Silent casualties from the measles outbreak in South Africa
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2011
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South African Medical Journal
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University of Cape Town
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Abstract
South Africa, home to the world’s largest population of people living with HIV (5.7 million), experienced a measles outbreak that started in late 2009.1 There was a stepped increase in cases of measles, with the highest incidence reported in March 2010.2 By September 2010, more than 17 000 new measles cases had been reported to the National Institute of Communicable Diseases since January 2009. A mass vaccination campaign from mid-April to early May 2010 resulted in a significant decline in new measles cases. The measles virus is highly contagious, and outbreaks are fuelled by overcrowding and poor vaccine coverage, making elimination status in South Africa difficult to attain. Measles may infect the central nervous system (CNS) as acute viral encephalitis, or result after 2 - 4 weeks in a post-infectious immune-mediated inflammatory disorder or acute disseminated encephalomyelitis (ADEM). There are 2 further rare and latent CNS complications resulting from a preceding measles infection: subacute sclerosing panencephalitis (SSPE) caused by years of viral persistence in a seemingly immunocompetent host,3 and subacute measles encephalitis (SME), occurring in an immunocompromised host.4 SME manifests 1 - 7 months after the acute measles infection.5 Patients present with seizures, often epilepsy partialis continua, and altered mental status.5 It carries a mortality rate of 85% and survivors often have significant psychomotor retardation.5 SME has hitherto only been described in single case reports as a rare complication of measles in the context of organ transplantation,6,7 immunosuppressive therapy or immunodeficiencies,5,8 and HIV and AIDS.5,9,10 We report 8 cases of SME in HIV-infected patients who presented to a tertiary referral hospital between July and October 2010.
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Albertyn, Christine, van der Plas, Helen, Hardie, Diana, Candy, Sally, Tomoka, Tamiwe, LeePan, Edward B, & Heckmann, Jeannine M. (2011). Silent casualties from the measles outbreak in South Africa. SAMJ: South African Medical Journal, 101(5), 313-317. Retrieved January 08, 2016, from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011000500014&lng=en&tlng=en. .