Research and analysis

HPR volume 17 issue 5: news (4 May 2023)

Updated 28 December 2023

Update on UK measles epidemiology and actions to prevent a measles resurgence

Measles elimination was briefly achieved in the UK in 2016 and 2017, but by 2018, measles virus transmission was re-established at a time when the whole of Europe was experiencing large epidemics.

In 2019, there were 880 laboratory-confirmed measles cases in the UK and 82 cases were confirmed in early 2020, prior to the first coronavirus (COVID-19) lockdown in March.

The public health measures implemented in response to the COVID-19 pandemic, in particular the limitations imposed on international travel, led to a sharp decline in many infections, including measles, with only 2 cases of measles confirmed in the UK in 2021 and 54 in 2022 (as shown in the graph below).

Since last year, measles activity has been slowly ramping up globally with large outbreaks currently underway in multiple countries in South Asia and Africa.

From 1 January to 20 April 2023, there were 49 lab-confirmed measles cases in England. Thirty three (67%) of these cases were in London; 7 of the UK Health Security Agency’s (UKHSA) 9 regions had detected at least one case. Forty per cent of cases were in children aged under 5 years and 27% in people aged 15 to 34 years (as shown in the table below). Twelve of the cases were imported or import-related, with the others reflecting community transmission in the UK, including a cluster involving a school and 2 cases in the traveller community.

Laboratory confirmed cases of measles by month of onset of rash or symptoms reported, London and England: January 2012 to April 2023

Laboratory confirmed cases of measles by age group and region in England: January to April* 2023

Age group	North East	North West	Yorkshire and Humberside	East Midlands	West Midlands	East of England	London	South East	South West	Total
Less than 1 year	0	0	0	1	0	0	4	0	0	5
1 to 4 years	1	1	0	0	0	1	10	0	2	15
5 to 9 years	1	0	0	0	0	0	6	1	1	9
10 to 14 years	0	0	0	0	0	0	1	0	0	1
15 to 19 years	0	0	0	0	0	0	1	0	2	3
20 to 24 years	0	0	0	1	0	0	0	1	0	2
25 to 29 years	0	0	0	0	0	1	4	0	0	5
30 to 34 years	0	0	0	0	0	0	3	0	0	3
35 years and older	1	0	0	0	0	0	4	0	1	6
Total	3	1	0	2	0	2	33	2	6	49

*Provisional totals

Global and UK MMR uptake: population immunity gaps

Due to the COVID-19 pandemic, vaccine uptake rates for routine childhood programmes have fallen globally, worsening immunity gaps and leaving more children vulnerable to this potentially fatal disease. Coverage for the measles, mumps and rubella (MMR) vaccination programme in the UK has also fallen to the lowest level in a decade.

Uptake for the first dose of the MMR vaccine in children aged 2 years in England is 89%, and uptake of 2 MMR doses at age 5 years is 85.5%. This is below the 95% target set by the World Health Organization (WHO) as necessary to achieve and maintain elimination.

Analyses of data published by Public Health England (PHE) in the Measles and rubella elimination UK strategy in 2019 highlighted that population immunity levels in the UK were below those required to interrupt measles transmission in many birth cohorts. People born between 1998 and 2004 (aged 19 to 25 years in 2023) were the most susceptible. London remains the most vulnerable region with immunity targets not achieved for many birth cohorts – including younger children of pre-school, primary and secondary school age. There are also inequalities in vaccine uptake by ethnicity, deprivation and geography. The burden of measles falls disproportionately on under vaccinated communities.

In February 2023, WHO Europe called for urgent action in all countries to implement catch-up of children and adults who missed MMR vaccine doses in order to prevent a resurgence of measles. WHO also urged countries to strengthen measles surveillance and ensure they are ready to respond swiftly and effectively in the event of measles outbreaks.

Actions to prevent a measles resurgence in the UK

UKHSA has been working closely with the NHS and other partners to support the recovery of the routine childhood immunisation programme and to catch-up children who missed out on their vaccinations during the COVID-19 pandemic. The measles and rubella elimination UK strategy sets out key recommendations for action including the development of local measles and rubella elimination action plans that address specific population needs.

In London, a polio and MMR catch-up campaign targeting unvaccinated or partially vaccinated children aged one to 11 years is under way through GP practices and primary schools during the summer term.

Health professionals are reminded of the need to notify all suspected cases of measles urgently to their local Health Protection Team to conduct a public health risk assessment and organise testing. NHS laboratories are reminded that any locally-tested, positive measles samples need to be referred to the UKHSA Virology Reference Department, Colindale, for confirmatory testing.

Measles is highly infectious and can lead to serious complications, particularly in immunosuppressed individuals and young infants. It is also more severe in pregnancy, and increases the risk of miscarriage, stillbirth or pre-term delivery. In order to prevent transmission to high risk patients especially the immunosuppressed, in healthcare settings, it is essential that all staff working with patients are fully immunised with 2 documented doses of MMR.

Primary care and other health professionals should opportunistically check that children and young people are up to date with their MMR vaccine doses, and bring them up to date if they are not. This offer should include younger adults at suitable opportunities, such as starting university or commencing work in healthcare. Local partners should work together to ensure tailored approaches to improve vaccine uptake in under-vaccinated communities are in place.

Related guidance

Measles: guidance, data and analysis

Measles: post-exposure prophylaxis

Measles: public health response to cases who have travelled by air whilst infectious

Measles: the green book, chapter 21

Infection reports in this issue

Group A streptococcal infections: 13th update on seasonal activity in England

Vaccine coverage reports

Meningococcal ACWY (MenACWY) vaccine coverage for adolescents in England, academic year 2021 to 2022

Td/IPV vaccine coverage for the NHS adolescent vaccination programme in England, academic year 2021 to 2022

Prenatal pertussis vaccination coverage in England from October to December 2022