Measles cases have risen in South Africa this year, and the increase has been linked to falling vaccination rates. Measles is often seen as a childhood illness, but it can affect people of any age and can cause serious complications.
According to the National Institute for Communicable Diseases (NICD), 6,186 laboratory-confirmed cases were reported nationally between 29 December 2025 and 4 October 2026.
Measles is largely preventable. This article explains how it spreads, what to look for, what to do if you suspect it, why vaccination coverage matters, and the role of vitamin A in treatment.
What is measles?
Measles is a highly infectious viral illness that causes fever, cough and a characteristic red rash. It starts in the respiratory system and then spreads through the body. It passes through the air when an infected person breathes, coughs, or sneezes. Infected droplets can stay in the air for up to two hours, so sharing an enclosed space with someone who has measles can be enough to catch it.
People can spread the virus from about four days before the rash appears until about four days after. Many are therefore contagious before they know they are ill, which makes outbreaks hard to control.
Signs and symptoms
Measles begins like a bad flu, so in the early stage, cases are easy to miss. Symptoms usually start 7 to 21 days after exposure and include:
- high fever
- cough
- runny nose
- red, watery eyes
- tiredness and general discomfort
About two to three days later, tiny white spots called Koplik spots may appear inside the cheeks, although they are easy to overlook. The rash follows. It starts on the face and upper neck and spreads down the body, appearing as flat red or reddish-brown spots that may merge. It lasts 5 to 6 days, and fever is often highest at this stage.
Because the early symptoms resemble other respiratory infections, it is important to consider measles whenever a fever comes with a rash, especially in someone who is not fully vaccinated.
Complications
Most healthy people recover, but measles can cause serious complications:
- Pneumonia: the most serious complication in young children.
- Diarrhoea and dehydration: especially in infants.
- Ear infections: these can occasionally affect hearing long term.
- Encephalitis: brain inflammation is rare, but it can cause seizures, permanent damage or death.
- Eye damage: particularly in children with low vitamin A levels, measles can lead to vision loss.
The NICD warns that malnourished children and infants under two are at highest risk. People with weakened immunity and pregnant women who are not immune also need prompt care.
What to do if you suspect measles
If you or your child has a fever with a rash, cough, or red eyes, the NICD advises that you seek medical care, avoid contact with others, and stay home.
Call your clinic or doctor before you go, so that staff can keep you apart from other patients, and wear a mask if you have one. Measles is confirmed with a blood test, which may be combined with a throat swab, and health workers must report every suspected case within 24 hours.
Stay home from school, work and crèche until at least four days after the rash first appeared, or as a clinician advises. Warn close contacts, especially people with babies, pregnant women, and anyone unvaccinated. Unvaccinated contacts should ask a clinic about vaccination, which can help if given soon after exposure, ideally within about three days.
At home, give plenty of fluids and keep feeding or breastfeeding. Treat fever with medicine as directed by a healthcare provider. Do not give aspirin to children.
Seek emergency care if there is
- fast or difficult breathing
- a seizure, confusion or unusual drowsiness
- signs of dehydration, such as not drinking or persistent vomiting or diarrhoea
- severe eye pain, sensitivity to light or changes in vision
- a fever that keeps rising or does not ease after the rash spreads
Babies under one year, malnourished children, and people with weakened immunity should always see a clinician, even if symptoms seem mild.
Falling vaccination rates
The rise in measles cases follows a decline in routine childhood immunisation. According to the South African Department of Health, the share of babies under one who received no vaccines at all has risen from 12.1% in 2017 to 36.3% in early 2026, and routine coverage has fallen in all 52 districts. At current rates, the department expects the country to fall short of the World Health Organisation's 90% target for overall childhood immunisation.
Measles needs even more protection than that. Because it spreads so easily, about 95% of a community must be immune to stop it circulating, and the national programme aims for at least 95% coverage with both doses. When coverage falls below that level, unprotected people are exposed to the virus, and outbreaks can take hold.
Babies under six months, who are too young to be vaccinated, and people who cannot be vaccinated for medical reasons depend on everyone else being immune. Cases are also rising among teenagers and adults, which suggests gaps in immunity that have built up over time. The Department of Health says it is prioritising catch-up vaccination for children who have missed doses.
Vaccination: the most effective protection
Two doses of the measles-rubella (MR) vaccine are the best way to prevent measles and its complications, and the vaccine is free at public clinics. Under the Expanded Programme on Immunisation, the first dose is given at 6 months and the second at 12 months. You can get it at public clinics, community health centres, and some pharmacies that offer the programme.
In the private sector and military health facilities, the MMR vaccine is used instead, at 12 and 18 months, and it also protects against mumps.
If a dose was missed
A missed dose does not mean restarting the schedule, and catch-up is possible at any age. Parents should check their child's Road to Health booklet and visit a clinic if any doses are outstanding. Schools have also been asked to check children's vaccination status, and the Department of Health runs outbreak vaccination campaigns at schools for children who missed their routine doses.
Teenagers and adults who are unsure of their status should ask a clinic or doctor. This matters most before pregnancy, if you work in health care or childcare, and before travel.
Safety
Measles vaccines are safe and widely used. A mild fever or a sore arm afterwards is common. Because MR and MMR are live vaccines, they are generally not given during pregnancy or to people with severe immune suppression, so vaccination status should be reviewed before pregnancy.
Vitamin A in treatment
There is no cure for measles, and treatment is mainly supportive: fluids, nutrition and managing complications. The NICD advises that vitamin A is given to all children with measles to help protect their eyes and reduce the severity of the illness.
Why it helps
Measles lowers the body's vitamin A levels, and low levels make the disease worse. The evidence comes partly from a South African trial in hospitalised children in Cape Town. Those given vitamin A recovered from pneumonia faster, and their risk of death or a major complication was half that of children given a placebo.
What the guidance says
The World Health Organisation recommends a high oral dose of vitamin A once a day for two days for children with measles. A Cochrane review found that two doses were linked to fewer deaths in children under two, with no clear benefit from a single dose. The exact dose depends on the child's age, so it should always be set by a doctor, nurse, or clinic. A further dose can be given two to four weeks later if the child has eye signs of vitamin A deficiency.
Key takeaways
- Measles spreads easily, and case numbers have increased in South Africa this year, including among older children and adults.
- The rise follows a fall in routine childhood vaccination, with more babies receiving no vaccines at all.
- Suspect measles if there is fever with cough, runny nose, red eyes and a rash that spreads downward from the face.
- Phone ahead for doctors’ appointments, stay home and get tested. Seek urgent care for breathing difficulty, seizures, dehydration or eye problems.
- Two doses of the MR vaccine, at 6 and 12 months, are free at public clinics, and catch-up is possible at any age. Check your child's Road to Health booklet.
- Vitamin A is a supportive treatment for children, given by a health worker. It is not a substitute for vaccination.