Laboratory confirmed cases of measles, rubella and mumps in England: January to March 2022
Updated 28 February 2023
Applies to England
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Measles, rubella and mumps are notifiable diseases and healthcare professionals are legally required to inform their local health protection team (HPT) of all suspected cases. National enhanced surveillance including oral fluid (OF) testing of all suspected cases is provided through the Virus Reference Department (VRD) at Colindale to support and monitor progress towards World Health Organization (WHO) measles and rubella elimination targets.
The 2 main WHO indicators for measuring the performance of national measles and rubella surveillance systems are:
- The rate of laboratory investigations (at least 80% of suspected cases).
- The annual rate of discarded cases (at least 2 per 100,000 population).
In order to achieve these targets our focus is on ensuring that all suspected cases are appropriately tested. IgM serology testing and oral fluid testing are the only 2 tests considered adequate by WHO for confirming and importantly discarding suspected measles and rubella cases. Recent infection is confirmed by measuring the presence of IgM antibodies or detecting viral RNA (by PCR) in these samples.
Samples that have been confirmed positive for measles or rubella are further sequenced and entered on the WHO global Measles Nucleotide Surveillance (MeaNS) or the Rubella Nucleotide Surveillance (RubeNS) system, respectively, which are hosted at the National Reference Laboratory. Genotyping and further characterisation of measles and rubella is used to support investigation of transmission pathways and sources of infection.
Data presented here is for the first quarter of 2022 (January to March). Analyses are done by date of onset of rash or symptoms and regional breakdown figures relate to Government Office Regions.
Historical annual and quarterly measles, rubella and mumps epidemiological data is available here from 2013 onwards:
Results from all samples tested at Colindale are reported on the MOLIS/LIMS system and reported back to the patient’s GP and local HPT.
Table 1. Total suspected cases of measles, rubella and mumps reported to health protection teams (HPTs) and proportion tested through different routes: weeks 1 to 13 of 2022
| Notified as | Number of suspected cases* | Number (%) tested by OF. [Target: 80% (measles and rubella only)] | Other samples received in Virus Reference Laboratory | Number of samples IgM positive or viral detection | Discard rate based on negative tests per 100,000 population (all samples)** |
|---|---|---|---|---|---|
| Measles | 308 | 174 (56%) | 11 | 1 | 0.33 |
| Rubella | 64 | 24 (38%) | 18 | 0 | 0.08 |
| Mumps | 1,179 | 309 (26%) | 8 | 10 | – |
| Rash fever surveillance¥ | 3,332 | 495 (15%)¥¥ | – | 0 | – |
The cases are broken down by:
- proportion tested by OF
- other samples received from notified cases
- cases confirmed (all tests) nationally at the VRD and at local NHS hospitals and private laboratories
- discard rate (measles and rubella only)
*This represents all cases reported to HPTs in England, that is, possible, probable, confirmed and discarded cases on HPZone.
**The rate of suspected measles or rubella cases investigated and discarded as non-measles or non-rubella using laboratory testing in a proficient laboratory. The annual discard rate target set by WHO is 2 cases per 100,000 population. We present quarterly rates here with an equivalent target of 0.5 per 100,000 population.
¥Includes samples received through the UK Health Security Agency (UKHSA) rash fever surveillance.
¥¥This quarter some rash fever samples may have been received but not tested due to a laboratory supply chain issue.
Measles
In the period between January and March 2022 there was 1 laboratory confirmed case of measles reported in England in an adult who had recently travelled to Pakistan (Figure 1). A total of 2 laboratory confirmed measles cases were identified in the UK in 2021.
Figure 1. Laboratory confirmed cases of measles by month of onset of rash or symptoms reported, London and England: January 2012 to March 2022
All suspected cases of measles and rubella should be reported promptly to HPTs, a risk assessment conducted, and an OF kit sent for confirmatory testing even if local diagnostic testing is underway. This quarter an OF sample was returned for 56% of all suspected measles cases, well below the 80% WHO target.
Mumps
In England, there were only 10 laboratory confirmed mumps infections in the period between January and March 2022 (1).
Most (7 out of 10) of the cases this quarter were in adults above the age of 18 years.
Figure 2. Laboratory confirmed cases of mumps by quarter, England: 2012 to 2022
Rubella
There have been no new laboratory confirmed cases of rubella reported in the UK since 2019.
Impact of the COVID-19 pandemic on measles, mumps and rubella surveillance and epidemiology
The routine surveillance and epidemiology of measles and rubella in the UK was impacted in a number of ways during the coronavirus (COVID-19) pandemic. Non-pharmaceutical interventions introduced for COVID-19 control, in particular the limitations imposed on international travel drastically reduced the number of measles and rubella importations, providing fewer opportunities for new chains of transmission. Health-seeking behaviour during the pandemic also changed, making it more likely that people with mild symptoms did not present to healthcare services and may not have been seen face to face.
During this period, coverage of the measles, mumps and rubella (MMR) vaccine fell. The latest quarterly UKHSA Cover of vaccination evaluated rapidly programme (COVER) statistics (October to December 2021) show that uptake of MMR1 at 2 years in England was 88.9% and in London was 78.5%. MMR2 at 5 years is well below the 95% WHO target at 85.5% for England and 73.8% for London (2). Although some catch-up is underway, it is likely that susceptibility will have increased in recent years, with potential for larger outbreaks as international travel and contact patterns resume.
On 1 February 2022, UKHSA and the NHS launched a campaign calling on parents and guardians to ensure their children are up to date with the MMR vaccine, and all other routine childhood immunisations (3).
Measles, mumps and rubella oral fluid testing and rash-fever surveillance
As previously described (1,4), measles, mumps and rubella OF kits are now being dispatched through a central service commissioned by the Immunisation and Vaccine Preventable Diseases Division at Colindale. HPTs are asked to familiarise themselves with the full details of Measles, mumps, rubella: OF testing forms and instructions.
A video that explains how to take an OF swab is available below.
In November 2021, the UKHSA Immunisation and Vaccine Preventable Diseases Division launched a new rash-fever surveillance scheme. The aim is to increase the number of samples tested for measles and rubella in order to meet the WHO target of testing 2 per 100,000 of the UK population (3). This involves OF kits being sent to patients notified to HPTs with scarlet fever. On a weekly basis, personal information on scarlet fever notifications is extracted from HPZone for the whole of England and sent in bulk to the UKHSA external kit supplier for dispatch. Samples received at the national reference laboratory are tested for measles and rubella antibodies.
Table 2. Monthly total number of OF kits dispatched for the UKHSA rash-fever surveillance with return rates, England
| Month | Number of OF kits dispatched | Return rate |
|---|---|---|
| January 2022 | 543 | 46% |
| February 2022 | 1,003 | 24%^ |
| March 2022 | 1,786 | 0%^ |
^ Some samples may have been received but not tested due to a laboratory supply chain issue.
References
1. UKHSA (2022). ‘Laboratory confirmed cases of measles, rubella and mumps, England: October to December 2021’ Health Protection Report volume 16 number 3
2. UKHSA (2022). ‘Quarterly vaccination coverage statistics for children aged up to 5 years in the UK (COVER programme): October to December 2021’ Health Protection Report volume 16 number 4
3. UKHSA (February 2022). ‘Around 1 in 10 children starting school at risk of measles’ (Press release)
4. Public Health England (September 2020). ‘MMR and pertussis surveillance and oral fluid testing’ (internal Briefing Note 2020/031)
5. Oral fluid test for measles, mumps and rubella kit instruction video
Oral fluid test for measles, mumps and rubella kit instruction video