As part of a catch-up vaccination campaign due to a five-month measles outbreak in South Africa, all children between the ages of six months and 15 years can get the vaccine free of charge in the public sector. This is even if they have missed a jab in the month (or their parents can not remember if they have all those shots) or if they no longer have a vaccination card, says the National Institute for Communicable Diseases (NICD).
Measles is a highly contagious disease that spreads when people breathe in tiny droplets containing the virus that become airborne when an infected person coughs or sneezes. People can also get the virus if they touch a surface that the droplets fell on and then touch their nose, mouth or eyes.
Especially children under the age of five who are infected or seriously ill. Although only one or two out of every 1 000 children will die from measles, being infected with the virus can lead to other complications such as ear infections which occur in one out of every six children. In serious cases, the infection can cause brain damage and deafness.
In the state sector, the measles vaccine is given to babies at six months and one year and a catch-up jab is available for children under the age of five who missed one of the shots.
This is the catch dose that is available now, as long as it has been more than a month since the previous jab, said Jack Manamela, epidemiologist from the NICD.
A national vaccination campaign was launched after the biggest measles outbreak in South Africa since 2009. Then, more than 18 000 cases were recorded in almost 24 months.
The outbreak began in October and affected five of the nine provinces (Gauteng, Limpopo, North West, Mpumalanga and Free State). As of February 2, NICD laboratory tests have confirmed 441 cases. Many cases (about 40%) are in children between the ages of five and nine, children under nine and children between 10 and 14 are also affected, NICD data shows.
That is why the vaccination campaign only includes people up to 15 years. Measles outbreaks occur when vaccine coverage rates are not high enough, leaving children unprotected from infection and the virus likely to spread.
South Africa usually has several cases of measles in a year, such as the 12 that occurred in 2020, for example. But the NICD only calls uptick in “outbreak” cases when there are three or more patients (confirmed by lab tests) in the same area in a month and they are linked to each other, said Michelle Groome, who leads the NICD team that monitors and responds to public health problems . The other 18 confirmed cases are not included in the 441 that make up the current outbreak tally, because they are unrelated and in provinces that have not yet declared an outbreak.
There is no specific treatment for measles – doctors usually just manage the patient’s symptoms – but the disease can be prevented with a vaccine.
Health workers and people over the age of 15 who have underlying diseases that damage the immune system, so they are more likely to get severe measles, are not included in the vaccination drive but the doctor will be able to tell you if they need additional. protection from the vaccine, explains Kerrigan McCarthy, a pathologist in the NICD vaccine team.
We unpack the insights the NICD team shared during a recent Facebook live session on the outbreak.
- Why is there a measles outbreak now?
South Africa has not been able to vaccinate enough children for measles to prevent it from spreading among people, Manamela said. To eliminate the disease, 95% of children should be vaccinated, the World Health Organization recommends.
Two doses of the vaccine between the ages of six months and two years will reduce a child’s chance of getting measles by at least 95%. Protection from two jabs lasts a lifetime.
In government clinics, people can get a measles-only shot (called MeasBio) for free, while in the private sector they can get a three-in-one jab for measles, mumps and rubella (German measles) for about R275.
Data from 2015 to 2020 show that South Africa can eliminate the disease – defined as less than one case per million people – in 2015, 2016 and 2020. This is due to the high vaccination rate in 2015 and 2016, during the lockdown and social. distancing measures lead to fewer cases in 2020.
In 2019, only 80% of children received two measles jabs, according to a health department survey. This “immune gap” leads to outbreaks every six years, the researchers found.
The current outbreak, Manamela said, is the result of babies not getting shots during the COVID lockdown, when caregivers can’t take them to vaccination clinics and because parents are worried that their children will get COVID if they take them to hospitals or clinics. .
At the moment, our vaccination rate is between 75% and 80%, McCarthy estimates – which is far from the ideal target of 95%.
- Why do so many people need to be vaccinated to prevent measles?
In unvaccinated groups of people, measles spreads rapidly.
Nine out of 10 unprotected people who become infected will get sick, and each person will spread the virus to between 12 and 18 others.
But when the measles virus reaches someone who is immune — because of vaccination or a previous infection — it usually can’t spread again.
Jab prevents infection and serious illness, said Groome. This is different from how the Covid vaccine works – it’s better at preventing people from getting seriously ill. Protection from measles jabs also lasts longer than immunity from the Covid shot, McCarthy added – a lifetime for measles compared to a few months for Covid.
