Measles outbreak: Record number of children underimmunised due to Covid pandemic

With the measles outbreak skyrocketing in recent weeks, experts have attributed South Africa’s risk of large outbreaks to the postponement of, or missed measles vaccine doses due to Covid-related delays in immunisation.

The National Institute for Communicable Diseases (NICD) reported that from 8 October, 2022 to 18 March, 2023, it tested 5 163 serum samples for measles, “of which 844 (16%) were confirmed” measles cases.

“The age of laboratory-confirmed measles cases ranges from two months to 60 years. The majority of cases (42%) are in the age group five to nine years, followed by the age groups one to four years (25%) and 10-14 years (19%),” the institute said.

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“The attack rates (per 100 000 population) are highest among age groups one to four years (4.7 /100 000) and five to nine years (6.6 /100 000). “Out of the laboratory-confirmed cases, 80 (10%) were vaccinated with at least one dose of measles-containing vaccine (MCV), 92 (12%) were unvaccinated, and the vaccination status of 570 (79.1%) is unknown.”

Routine measles vaccine coverage

According to Wits University professor of vaccinology Shabir Mahdi, one of the many reasons why South Africa was at risk for such outbreaks was the routine measles vaccine coverage of two doses in only 80% of children.

“This results in significant immunity gaps and, consequently, places the country at risk of large outbreaks when there is a seeding of cases,” he said.

“This was compounded during the Covid pandemic when routine vaccine coverage also dropped.”

Unless there is high level of measles vaccine coverage [more than 90%] in children under 15-18 years, the case count will continue to rise.

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The World Health Organisation (WHO) last year noted that measles vaccination coverage had steadily declined since the beginning of the pandemic.

“In 2021, a record high of nearly 40 million children missed a measles vaccine dose: 25 million children missed their first dose and an additional 14.7 million children missed their second dose,” WHO said.

“This decline is a significant setback in global progress towards achieving and maintaining measles elimination and leaves millions of children susceptible to infection.”

‘Punishing pandemic’

Former lecturer at Stellenbosch University’s faculty of medicine and health sciences Dr Jo Barnes said apart from the historical vaccination rates being too low before Covid, the record number of children under-immunised was as a result of the “a punishing pandemic”.

She said: “Schools were closed and general movement was severely restricted. The health services were under huge pressure to the point where temporary health facilities had to be hastily constructed.

“All this led to a really large group of children who did not receive their vaccinations against measles on time, or at all.”

Barnes said another reason was the anti-vaxx sentiments which were exaggerated during the pandemic.

“Many of these for political or manipulative reasons that had nothing basically to do with the pandemic itself,” she added.

“Now, there are far too many young parents who are hesitant to have their children vaccinated because of all the scare stories that were circulated during the pandemic.

“This is one of the tragic legacies of the pandemic that will influence the health of the nation for a long time to come.”

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– reitumetsem@citizen.co.za