‘Polio and other preventable disease outbreaks’ possible

Health authorities have made a plea for children to receive their immunisation. File Image

Health authorities have made a plea for children to receive their immunisation. File Image

Published May 27, 2023


Cape Town – FEARS are mounting that life-threatening diseases such as polio, that was eradicated for decades, could return because of the immunisation gap caused by the Covid-19 pandemic.

The World Health Organization sounded the alarm after cases of polio, which had been eradicated in 1989, were recorded in neighbouring countries.

This comes as Hammanskraal, just north of the country’s capital Pretoria, is battling a cholera outbreak with the death toll climbing past 20 as of yesterday.

“It is a sad state of affairs that we are catering for outbreaks of diseases (from) ... the middle ages. SA is the richest economy on the African continent,” said Jo Barnes, senior lecturer emeritus at the Faculty of Medicine and Health Sciences at the University of Stellenbosch.

The WHO said if the immunisation gap continued unabated, it would create a playground for vaccine-treatable diseases that could be fatal.

Cholera, measles, diphtheria, and mumps were some of the illnesses that have cropped up across the country, in some cases causing deaths.

This week, the Western Cape Health Department confirmed a case of Diphtheria in a 3-year-old who died last month. Another case was detected in KwaZulu-Natal.

The bacteria that causes diphtheria was first identified by Edwin Klebs in 1882. The vaccine is given during childhood.

Dr Simangele Mthethwa and Dr Joseph Wamala of the WHO Emergency Preparedness Response Team (EPR) were concerned because any disease could become an outbreak.

“We should be worried about all vaccine-preventable diseases for which our children are not vaccinated against because all have a potential of spiralling into outbreaks,” they said in a statement.

“There is a potential for diphtheria cases to increase because of the immunisation gap, therefore we should be worried.

“As an example, Africa was certified as polio-free, however during the pandemic our neighbouring countries have seen polio cases and as South Africa, although the last case was recorded in 1989, we are at risk of case importation from those countries with outbreaks if our children are not immunised.”

They said vaccines were essential to reduce the burden of vaccine- preventable diseases.

“During the Covid-19 pandemic, the uptake of vaccines significantly declined, and this exposed our population to these diseases which were controlled because of high vaccine coverage,” the statement said.

“There is still an opportunity to close the low immunisation gap by bringing children for catch-up immunisation for the antigens missed and thus reducing the risk of outbreaks. For mumps, the vaccine is not yet introduced in the public sector but is available in the private sector.”

Provincial Department of Health spokesperson Mark van der Heever said they were on high alert following the case of diphtheria.

“The case was detected and reported to the NICD (National Institute for Communicable Diseases) and National Department of Health in April.

“A 3-year-old child was admitted to hospital where tests were done and it confirmed diphtheria. Sadly, the child passed away. The response team was activated and followed up with all close contacts.”

Van der Heever said while there was an ongoing risk of imported cholera cases from countries experiencing outbreaks, they were vigilant and continued testing for the disease.

Minister of Health Joe Phaala called for vigilance after the detection of diphtheria cases, stating that there was a shortage of vaccines.

Phaala said diphtheria was an uncommon, but vaccine-preventable serious infection caused by a toxin-producing bacterium called Corynebacterium diphtheria.

The toxin may lead to difficulty in breathing, heart rhythm problems, and even death.

The bacteria spreads from person to person, usually through respiratory droplets from coughing or sneezing.

Dr Linda Erasmus of the NICD said the lack of human contact during the pandemic led to a decrease in diseases but that has now changed.

“Disruptions to health services during the Covid pandemic contributed to lower vaccination coverage rates resulting in immunity gaps,” said Erasmus.

“In addition, social isolation may also have reduced exposure to diseases. Low vaccine coverage can increase the risk of outbreaks of any of the vaccine-preventable diseases.

“There are systems in place to monitor these diseases and provide warning of any unusual increase in cases.”

Dean of the Faculty of Health Sciences, Shabir Madhi, and Professor of Vaccinology at Wits, Professor Shabir Madhi, said all children were meant to get at least four doses of the diphtheria vaccine in the first two years of life and a booster dose at school entry.

“Unfortunately, around 80% of children receive all their vaccines in the first two years, and less than 20% receive the booster dose at school entry.

“Mumps occurs each year, usually during spring. The outbreak this year is unseasonal and has more cases than usually occurs. This is likely due to there being an immunity gap which has transpired during Covid-19.

“There was likely disruption of mumps virus circulation in the past three years, resulting in a build up of susceptibility in the population, lending itself to a larger than usual epidemic.”

The concerns come while the Freedom Alliance of South Africa (Fasa) has launched a substantive judicial review against the South African Health Products Regulatory Authority’s (Sahpra’s) authorisation of Pfizer’s vaccine products.

Fasa’s lawyers said they had a medical doctor who spoke on their case.

“The issue is about Pfizer’s trial data,” they said in a statement.

“This case asks for a review and setting aside of Sahpra’s decision to authorise the Pfizer vaccine.

“Sahpra relied solely on Pfizer’s data rather than any external checks.”

Debbie Els, who said she doesn’t identify as an anti-vaxer but has refused to take the Covid vaccine, said she encouraged immunisation.

“The childhood vaccines have been around for years and I do not have a problem with that but I will not trust vaccines which are made in a month and are trial-based.”