SA reports surge in seasonal rubella cases among children

The National Institute for Communicable Diseases (NICD) has reported a significant rise in rubella cases across the country. 

By the end of September, the NICD identified over 8 700 IgM-positive cases.

Data indicates that 98% (8543 out of 8723) of these cases have affected children under 15 years old, with the majority occurring in the age group of five to nine years.

The Centre for Vaccines and Immunology (CVI) at the NICD has recorded a rise in rubella cases in 2024, exceeding the numbers from fever-rash surveillance since 2015.

“This surge is attributed to a large number of children entering 2024 without prior rubella exposure or vaccination,” said the NICD in a statement. 

The institute observed that the significant seasonal increase in rubella cases is due to the disease being transmitted through droplets containing the virus. 

Additionally, non-pharmaceutical interventions, such as lockdowns, social distancing, and mask-wearing implemented during the COVID-19 pandemic, disrupted the natural seasonal transmission patterns of rubella.

The NICD noted that between 2020 and 2022, almost no rubella cases were identified from the fever-rash surveillance. 

“Children who would have been infected with rubella over the past three years are now becoming infected with the infection.” 

Rubella is a mild, self-limiting infection that presents with fever and a maculopapular rash, myalgia, enlarged lymph nodes, headache and conjunctivitis. 

Occasionally, the NICD said people may develop joint pain or arthralgia, low platelets and mild encephalitis. 

Meanwhile, pregnant women who are susceptible to rubella or who have not been vaccinated against rubella nor had natural rubella infection at some point in their lives are at risk of passing rubella infection to their unborn child, resulting in “congenital rubella infection”. 

“Fortunately, this is uncommon, as studies have shown that up to 98% of women of childbearing age are immune to rubella.” 

The NICD explained that the congenital rubella syndrome may lead to foetal death or congenital abnormalities such as congenital heart disease, blindness and deafness. 

Any pregnant woman who has been exposed to a case of rubella, or a person with fever and rash should report this urgently to their health practitioner who will then conduct tests. 

“A pregnant woman who is diagnosed with rubella infection should undergo specialist obstetric evaluation.” 

Rubella is a notifiable medical condition and people meeting the case definition for rubella should be notified, and a blood specimen for rubella antibody testing should be sent to the NICD. 

“Specimens are routinely tested for measles and rubella,” the institute explained. 

Due to the backlog of tests at the NICD, the institute stated that priority rubella testing should be requested under three conditions.

A pregnant woman in her first trimester may need testing if she is exposed to someone with rubella or a person exhibiting fever and rash. 

In addition, testing is necessary for severely ill patients admitted to the hospital to rule out rubella or measles. 

Furthermore, testing is warranted if a newborn is suspected of having congenital rubella syndrome.

The specimen should be marked “Priority sample, urgently required.” 

Health practitioners are advised to email Busisiwe Masengemi at BusisiweM@nicd.ac.za (NICD receiving office), Jayendrie Thaver at jayendriet@nicd.ac.za, and Lillian Makhathini at LillianM@nicd.ac.za (both from the CVI laboratory) to request urgent testing. – SAnews.gov.za

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