Guidance

UK measles and rubella elimination indicators and status

Updated 23 November 2023

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UK measles and rubella elimination

Measles and rubella can be eliminated, and congenital rubella infections prevented by achieving high uptake of the combined measles, mumps and rubella (MMR) vaccine in national childhood immunisation programmes. All Member States of the World Health Organization (WHO) European Region have a longstanding commitment to eliminating measles and rubella and this is a core goal of the European Vaccine Action Plan 2015 to 2020. In the UK the MMR vaccine is offered to all children at one year of age, with a second dose given at 3 years and 4 months.

The UK Health Security Agency (UKHSA) is responsible for collating and submitting evidence every year, on behalf of the devolved administrations, to the UK national verification committee (NVC) and the WHO Regional Verification Commission for Measles and Rubella Elimination (RVC) for review and evaluation on an annual basis.

The elimination verification process is based on evidence documented by each Member State to show whether interruption of endemic transmission of measles and/or rubella at national level has been achieved and, if not, that a national plan has been developed to address this.

The following essential criteria are required to verify elimination of measles and rubella in the UK:

  • the absence of endemic measles and rubella cases for a period of at least 12 months from the last known case, due to complete interruption of endemic virus transmission
  • the presence of a high-quality surveillance system that is sensitive and specific enough to detect, confirm and classify all suspected cases
  • genotyping evidence that supports the interruption of endemic transmission

The WHO confirmed that the UK achieved elimination status for rubella in 2016. The UK achieved measles elimination in 2017 and then lost that status due to re-established endemic transmission of measles due to outbreak linked to a measles resurgence across Europe. In 2021 the UK regained measles elimination status based on a significant decline in measles circulation globally due to the COVID-19 pandemic. See Tables 1 and 2.

Table 1. Measles elimination indicators and status, 2010 to 2022, UK

Year MMR vaccine coverage 1st dose (%) MMR vaccine coverage 2nd dose (%) Measles cases [footnote 1] Incidence per million WHO status
2010 92.5 85.0 407 6.09 endemic transmission[footnote 2]
2011 93.4 86.5 1,112 15.99 endemic transmission[footnote 2]
2012 94.3 88.2 2,052 32.15 endemic transmission[footnote 2]
2013 93.9 87.7 1,853 28.91 endemic transmission[footnote 2]
2014 94.8 89.3 96 1.50 interrupted endemic transmission[footnote 3]
2015 95.1 88.9 90 1.10 interrupted endemic transmission[footnote 3]
2016 95.3 88.2 562 10.40 eliminated
2017 95.2 87.8 349 4.40 eliminated
2018 94.8 87.2 1,250 17.10 re-established transmission of measles virus[footnote 2]
2019 94.8 87.5 1,117 15.30 re-established transmission of measles virus[footnote 2]
2020 94.6 87.4 95 1.30 re-established transmission of measles virus[footnote 2]
2021 93.8 86.5 2 0.00 eliminated
2022 92.9 85.2 63 0.70 pending

As history teaches us, elimination can only be sustained going forward by maintaining and improving coverage of the MMR vaccine in children and by using all opportunities to catch up older children and adults who missed out when they were younger. A new UKHSA assessment of the risk of measles resurgence in the UK shows that the risk of a large measles epidemic outside of London is considered low. Models suggest, however, that an outbreak of between 40,000 and 160,000 cases could occur in London where vaccine uptake has consistently been lower than the rest of the UK.

Table 2. Rubella elimination indicators and status 2010 to 2022, UK

Year MMR vaccine coverage 1st dose (%) MMR vaccine coverage 2nd dose (%) Rubella cases [footnote 4] Incidence per million WHO status
2010 92.5 85.0 12 0.14 interrupted endemic transmission[footnote 3]
2011 93.4 86.5 6 0.11 interrupted endemic transmission[footnote 3]
2012 94.3 88.2 61 0.75 endemic transmission[footnote 2]
2013 93.9 87.7 7 0.11 interrupted endemic transmission[footnote 3]
2014 94.8 89.3 1 0.02 interrupted endemic transmission[footnote 3]
2015 95.1 88.9 2 0.02 eliminated
2016 95.3 88.2 2 0.02 eliminated
2017 95.2 87.8 10 0.10 eliminated
2018 94.8 87.2 3 0.02 eliminated
2019 94.8 87.5 3 0.02 eliminated
2020 94.6 87.4 0 0.00 eliminated
2021 93.8 86.5 0 0.00 eliminated
2022 92.9 85.2 0 0.00 pending

Table 3. WHO indicators and targets for measuring performance of measles surveillance 2010 to 2022

