Measles… over 60 confirmed cases in parts of the country last year.
In light of this and vaccine-preventable diseases having killed millions of children over the years, ER24 is urging parents to ensure their children receive all their vaccinations.
With the National Polio and Measles Immunisation Campaign currently underway and Global/African Vaccination Week held recently, Dr Robyn Holgate, from ER24, said, “It is critical to vaccinate children against potentially common and preventable conditions. Vaccines are a safe way of preventing serious childhood disease.”
Julia Hill, the South Africa Access Advocacy Officer at Médecins Sans Frontières/Doctors Without Borders (MSF), said when parents choose not to vaccinate their children, they not only put their own children at risk, but also create a larger pool of individuals who could contract and spread the disease. “This puts at risk children who are too young to have received vaccinations and can lead to outbreaks. “Some vaccines, such as those protecting against the Human Papilloma Virus (HPV), can also prevent the development of non-communicable diseases like cervical cancer later in life,” said Hill. She added that according to the Global Vaccine Action Plan, the number of deaths among children under five years of age fell by two million between 2000 and 2010. “This despite more children being born. The decrease is part due to expanded access to immunisation,” said Hill.
She said children are supposed to receive all recommended vaccinations in a country’s schedule however, for various reasons children may not receive all of them. “In the South African EPI schedule, a child that is vaccinated in the public health system must receive 19 jabs before the age of 12, requiring at least 11 interactions with the health care worker immunising the child. Six of these interactions are within the first year of life,” she said.
In March this year, the National Institute for Communicable Diseases (NICD) confirmed a case of diphtheria that claimed the life of an eight-year-old boy.
The child had a three-day history of fever and sore throat with progressive difficulty in swallowing and breathing. The NICD said the severely ill child had a swollen anterior neck, massive swelling of the tonsils and a whitish membrane covering the uvula. A tracheostomy was performed and the child was transferred to the intensive care unit for further management. NICD stated despite initial improvement and subsequent step-down from the intensive care unit, the child developed unexpected complications and died. The last laboratory-confirmed case of respiratory diphtheria in South Africa, prior to the case earlier this year, was in February 2010.
The NICD stated that although uncommon in South Africa, there is concern that this potentially lethal disease may resurge, as it has in other regions of the world over the past decade.
According to the NICD, diphtheria spreads from person to person very easily by contact with large respiratory droplets or hand-to-mouth contact with secretions from an infected person’s mouth, nose, throat or skin, or from an asymptomatic carrier of the bacteria. Diphtheria can also spread by contaminated objects or food.
Dr Holgate said diphtheria is a disease caused by gram-positive bacteria called Corynebacterium Diphtheriae.
“Infection may lead to respiratory disease, cutaneous disease or an asymptomatic carrier state. The word diphtheria comes from the Greek word for leather, which refers to the pharyngeal membrane that is clinically diagnostic of infection. This membrane is formed as a result of the bacteria producing a toxin.
“The onset of symptoms is typically within two to five days after infection. The most common presenting symptoms are sore throat, general malaise, swollen lymph glands (especially in the neck), and low-grade fever. The earliest throat/pharyngeal finding is mild erythema or redness, and the membrane as described above. This membrane can extend to any part of the respiratory tract. In untreated patients, the infectious period begins at symptom onset and lasts for two weeks in the majority of patients,” said Dr Holgate. In some cases, it can last as long as six weeks. In patients treated with appropriate antibiotics, the infectious period usually lasts less than four days. That membrane can be life threatening as it may obstruct the airway and breathing.
“Cutaneous diphtheria usually presents with non-healing sores with a greyish membrane. Adequate vaccination is crucial to prevent the spread of diphtheria. If you have been in close contact with a person who has diphtheria, contact your health care provider immediately. Anyone who has come into contact with an infected person should get an immunisation or booster shot if they have not already received it,” said Dr Holgate.
Dr Hape Makoe, from ER24, said there was an increase in confirmed cases of measles in South Africa last year.
According to the NICD, in 2014, a total of 63 laboratory-confirmed measles cases were reported from Northern Cape and Gauteng Provinces. Dr Makoe said, “Measles is a highly contagious disease usually seen in children. However, it can affect adolescents and adults as well.
“NICD states that childhood vaccination is the most important preventive strategy against measles. Vaccinations are done as part of the SA-expanded programme on immunisation (EPI), scheduled at nine months of age and then a booster at 18 months of age,” said Dr Makoe.
NICD also states that the measles vaccine is safe and effective. After these two doses of vaccine the protection rate is 95% and immunity lasts for years.
Dr Makoe encouraged healthcare workers to check all Road to Health cards for children. “Any missed doses of the measles vaccine should be caught up regardless of the child’s age,” said Dr Makoe.
The last confirmed case of polio in South Africa was in 1989. The most effective way to avoid an outbreak is to ensure vaccination against polio.
Dr Makoe said polio mostly affects children less than five years of age. “Polio cannot be cured but can be prevented,” he said.
Infection occurs via faecal-oral route. The virus survives in the gastrointestinal tract, infects the host and spreads throughout the body via the lymphatic system. 95% of cases are asymptomatic. Symptoms include headache, fever, vomiting, constipation and sore throat. Less than 1% of infection enters the central nervous system and can cause temporary or permanent paralysis and even death.
ER24’s Emergency Contact Centre can be reached 24 hours a day on 084 124 for any medical emergency.