9 April 2009
The National Department of Health (NDoH) wishes to alert all members of the
public, health professionals and health workers that there is a measles
outbreak in the Tshwane (Pretoria) Health District of Gauteng Province
(GP).
From 11 March to date, six laboratory confirmed cases and three
epidemiologically linked cases have been confirmed, with one laboratory result
outstanding. Ages of the cases range between five months to 34 years of age.
Some children attend crèches and private and public schools in and around
Pretoria. Both adults of 34 years and 26 years of age have children that have
also contracted measles.
Measles is a highly infectious viral disease. Measles commonly presents with
high fever, a general feeling of unwellness, cough and a runny nose and teary
eyes two to three days before a typical rash appears. Although there is no rash
at the onset, the patient is highly contagious during this time. A
non-productive cough is usually present throughout the feverish period,
persisting for one to two weeks in uncomplicated cases and 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% of cases before the onset of the rash. The 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 of measles 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 eleven 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% or 30% have been reported in infants less than one year of age. One
positive case of measles may spread to up to 17 unprotected/unimmunised cases
over a very short period of time.
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 spread of measles
particularly difficult. Therefore the whole country is 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 your local clinic.
Two doses of measles vaccine should be administered â at nine and 18 months of
age. Measles immunisations are available free of charge from all public and
municipal health clinics.
Medical practitioners especially are reminded that prompt telephonic
reporting to their nearest local authority Health Department of suspected
measles or Rubella cases is imperative to initiate swift outbreak response
action by community health services (CHS). In addition, every case of suspected
measles (those with fever, a blotchy rash and a dry cough, runny nose or
conjunctivitis (teary eyes), must have blood and urine tests done to determine
whether the patient's symptoms are due to Measles, Rubella (German Measles) or
any other infectious condition as part of the Measles Elimination Programme.
Blood and urine specimens must be obtained from each suspected case and sent to
the National Institute of Communicable Diseases (NICD), the World Health
accredited Regional laboratory for testing.
Hospital infection control nurses should ensure that active surveillance and
reporting is done to detect any suspected measles cases. Hospital and clinic
waiting room spread of measles infections (not only amongst patients, but also
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.
For further information, contact:
The nearest Local Authority Health Service
Johann van den Heever
Manager: Expanded Programme on Immunisation
Tel: 012 312 3174
Issued by: Department of Health
9 April 2009
