Low take-up of vaccines was said to be to blame for a surge in measles cases in the UK, and across Europe, this winter, as the government launched a campaign urging parents to check their children's immunisation history.
The UK Health Security Agency (2024a) declared a national incident in January after a sharp rise in the number of measles cases, coinciding with the lowest uptake of vaccines recorded in more than a decade and ‘well under’ the recommended coverage.
One of the worst-hit areas in the new year was the West Midlands. As of 18 January, there were 216 confirmed cases and 103 probable cases since October 2023. Around 80% of cases were in Birmingham, with about 10% in Coventry, the majority being in children aged under 10 years. However, further cases were reported in other parts of the country in the weeks that followed.
Professor Dame Jenny Harries, Chief Executive of UK Health Security Agency (UKHSA), warned that cases would rise across the country because too few children had been vaccinated.
She said: ‘Children who get measles can be very poorly and some will suffer life-changing complications. The best way for parents to protect their children from measles is the MMR vaccine. Two doses of the MMR vaccine give lifelong protection and it's never too late to catch up.
‘Immediate action is needed to boost MMR uptake across communities where vaccine uptake is low. We know from the pandemic that the communities themselves, and those providing services within them, will have the knowledge to best support local families to understand the risks of measles, to learn more about the vaccines that can protect them and to enable innovative vaccine delivery approaches.
‘We need a long-term concerted effort to protect individuals and to prevent large measles outbreaks.’
The average number of children starting school having had both MMR doses had dropped to 85%, she added, with figures in some areas down to 81% in the West Midlands, and just above 70% in the NHS Surrey Heartlands region. Birmingham children's hospital had treated more than 50 measles cases.
London has the lowest percentage of children who have received both doses of the MMR vaccine, with Hackney in east London at 56.3%, followed by Camden in north London at 63.6%. In areas such as Camden, mobile vaccination clinics are being used to try to increase uptake.
‘We are well under the recommended coverage for MMR vaccination,’ said Harries. ‘It's clearly not where we want the vaccination programme to be, we want it to be 95%.’
Measles often begins with what appears like cold-like symptoms, followed by a rash. It can lead to severe illness, with an estimated 20–40% of children hospitalised (Devlin, 2023), according to the UKHSA. It is spread through coughing and sneezing, and symptoms include watery eyes, small spots inside the mouth, a cough and a skin rash.
Complications of measles can include life-changing infections of the lungs and brain are potentially life-threatening. It can cause pneumonia, meningitis, blindness and seizures
‘The UK Health Security Agency declared a national incident in January after a sharp rise in the number of measles cases, coinciding with the lowest uptake of vaccines recorded in more than a decade and ‘well under’ the recommended coverage.’
The disease was thought to be eliminated in the UK in 2016 and 2017, with no known cases, but it surfaced again in 2018. The latest figures showed 465 known cases since October 1, 2023 (UKHSA, 2024b).
The MMR jab is given to children in two doses: the first when they are 12 months old, and a second when they are aged 3 years and 4 months. The World Health Organization recommends that at least 95% of children in a population should be inoculated for diseases that can be stopped by vaccines.
The UKSHA's campaign for increased vaccine uptake has included asking parents to check their child's immunisation history. In some regions, the reminder was included in correspondence relating to teenage immunisation programmes, urging young people to come forward to receive the MMR jab.
The UKHSA warned of a major outbreak of measles last July, after carrying out a risk assessment in London, with an anticipated tens of thousands of cases, dozens of deaths and thousands of hospitalisations. Warnings were also issued by the World Health Organisation (WHO) after a huge spike in cases in Europe. The WHO blamed falling vaccination rates, and the fact more people were travelling abroad post-COVID-19, increasing the risk of cross-border disease transmission and spread within communities.
One of the reasons for vaccine uptake varying among different communities in the UK is thought to be the use of porcine gelatine in an MMR vaccine. Since MMR vaccines are available that do not contain pork products, Harries said information needed to be disseminated with the support of trusted community leaders.
‘It's clearly important that communities have good information in a way which is meaningful for them, it's accessible to them, and that doesn't necessarily mean just a pamphlet or a translation,’ said Professor Harries.
Dr Jacqui Bradley, a Midlands-based GP, said a rise in cases had been accompanied by a local campaign to encourage parents to vaccinate.
‘We have found that when people know the dangers then they are willing to vaccinate their children, so it is not always a case of resistance to immunisation but a lack of knowledge that is holding them back,’ she said.
‘We have also noticed that some children who would have been infants during the COVID pandemic haven't been vaccinated, so there has been a lag there because vaccination services weren't always available.
‘We really need a campaign of awareness about the dangers of measles because this isn't the mild illness that people often think it is. For some children and young people, it can have far-reaching health consequences. It is not worth taking the risk, when the vaccination is quick, easy, free of charge and highly effective.’
The UKSHA also issued guidelines for health professionals in February on how to manage an outbreak of measles, how to record information and what measures to take.
‘London has the lowest percentage of children who have received both doses of the MMR vaccine, with Hackney in east London at 56.3%, followed by Camden in north London at 63.6%. In areas such as Camden, mobile vaccination clinics are being used to try to increase uptake.’