, Mumps and Rubella (MMR) vaccine as precaution, if they haven’t already. MMR vaccination given within 72 hours after exposure can be effective to prevent measles.
• An infection control plan, to prevent and control the spread of measles in office, should be developed, especially in high-risk workplaces such as healthcare facilities. The control plan may include preventive measures – providing gloves, eye and face protection, and respiratory protection – early symptoms identification procedures, and quick isolation of suspected and confirmed cases.
• Maintaining good hygiene and have regular cleaning procedures is vital in workplaces to prevent spread of the measle virus through body fluids. Surfaces such as door knobs, tables, cabinets, chairs, phones, handles, faucet, etc., are prone to contamination and should be clean often.
• Advised to follow the National Institute For Communicable Diseases (NIDC) website a t https : //www.nicd. ac.za/ and Twitter handle at https://twitter.com/nicd_sa?s=20. Contact the Notifiable Medical Conditions (NMC) helpline numbers on 072 621 3805.