Research and analysis

HPR volume 12 issue 16: news (11 May)

Updated 21 December 2018

Measles outbreaks in England, 2018

Between 1 January and 9 May, 2018, 440 laboratory-confirmed measles cases were reported in England, with London (164), the South East (86), West Midlands (78), South West (42) and West Yorkshire (37) reporting the most cases. The majority of cases (54%) are over 15 years of age.

The increase in cases is mainly associated with importations from Europe that have led to some limited spread in the population, particularly young people and adults who missed out on MMR vaccine when they were younger, and under-vaccinated communities such as migrant populations, travellers and the anthroposophic (Steiner) community. A number of strains have been identified – which is consistent with multiple importations; however the commonest strain is the same B3 genotype currently circulating in Romania.

Measles is a highly infectious viral disease easily prevented by vaccination and yet remains an important cause of morbidity and mortality globally. There are currently several large outbreaks across Europe in countries where MMR vaccine uptake has been low historically. Earlier this year the European Centre for Disease Prevention and Control (ECDC) published a rapid risk assessment on measles [1]. This concluded that:

• there is a high risk of continued measles transmission with mutual exportation and importation between European and ‘third countries’
• even if a country achieves 95% MMR uptake, there is still potential for outbreaks in subnational zones or communities and older age cohorts with low coverage
• the occurrence of measles among healthcare workers highlights the need for targeted interventions to ensure proof of immunity or immunisation ahead of employment

PHE local health protection teams are working closely with the NHS and local authorities to raise awareness of the measles outbreaks among health professionals and local communities. PHE has developed a series of posters and leaflets that can be ordered free via the Health and Social Care Orderline [2]. In addition social media banners are available to anyone wishing to promote MMR vaccination: these are suitable for Twitter and Facebook and can be used on digital displays [3].

MMR vaccine is available to all adults and children who are not up to date with their two doses. Practices should maximise all opportunities for catch-up. The vaccine can also be given from 6 months of age before travel to a high risk country.

References

1. ECDC (21 March 2018). Rapid risk assessment: risk of measles transmission in the EU/EEA.

2. Health and Social Care Publications Orderline (registration required). PHE has developed a range of campaign resources which are available from the Orderline webpages, including:
   MMR for all, general leaflet (product code 3219250); Measles – young person 16 to 25”, leaflet (product code 3205760); Measles – young person 16 to 25”, poster (product code 3285852); Measles poster, (product code 2900430). (Select ‘Measles resources’ button under ‘Campaign search’, or enter keyword ‘MMR’).

3. Images for use on social media, and other downloadable artwork, are available via the following links: MMR and measles social media banners and Measles adverts suitable for local publications, newsletters, newspapers and local authority use.

Interim guidance on tetanus prophylaxis during period of immunoglobulin shortage

PHE has published updated interim recommendations for immunoglobulin use in the treatment and prophylaxis of tetanus, taking account of current shortages in supply of approved immunoglobulin (Ig) products [1].

The interim guidance updates the list of available intravenous immunoglobulin products that are recommended for the treatment of clinical tetanus based on recent testing. It also provides recommendations for the use of human normal immunoglobulin as an alternative to tetanus-specific immunoglobulin (for intramuscular use) to manage tetanus-prone injuries. Trusts are advised to contact manufacturers directly for supplies of Ig products for treatment and prophylaxis of tetanus, which are not available from PHE.

The recommendations are published ahead of fully-revised guidelines for management of clinical tetanus and of tetanus-prone wounds, due to be available later in 2018.

Reference

1. PHE (April 2018). Interim recommendations on the treatment and prophylaxis of tetanus.

Hepatitis C in England: analysis of 2016 data published

PHE has published an annual report on hepatitis C in England that presents an analysis of data to end-2016 and a progress report on actions in train to reduce HCV incidence and HCV-related mortality [1].

Most recent estimates suggest that around 160,000 people in England are living with chronic HCV infection, with injecting drug use remaining the most important risk factor for the infection.

Falls in HCV-related mortality were recorded year-on-year between 2014 and 2016, suggesting that increased treatment with new direct acting antiviral (DAA) drugs may be starting to have an impact, the report notes.

Nevertheless, over the last two decades (1996 to 2016) there has been a more than five-fold increase in the number of laboratory-confirmed HCV cases in England, with 10,731 reports of individuals testing positive for antibodies to HCV and/or HCV RNA in 2016. Increased testing was also noted by sentinel surveillance, which suggested a 24% increase overall, and a 21% increase in testing via GP surgeries, between 2012 and 2016.

PHE’s annual report on hepatitis C in the UK will be published this summer, to mark World Hepatitis Day on 28 July 2018.

Reference

1. PHE (March 2018). Hepatitis C in England: 2018 report.

Infection reports in this issue of HPR

‘Laboratory reports of respiratory infections made to PHE Colindale from PHE and NHS laboratories in England and Wales: weeks 14 to 17, 2018’ is published in this issue of HPR.