Because the measles virus is so contagious, Groome explained, even small pockets of people who aren’t immune will allow the germs to spread and cause more cases.
- Is Covid playing a role in poor vaccination rates in South Africa?
yes already.
Overall, there doesn’t seem to be any difference in people getting measles during Covid. It seems to remain stable between 2019 (82%) and 2020 (81%), according to data presented in parliament in June 2022.
But zooming into the details changes the picture a bit.
National figures show that 84% of children get their first shot in 2019, just under 85% in 2020, and 87.5% in 2021.
But the number of children who got the second jab dropped: from 80% in 2019 to 77% in 2020. Vaccination increased to 82% again in 2021.
The second jab of measles is very important – it gives great protection. Children who received only one dose were five times more likely to be infected with measles than those who received two.
In five provinces (Gauteng, Eastern Cape, Mpumalanga, Northern Cape and North West) the vaccination rate or taking two rounds of vaccination decreased in 2020.
The numbers increase again in 2021, possibly because the health department’s catch-up efforts began in late 2020.
- Are these problems unique to South Africa?
Not.
Worldwide, 40 million children will miss one of the measles vaccinations in 2021, according to a report by the Centers for Disease Control (CDC).
In Zimbabwe last year, an outbreak left 6 551 children infected. There, 85% of children had at least one jab. But the number of new cases has decreased since the Zimbabwean government launched a vaccine campaign in August, McCarthy said, with only 1 299 new cases recorded between September and January.
Also, a report from the CDC shows that between 2016 and 2018, measles cases more than doubled worldwide.
There were similar outbreaks in Europe between 2016 and 2018, McCarthy said. For example, Romania has about 18 000 cases of measles, which are mainly among unvaccinated children. The vaccination coverage rate was about 81% at that time.
- Why aren’t other childhood illnesses increasing in the same way?
Measles spreads faster than other childhood diseases that can also be prevented through immunization, McCarthy explained.
For example, if someone gets the virus that causes rubella, they will spread the bug to between five and 10 others, while someone with measles will spread it to between 12 and 18 others). (Rubella looks almost like measles, as it also causes a red rash, which may be a bit itchy, and a fever with mild but generally not measles-like symptoms.)
Thus, if both viruses spread in the community, measles will more quickly reach unvaccinated or partially vaccinated people.
It is possible that the “immunity gap” for measles is greater than for other childhood diseases because of the way South Africa’s childhood vaccine program is structured, McCarthy said.
Babies get the most vaccines in the group. At 14 weeks, for example, babies get three jabs that protect against eight infections (including viral diarrhea, polio, whooping cough and pneumonia).
But parents have to make two trips to the clinic to make sure their children get two measles shots – once at six months and then again at their first birthday – which can be difficult to do.
That said, South Africa also has pertussis (whooping cough), another vaccine-preventable disease, although it is not as contagious as measles, so the number of cases is lower.
- What side effects can be expected after vaccination?
The measles shot is a live-attenuated vaccine (like the rotavirus and chicken pox jabs), which means it contains a weakened form of the virus to prompt the body to make antibodies to fight the virus without causing severe illness. This is different from mRNA vaccines, for example, which are used to fight Covid.
McCarthy says this has its advantages and disadvantages.
“This type of vaccine [one that contains live attenuated virus] it causes a strong immune response, making it almost impossible to get measles if you’ve had the jab. But because it mimics a real measles infection, it can feel like you’re infected, but in a mild way.
But these side effects are usually mild, unlike the serious complications that can occur with natural infections.
Therefore, about one in 20 children may develop a fever after the shot and one in 100 may develop a rash, McCarthy said.
Brain infection occurs in one in 2 million cases, which makes it a very rare side effect.
- How do I know if my child has measles?
It takes between 10 and 14 days for people to develop symptoms after being infected.
Early symptoms include fever and a red rash that is not painful or itchy. Children may have a cough and red eyes.
Groome said: “It’s important to treat the fever, and if symptoms worsen, take your child to a health professional – especially if they haven’t been vaccinated.”
The virus is also contagious from four days before the rash starts to four days after.
- Can you be vaccinated if you have symptoms of measles?
No, said Groome.
Children should not be vaccinated if they have a moderate or severe illness. That’s because it can increase the chance of side effects or interfere with the immune response, he said.
Groome said, “We don’t recommend you give your child if he has symptoms. But if the measles diagnosis is not confirmed, and the child is better, then the vaccine can be given.
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