Year Timeliness (%) [footnote 5] Completeness of reporting (%) [footnote 6] Rate of laboratory investigations (%) [footnote 7] Rate of discarded cases per 100,000 population [footnote 8] Representativeness of reporting discarded cases [footnote 9] Viral detection [footnote 10] Origin of infection identified [footnote 11] Timeliness of investigation [footnote 12]
2010 83 [footnote 13] 100 122 [footnote 14] 5.4     100  
2011 73 [footnote 13] 100 105 [footnote 14] 5.8     100  
2012 70 [footnote 13] 100 111 [footnote 14] 8.5     100  
2013 100 100 >89 UK [footnote 15] 10.3 UK 72 100 100 >89 [footnote 15]
2014 100 100 73 England;
83 Wales;
94 N Ireland;
NK Scotland		 4.9 England;
4.8 Wales;
0.8 N Ireland;
0.8 Scotland		 50 100 100 100
2015 100 100 73 England;
81 Wales;
56 N Ireland;
NK Scotland		 3.1 England;
2.7 Wales;
0.9 N Ireland;
NK Scotland		 50 100 in clusters; 50 in sporadic cases 100 100
2016 100 100 78 England;
79 Wales;
92 N Ireland;
NK Scotland		 3.7 England;
3.6 Wales;
2.9 N Ireland;
NK Scotland		 66 91% clusters; 66% sporadic cases 100 100
2017 100 100 98.3 4.4 England;
5.2 Wales;
2 N Ireland;
1.9 Scotland		 92 96.1 99 100
2018 100 100 94.4 5.8 England;
10 Wales;
1.6 N Ireland;
1.3 Scotland		 83.3 98.8 100 100
2019 100 100 93.9 5.4 England;
5.9 Wales;
4.6 N Ireland;
14.9 Scotland		 100 86 96.3 85.4
2020 100 100 98.7 2.8 England;
1.5 Wales;
1.6 N Ireland;
4.4 Scotland		 25 100 100 100
2021 100 100 99.9 1.7 England;
1.7 Wales;
0.4 N Ireland;
3.8 Scotland		 33.3 100 100 100
2022 100 100 97.2 3.1 England;
1.6 Wales;
1.1 N Ireland;
4.9 Scotland		 83.3 80 93.7 100

Table 4. WHO indicators and targets for measuring performance of rubella surveillance 2010 to 2022

Year Timeliness (%) [footnote 5] Completeness of reporting (%) [footnote 6] Rate of laboratory investigations (%) [footnote 7] Rate of discarded cases per 100,000 population [footnote 8] Representativeness of reporting discarded cases [footnote 9] Viral detection [footnote 10] Origin of infection identified [footnote 11] Timeliness of investigation [footnote 12]
2010 61 [footnote 13] 100 105 [footnote 14] 1.2     100  
2011 57 [footnote 13] 100 93 [footnote 14] 1.1     100  
2012 69 [footnote 13] 100 162 [footnote 14] 2.4     100  
2013 100 100 124 [footnote 16] 1.6 <80 [footnote 17] 0 100 >84 [footnote 15]
2014 100 100 79 England;
94 Wales;
100 N Ireland;
NK Scotland		 1.4 England;
0.1 Wales;
0.1 N Ireland;
0.05 Scotland		 0 N/A 100 100
2015 100 100 74 England;
65 Wales;
60 N Ireland;
NK Scotland		 2.4 England;
0.6 Wales;
0.2 N Ireland;
NK Scotland		 25 35 100 100
2016 100 100 64 England;
63 Wales;
0 N Ireland;
NK Scotland		 3.4 England;
0.6 Wales;
0 N Ireland;
NK Scotland		 41 0 100 100
2017 100 100 99.6 2.4 England;
0.4 Wales;
0.3 N Ireland;
0.2 Scotland		 50 N/A 60 100
2018 100 100 100 3.1 England;
3.1 Wales;
0.7 N Ireland;
0.6 Scotland		 75 N/A 100 100
2019 100 100 100 1.6 England;
1.8 Wales;
0.4 N Ireland;
1.2 Scotland		 33 0 100 87
2020 100 100 100 1.4 England;
1.1 Wales;
0.4 N Ireland;
0.4 Scotland		 8.3 N/A N/A 100
2021 100 100 100 1.0 England;
0.4 Wales;
0.2 N Ireland;
0.5 Scotland		 0 N/A N/A 100
2022 100 100 100 2.1 England;
0.7 Wales;
0.2 N Ireland;
0.4 Scotland		 58.3 N/A N/A 100

  1. a suspected case that meets the laboratory/epidemiological/clinical criteria for measles (definitions have changed over time) ↩

  2. continuous transmission of indigenous or imported measles or rubella virus that persists for a period of 12 months or more in a defined geographical area ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8

  3. the absence of endemic measles or rubella cases in a defined geographical area for a period of at least 12 months, in the presence of a well-performing surveillance system. Regional elimination can be declared after 36 or more months of the absence of endemic measles or rubella in all Member States ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  4. a suspected case that meets the laboratory/epidemiological/clinical criteria for rubella (definitions have changed over time) ↩

  5. percentage of measles or rubella routine surveillance reports submitted to the national level by the deadline ↩ ↩2

  6. percentage of measles or rubella routine surveillance reports submitted to the national level ↩ ↩2

  7. percentage of cases suspected for measles or rubella with adequate specimens collected and tested in a WHO accredited or proficient laboratory ↩ ↩2

  8. the rate of suspected measles or rubella cases investigated and discarded as non-measles or non-rubella cases using laboratory testing in a proficient laboratory and/or epidemiological linkage to another confirmed disease ↩ ↩2

  9. percentage of subnational administrative territories (e.g. at the province level or its administrative equivalent) reporting the rate of discarded cases at least 2 per 100 000 population per year ↩ ↩2

  10. percentage of laboratory-confirmed chains of transmission of measles or rubella with samples adequate for viral detection collected and tested in an accredited laboratory ↩ ↩2

  11. percentage of measles or rubella cases for which the origin of infection (imported, import-related or endemic) has been identified ↩ ↩2

  12. percentage of suspected measles or rubella cases with an adequate investigation initiated within 48 hours of notification ↩ ↩2

  13. there are percentages of IgM results reported out within 7 days of receipt of specimen. If public health action is required specimens are tested and reported out within 1 working day. ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  14. this is based on the number of specimens tested / cases reported in England (2010 to 2012) and Wales (2012 only) ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  15. estimate based on England and N Ireland records where data available; (likely to be an underestimate) ↩ ↩2 ↩3

  16. estimate based on number of cases reported to local teams (England) and number of suspected cases tested at proficient lab ↩

  17. not meaningful for UK as not meeting the 2 per 100,000 rate at national level ↩

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