The national Department of Health would like to alert all members of the public, health professionals and health workers to the outbreak of measles in Gauteng province, which may spread to other provinces.
The number of laboratory tested positive measles cases for the year to 30 August 2009 in South Africa have increased to 131 cases, 109 of which are from Gauteng province. Of the 109 cases in Gauteng, 97 are from the Tshwane (Pretoria) health district.
There have also been sporadic cases confirmed in the Eastern Cape (three cases), Mpumalanga (eight cases), North West (one case), Northern Cape (one case) and Western Cape (five cases), and a number of cases to be confirmed are suspected from Limpopo province. Of these confirmed cases, ages were known for 95 percent (124) and range from four months to 38 years with a median age of 13 years. (See http://www.nicd.ac.za and http://www.health.gov.za.)
Measles is a highly infectious noticeable viral disease. Measles commonly presents with high fever, a general feeling of illness, coughing, a runny nose and teary eyes two to three days before a typical rash appears. Although there is no rash at the onset of the fever and flu-like symptoms, the patient is highly contagious during this time before the rash appears.
A non-productive cough is usually present throughout the feverish period, persisting for one to two weeks in uncomplicated cases, often being the last symptom to disappear. Swelling of the glands commonly occurs in young children. Older children usually complain of sensitivity to light and joint pains.
Koplik's spots (small spots with white or bluish-white centres resembling grains of salt sprinkled on a red background) may be seen on the insides of the cheeks in over 80 percent of cases before the onset of the rash. A blotchy red rash usually appears behind the ears and on the face within two to four days after the pre-rash feverish period. The rash peaks in two to three days and becomes most concentrated on the trunk and upper extremities. It lasts from three to seven days. Malnourished or vitamin deficient children may develop severe skin exfoliation.
Complications may include middle ear infection, blindness, diarrhoea, dehydration, respiratory infections, pneumonia, neurological complications such as convulsions, and even death. The highest death rates occur in infants six to 11 months of age. These rates may underestimate the true lethality of measles because of incomplete reporting of the outcomes of measles illness, such as delayed deaths related to chronic diarrhoea.
In certain high risk populations case fatality rates as high as 20 percent or 30 percent have been reported in infants younger than one year old. Measles can also cause severe illness in children, and also in adults. One positive case of measles may quickly spread to up to 17 unprotected and not immunised cases in a short period of time. Because measles spreads easily among groups of people, especially in schools and crèches, it is absolutely important to protect groups of children and people by immunisation or vaccination with a safe measles vaccine.
The movement of people across municipal borders and provinces and between different levels of health service provision (public and private service providers) makes the containment and prevention of the spread of measles particularly difficult. Therefore health workers and the public are put on the alert.
Parents and caregivers of children are urged to ensure that children have received all their vaccines for the age of the child, by checking their road to health immunisation cards. If unsure, have these checked at the local clinic. Two doses of measles vaccine should be administered at nine and 18 months of age. Measles immunisations are available free of charge from all public and municipal health clinics. Mass immunisation campaigns targeting all children irrespective of their immunisation status are also meant to offer additional protection even to children who are fully immunised.
Medical practitioners in particular are reminded that prompt telephonic reporting to their nearest local authority health department of suspected measles or rubella (German measles) cases is imperative to initiate swift outbreak response action by community health services. In addition, every case of suspected measles (patients with fever, a blotchy rash and a dry cough, runny nose or conjunctivitis teary eyes), must have blood and urine tests done as part of the measles elimination programme in order to determine whether the patient's symptoms are due to measles, Rubella or any other infectious condition.
Blood and urine specimens must be sent to the National Institute of Communicable Diseases (NICD), the World Health accredited regional laboratory for testing. Tests for suspected measles are done free of charge. All positive cases should receive at least two doses of vitamin A, with a third dose administered to patients with visual complications after two weeks
Hospital infection control nurses should ensure that active surveillance and reporting is done to detect any suspected measles cases. The spread of measles infections in hospital and clinic waiting rooms (not only among patients, but also among staff and visitors) could lead to the epidemic being difficult to contain or interrupt if strict isolation and infection control measures are not applied and adhered to.
To contain the outbreak, the Tshwane district has embarked on a mass measles immunisation campaign targeting all public, private, primary and secondary schools from 24 August to 4 September. Parents are urged to bring their children for immunisation even if they have received all their measles vaccines.
School children will be immunised at school, and therefore parents are asked to complete and return consent forms obtained from the schools. Parents whose children are not in school should please take their children to the local clinic or health facility for immunisation.
Let us work together to ensure that our children are vaccinated and protected from measles.
For further information, refer to:
National Institute for Communicable Disease website - http://www.nicd.ac.za or Department of Health website - http://www.health.gov.za or contact your nearest clinic.
Contact:
Fidel Hadebe
Tell: 012 312 0663
Cell: 079 517 3333
Issued by: Department of Health
1 September 2009
