The cause of a measles outbreak sweeping South Africa has not as yet been determined, but initial suspicions point to religious objections and unfounded fears that immunizations against the disease increase the risk of autism in children.
The National Institute of Communicable Disease (NICD) said last week that the Western Cape had recorded the highest number of new measles cases, 82, bringing the total in the province to 447, although Gauteng Province remained worst affected, with 4,359 cases since the outbreak began almost a year ago. In other provinces KwaZulu-Natal recorded 631 cases, North West 563, and Eastern Cape 314.
The World Health Organisation (WHO) describes measles as a highly contagious viral disease affecting mostly children, and that it can be effectively prevented by immunization.
Symptoms usually appear about 8 to 12 days after infection and include high fever, bloodshot eyes, and tiny white spots on the inside of the mouth. A rash also develops, starting on the face and upper neck and gradually spreading over the body.
Measles cause the deaths of hundreds of thousands of children in developing countries annually.
Most people recover in two to three weeks, "However, particularly in malnourished children and people with reduced immunity, measles can cause serious complications, including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia," WHO said on its website.
Adrian Puren, NICD deputy director of virology, told IRIN there were 40 confirmed measles cases in South Africa in 2008, and the key to preventing outbreaks was a comprehensive vaccination programme.
The high infection rate suggested there were "a large number of susceptible individuals" who had not received the highly effective vaccinations, which he attributed to religious objections or the belief that the Measles, Mumps and Rubella (MMR) inoculation was a cause of autism.
Autism and vaccinations
The MMR vaccination programme in South Africa provides children with a first vaccination at about 9 months, followed by a measles booster jab at 18 months free of charge. Private medical care offers the option of a separate measles vaccination, or the three-in-one MMR.
Earlier in February, The Lancet, the highly respected medical journal, debunked an article describing a link between MMR and autism, published in 1998.
British gastroenterologist Andrew Wakefield surmised in a paper that from a sample of 12 children who had received the vaccination, eight had displayed effects of autism.
|l think that the problem is there are people who simply don't believe the science. They hold on to this notion that MMR causes autism, or that vaccines cause autism, much as one holds a religious belief|
The article elicited a strong response and by 2004, 10 of the 13 co-authors had distanced themselves from it after charges that the results had been falsified.
Paul Offit, a vaccine researcher at the Children's Hospital in Philadelphia, in the US, told the Voice of America radio station that numerous studies since then had concluded there was no link between MMR and autism.
"We've reached the many hundreds of thousands mark of children who did or didn't receive MMR to see whether risk of autism was greater in the vaccinated group, and it wasn't - consistently, reproducibly, redundantly," he said.
"I think that the problem is there are people who simply don't believe the science. They hold on to this notion that MMR causes autism, or that vaccines cause autism, much as one holds a religious belief."
Jill Stacey, national director of Autism South Africa, a support and advocacy organization, said they did not have a position on the link between autism and MMR, as the 300 members were split on the issue, with two-thirds not believing in the link and one-third supporting the idea.
Her organization fielded at least 10 enquiries a month about the connection between MMR and autism, and more if the issue was subject to media attention, but never said, "Do not vaccinate", she told IRIN.
The concern among some members of Autism South Africa was that they believed there was a connection when the measles and mumps vaccination took place simultaneously, especially if the child had a weakened immune system.
"What is infuriating is the [MMR] vaccine cannot be split", and the single dose mumps vaccine was no longer available in South Africa, Stacey commented.
She said The Lancet's decision to retract the Wakefield article was unlikely to sway perceptions either way.