Why measles is on the rise

From 1 January to 30 November 2023, there were 209 confirmed measles cases in England. More than 8 out of 10 of these cases were the result of community transmission in England as opposed to those who caught measles abroad and imported it to the UK. In 2022 there was a total of 54 cases of measles in England¹.

Numbers continued to increase with 43 new cases reported in November, mainly due to outbreaks in the West Midlands, and Yorkshire and the Humber. Around 8 out of 10 cases in 2023 were in children aged under 10 years, with around 1 in 4 of the cases in teenagers and young people aged 15 to 34 years.

A decline in immunisation rates is partly to blame for the disease's growth with only 89% of children aged two in England having received the first dose of the MMR vaccine, and 85% completing the recommended two doses by the age of five². These rates are short of the World Health Organization's (WHO) target of 95% coverage, which the body says is necessary to achieve and maintain elimination of the disease.

Is the MMR vaccine safe?

"Unlike the diseases they prevent, vaccines are very safe," says Dr Patrick O'Connor, a measles specialist at the WHO.

He points out that the measles vaccine continues to be highly effective. In the majority of cases, two doses given at the appropriate times provide full protection for at least several decades of life.

So why are some parents so wary of allowing their children to be vaccinated?

GP Dr Clare Morrison, explains: "Discredited research suggesting a link between the measles, mumps and rubella (MMR) vaccine and autism caused many parents to decide against having their child vaccinated". She says that some of this mistrust still continues today, despite official NHS advice, and education from health visitors and doctors.

"Measles is most common amongst children, and those who haven't been vaccinated are the most at risk. This includes babies who haven't yet had the routine MMR vaccination and those whose parents deliberately avoided the vaccine due to misplaced health scares."

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Symptoms of measles

Measles is caused by a highly contagious virus spread by coughing and sneezing, close personal contact, or direct contact with infected nasal or throat secretions.

The virus infects the respiratory tract then spreads throughout the body. It can be transmitted by an infected person from 4 days before to 4 days after a rash appears. The measles virus can stay active and contagious in the air or on infected surfaces for up to two hours.

The first sign of measles is usually a high fever, which can begin anywhere from 7 to 21 days after exposure to the virus - although 10-12 days is most common - and lasts 4 to 7 days. The other symptoms at the early stage include:

• A runny nose.

• A cough.

• Red and watery eyes.

• Small white spots inside the cheeks can develop in the initial stage.

After several days, a rash erupts, usually on the face and upper neck. Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus - within a range of 7 to 18 days.

Any non-immune person - anyone who has not previously had the disease, has not been vaccinated, or was vaccinated but did not develop immunity - can become infected, O'Connor says.

"If the child is over 6 months old, the best strategy is to have the MMR vaccine within 72 hours of contact," says Morrison. "If they are under 6 months old, then an injection of 'human normal immunoglobulin', or 'HNIG', may be recommended. This needs to be given within 6 days of exposure, and gives temporary but immediate protection.

"Measles cases must be notified to the local Health Protection Team (HPT), by the patient's doctor. A child with measles should stay off school until at least 4 days after the rash appears."

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Potential complications of measles

According to O'Connor, anyone with measles can develop serious and even fatal complications, but complications are more common in children under the age of 5 years or adults over the age of 30.

The most serious complications of measles include:

• Loss of vision.

• Encephalitis - an infection that causes brain swelling.

• Severe diarrhoea and related dehydration.

• Ear infections.

• Severe respiratory infections such as pneumonia.

Connor says: "No specific antiviral treatment exists for measles virus. However, severe complications from measles can be avoided through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia."

The herd immunity myth

Measles is highly contagious, and will spread wherever there is a cluster of susceptible people. Morrison warns against complacency:

"Some parents rely on 'herd immunity' - the fact that most other people are immune, and that therefore the risk of contact is relatively low. However, you only need a few people to be unvaccinated for a mini-epidemic to start, or the child might come across the infection while travelling abroad."

Practical advice for parents

If you are concerned your child may have contracted the measles virus, Dr Morrison says: "If your child comes into contact with measles, but has had the routine vaccines - given at around 12 months and again at 15-18 months - they are unlikely to catch it." She adds that even just the first vaccine gives 93% immunity.

1. UKHSA: Confirmed cases of measles in England by month, age and region: 2023

2. NHS: Childhood Vaccination Coverage Statistics, England, 2022-23