Symptoms of measles include an itchy rash of red-brown spots.Credit: Jim Goodson/CDC/Science Photo Library
UK health services are grappling with a measles outbreak that has caused concern in a country where the disease was eradicated in 2017. The UK Health and Security Agency (UKHSA), the public health authority, declared a national incident due to the increasing measles cases on 19 January. Since 1 October 2023, over 200 cases have been recorded by the agency (see ‘Measles surge’). The decline in measles, mumps, and rubella (MMR) vaccine uptake during the COVID-19 pandemic has led to the spread of the disease across England and Europe, with small outbreaks occurring in a few US states. Measles, caused by a virus, is highly contagious and spreads through coughing and sneezing. Its symptoms include fever, runny nose, and an itchy rash of red-brown spots. Helen Bedford, a population health researcher at University College London, describes it as one of the most infectious respiratory infections. Babies, young children, pregnant women, and individuals with a weakened immune system are most at risk. Nature delves into the increase in cases.
Source: UK government
“Seeing another measles outbreak in the UK is worrying but not entirely surprising,” stated paediatrician Ronny Cheung at the Evelina London Children’s Hospital. “Vaccination coverage for children under the age of 5 is now the lowest it has been in the past 10 years,” he added. Bedford pointed out that the COVID-19 pandemic exacerbated the situation. Measles cases declined during the pandemic due to social distancing measures, but the drop in vaccine uptake contributed to the recent surge in cases. Additionally, the pandemic may have raised concerns about vaccine safety, potentially delaying uptake due to inadequate public health funding for addressing public inquiries.
How is the UK addressing the surge?
The NHS initiated a vaccination campaign on 22 January, urging parents and caregivers to schedule vaccine appointments for their children. Health services will reach out to parents of unvaccinated children aged 6 to 11. Bedford emphasizes that if parents and young people respond to the vaccine information and the message to get vaccinated, it could halt the spread of measles. London has the lowest vaccination rates, with only 74% of children receiving two doses of the vaccine. Two doses are 97% effective against measles. A local council in the capital has launched a vaccine awareness campaign in multiple languages to reach more people. Bedford warns that without further action, the outbreak could spread more widely across the United Kingdom, leading to deaths.
When was the last time there was a spike in UK cases?
In 2018, England experienced an outbreak of around 900 cases. This occurred after the WHO declared in 2017 that the United Kingdom had eliminated the disease. Public Health England, UKHSA’s predecessor, recommended the MMR vaccine in response to the outbreak. Bedford stresses the importance of vaccination in stopping the spread of measles, especially for those who missed it 20 years ago.
What’s happening elsewhere?
In the United States, there have been 23 confirmed measles cases across Georgia, Missouri, New Jersey, and Pennsylvania in recent weeks. Many cases were linked to international travelers returning to the country, reflecting a global rise in measles cases, according to a newsletter from the US Centers for Disease Control and Prevention (CDC) on 25 January. Last year, there were 56 reported US cases, down from 121 in 2022, significantly lower than the 1,200 US infections in 2019. However, Europe faces a more alarming situation. The WHO’s European region saw a 45-fold increase in measles cases from 2022 to 2023, with 40 member states reporting around 42,200 cases in 2023, up from less than 1,000 in 2022. The rise in cases is attributed to declining national vaccination rates, dropping from 92% on average in 2019 to 91% in 2022, according to the WHO. Globally in 2022, measles cases increased by 18%, and measles-related deaths increased by 43% compared to 2021, according to a WHO report released last November.
