Health Service Focus

29.10.19

The UK no longer has 'mealses-free' status

Source: NHE SEPT-OCT 19 

Dr Mary Ramsay, head of the immunisation, hepatitis and blood safety department at Public Health England (PHE), focuses in depth on vaccine uptake in the UK and the country’s recent loss of ‘measles-free’ status.

In 2017, based on data from 2014-2016, the World Health Organization (WHO) declared that the UK had eliminated measles. However, the WHO has now confirmed that the UK’s elimination status has not been maintained.

 In 2018, there was a marked increase in the number of confirmed measles cases, with 991 confirmed cases in England and Wales, compared with 284 cases in 2017. Furthermore, the same strain of measles virus (called B3 Dublin) was detected for more than 12 months across 2017 and 2018. Based on this, WHO determined that the UK could no longer be consider as ‘eliminated’ and that transmission of measles had been re-established.

 Measles remains endemic in many countries around the world and there are currently several large outbreaks in countries across Europe where MMR vaccine uptake has been historically low. Until measles elimination is achieved globally we will continue to see importations of the measles virus to the UK. In order to limit spread within the UK, it is important to maintain high coverage of two doses of the MMR vaccine in the population.

 While coverage of the first dose of MMR in the UK has reached the WHO target of 95% for children aged five, coverage of the second dose is at 87.4%. Coverage of MMR vaccine was also lower in the early part of this century, and that means that some teenagers and young adults are not protected. Coverage of all vaccines given to younger children has also fallen very slightly, and as measles is highly infectious, even small declines in uptake can have an impact.

 The media has speculated that anti-vaccine groups and messaging may be having an impact on the programme. While parents may be exposed to anti-vaccine content on social media, PHE research shows that they are far more likely to trust advice from the NHS and their healthcare professional.

 Evidence from PHE’s attitudinal surveys suggests that parental confidence in the national immunisation programme is at an all-time high. There is therefore currently no evidence that anti-vaccine activity has had a major impact on vaccine coverage in England. Some major reasons for the decline in coverage are instead related to how people can best access and use local services.

 To ensure more people are protected, our efforts should focus on increasing uptake of the MMR vaccine as part of the routine childhood immunisation programme as well as catching up older children and young adults who missed out previously.

 The NHS Long Term Plan includes a range of measures to maintain and increase uptake of both MMR doses. These include a fundamental review of the GP contract for vaccination and immunisation, and improved local co-ordination to support improving immunisation coverage in each area which can help target those groups who have low uptake. A check of MMR status for 10 and 11-year olds has recently been added to the GP contract.

The recent government Green Paper on prevention proposed a vaccine strategy in addition to the implementation of the existing Measles and Rubella Elimination Strategy. The Department of Health and Social Care, working with PHE and NHS England, will deliver this comprehensive strategy in the Autumn.

 Overall, it’s important to remember that, even though there has been an increase in measles over the past three years, measles remains uncommon in the UK because of the highly effective MMR vaccination programme. Before the measles vaccine was introduced in 1968, hundreds of thousands of cases occurred each year.

 Measles is a highly infectious disease which can only be controlled by vaccination. If we wish to sustain elimination this can only be done by maintaining and improving coverage of the MMR vaccine.

 Losing the elimination status is a stark reminder of how important it is that every eligible person gets vaccinated. It provides an opportunity to raise awareness of the potential risks posed by measles, the importance of vaccination and timely reporting of suspected cases to limit further spread.

For More Information

Tw: @PHE_uk

W: www.gov.uk/phe

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