South Africa reports 'marked increase' in rubella cases
The National Institute for Communicable Diseases in South Africa reports a marked increase in rubella cases across the country, with 10137 cases in 2024. This number exceeds the typical annual number of rubella cases observed since 2015 .
A seasonal increase is expected each year, usually between September to December, however the number of cases in 2024 is notably higher than in previous years.
Rubella circulation had increased in Gauteng, Kwazulu-Natal and North West in recent epidemiological weeks, with sustained circulation in Mpumalanga, Northern Cape and Eastern Cape. The Western Cape Province has shown a decrease in the number of reported rubella cases.
Rubella infection affected mostly children from 1 to 9 years of age, with the largest number of cases among those aged 5 to 9 years of age.
The reason for the large number of cases this year, compared with previous years, is because many children entered 2024 without prior exposure to rubella, or without being vaccinated against rubella. Three factors have led to the large number of children entering 2024 without rubella immunity – as follows:
Immunity to rubella infection or rubella vaccination is lifelong. If children are not vaccinated against rubella, and never come into contact with rubella virus through natural infection, children will remain susceptible to rubella.
Vaccination against rubella has not been not part of our routine EPI programme prior to 2024. The Department of Health is presently rolling out the combined measles-rubella-containing vaccine (MRCV), which will be administered to 6 and 12 months old children as soon as each province exhausts their stock of measles-containing vaccine (MCV)
The non-pharmaceutical interventions that were applied during the SARS-CoV-2 pandemic interrupted transmission of rubella, and for the period 2020-2022 there were almost no rubella cases identified from the NDoH/NICD fever-rash surveillance.
The above three facts mean that children who were born in the last 3-5 years and children between the age of 5-14 years who have not been infected before 2020 during seasonal rubella have had very little natural exposure to wild-type rubella virus, and have not received rubella vaccine. This has created an ‘immunity gap’ – i.e. a larger than usual number of children who are susceptible to rubella. The seasonal increase in 2024 has exposed these many susceptible children to rubella infection, and thus, there is a larger number of rubella cases than in prior years.
Rubella is a contagious disease caused by a virus. Rubella is sometimes called “German measles,” but it is caused by a different virus than measles.
Rubella is usually mild, with few noticeable symptoms. For children who do have symptoms, a red rash appearing on the face is typically the first sign.
Most adults who get rubella usually have a mild illness with:
Low-grade fever
Sore throat
A rash that starts on the face and spreads to the rest of the body
Up to 70% of women may experience arthritis as a rubella complication; this is rare in children and men.
Anyone who is not vaccinated against rubella is at risk of getting rubella.
Rubella is very dangerous during pregnancy and for developing babies. If you are pregnant and infected with rubella, you can pass rubella to your developing baby. When a baby is born with rubella, this is called congenital rubella syndrome (CRS).
Rubella can cause a miscarriage or serious birth defects in a developing baby. CRS can affect almost everything in the developing baby’s body.
Rubella can be prevented with the MMR vaccine. This protects against three diseases: measles, mumps, and rubella.
MMR vaccine is very safe and effective. One dose of the MMR vaccine is about 97% effective at preventing rubella.