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. 2013;8(2):e55682.
doi: 10.1371/journal.pone.0055682. Epub 2013 Feb 20.

Measles outbreak in South Africa: epidemiology of laboratory-confirmed measles cases and assessment of intervention, 2009-2011

Genevie M Ntshoe  1 , Johanna M McAnerney, Brett N Archer, Sheilagh B Smit, Bernice N Harris, Stefano Tempia, Mirriam Mashele, Beverley Singh, Juno Thomas, Ayanda Cengimbo, Lucille H Blumberg, Adrian Puren, Jocelyn Moyes, Johann van den Heever, Barry D Schoub, Cheryl Cohen
Affiliations

Measles outbreak in South Africa: epidemiology of laboratory-confirmed measles cases and assessment of intervention, 2009-2011

Genevie M Ntshoe et al. PLoS One. 2013.

Abstract

Background: Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa.

Methods: Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa.

Results: A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥ 5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥ 40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented.

Conclusion: We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Weekly* number of measles IgM positive cases: South Africa, 2009–2011.
* Week calculated from date of specimen collection (n = 17 351), date received (n = 1 067) or date tested (n = 13).
Figure 2
Figure 2. Map showing nine South African provinces and overall cumulative incidence per 100 000 population by province, 2009–2011.
Figure 3
Figure 3. Age-specific incidence of laboratory-confirmed measles cases, South Africa, 2009–2011.
See this image and copyright information in PMC

References

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