The National Institute for Communicable Diseases has reported a significant uptick in rubella (German measles) in the Western Cape since the second week of September 2023. While isolated cases have occurred nationwide, a week-on-week increase in laboratory-confirmed cases has been noted in Khayelitsha.
Health experts are attributing the resurgence to reduced non-pharmaceutical interventions initiated to combat COVID-19, which inadvertently disrupted rubella transmission.
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As of now, 19 cases have been identified through serological testing, exclusively within the 5–9-year age group. Additionally, the NICD (National Institute for Communicable Diseases) has received anecdotal reports of increased clinically suspected cases in the same area, even though these cases have not been confirmed in the lab.
Before 2020, approximately 800 000 rubella cases were recorded annually. The years 2020–2023 saw fewer than 50 cases countrywide due to COVID-19 preventive measures.
Rubella is generally a mild illness in children and adults but can have severe implications for pregnant women, especially if infected during the first trimester. The virus could lead to congenital rubella syndrome (CRS), causing complications like foetal death, congenital heart disease, cataracts and deafness.
Despite its preventable nature, there is currently no rubella vaccination included in the National Expanded Programme of Immunisation (EPI). However, the National Department of Health aims to roll out the rubella vaccination by 2024 to align with the WHO’s global measles-rubella eradication target for 2030.
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At present, the vaccine is available in the private sector as part of the Measles, Mumps and Rubella (MMR) vaccine.
Rubella is classified as a Category 1 notifiable medical condition. Upon clinical suspicion, clinicians should notify the Department of Health. Healthcare workers are encouraged to be vigilant when identifying symptoms and reporting cases. Pregnant women suspected of having rubella should be referred for specialised gynaecological assessments. Ideally, healthcare workers should be tested for rubella and vaccinated if seronegative.
Clinicians can notify the NICD either electronically through the NMC (Notifiable Medical Conditions Surveillance System) app or by filling out a paper-based form. They should also submit a blood sample and a throat swab for confirmatory testing.
While no immediate public health action is required following the identification of rubella cases, experts anticipate a surge in cases throughout 2023.
The upcoming rubella vaccination programme in 2024 offers hope for future containment, but the current situation demands caution, particularly among healthcare professionals and pregnant women.
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