By Nadya Swart
Spotlight reports that South Africa is currently grappling with simultaneous outbreaks of measles, mumps, and diphtheria, all of which are vaccine-preventable diseases. The National Institute for Communicable Diseases (NICD) has been monitoring these outbreaks, which were anticipated due to declining immunisation rates exacerbated by the COVID-19 pandemic. Dr Kerrigan McCarthy from the NICD highlights that vaccination coverage rates in the country remain suboptimal for most vaccines, emphasising the need for high population immunity to prevent outbreaks. Low vaccination coverage allows for the circulation of bacteria and viruses within the community, leading to cluster outbreaks and potentially full-scale outbreaks.
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The measles outbreak began late last year and has already resulted in over 1,000 cases across eight provinces. In addition, diphtheria and mumps outbreaks have also been confirmed, with several cases reported. While periodic mumps outbreaks are expected due to the absence of the mumps vaccine in routine immunisation programs, the diphtheria outbreak is of greater concern. Diphtheria can cause severe complications and even death, particularly in unvaccinated individuals. Dr Anthonet Koen, a senior researcher at the University of the Witwatersrand, suggests that the COVID-19 pandemic, with limited access to healthcare facilities, has left children unvaccinated and vulnerable to these preventable diseases.
Health experts stress that measles and diphtheria pose more significant risks than mumps due to the severity of their associated illnesses. Measles, however, may have reached its peak and started declining, according to surveillance data. While a catch-up immunisation campaign helped mitigate the measles outbreak, it is not deemed necessary for diphtheria or mumps at present.
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Concerns about vaccination coverage in South Africa have been raised, as pre-pandemic rates were already suboptimal. The 2019 Expanded Programme on Immunisation (EPI) National Coverage survey revealed inadequate coverage in most districts, with only a few districts meeting the national target of 90% coverage for fully vaccinated children under one year of age. Although data on post-catch-up campaign coverage rates is awaited, the drop in routine immunisation rates during the pandemic likely contributes to the concurrent outbreaks of diphtheria and measles.
While experts do not predict a dramatic resurgence of other vaccine-preventable diseases, low vaccination coverage does increase the risk of potential outbreaks. Polio and rubella are highlighted as particularly concerning due to suboptimal vaccination rates and the potential for importation from neighbouring countries. The healthcare system’s surveillance capabilities improved during the pandemic and have facilitated the rapid detection of these outbreaks.
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To address these challenges, improving immunisation coverage is crucial. Health providers stress the safety and efficacy of routine immunisation vaccines and emphasise the importance of consistent communication, leadership, and motivation from the National Department of Health and healthcare workers. Failure to vaccinate could result in a vulnerable future generation and place additional strain on an already burdened healthcare system.
Overall, urgent action is needed to improve vaccination coverage in South Africa and prevent future outbreaks of vaccine-preventable diseases.
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