January 22, 2024

expert reaction to measles cases in West Midlands

Scientists react to reports of measles cases in the West Midlands.

Professor Mike Tildesley, Professor of Infectious Disease Modelling at The University of Warwick, said:

“The measure for how infectious a disease is, known as R0, for measles is higher than 10 – whereas COVID (dependent upon the variant) was much lower, around less than 5.

“This means we need over 90% of the population to be immune or you’re going to start seeing cases growing. We have childhood vaccinations for measles which for many years have helped us to get rid of the disease.

“Unfortunately, if those vaccination levels drop then we will start to see cases going up. That’s what we are seeing at the moment – according to NHS data around 85% of children received their second MMR jab at 5 for 2022/23, which is much lower than it needs to be and this is quite variable across different parts of the country, with lower rates in some places, which is a worry.”

Comments sent out on Friday 19 January 2024:

Dr Mariam Molokhia, Clinical Reader in Epidemiology & Primary Care at King’s College London, said:

“Measles is a potentially serious but preventable disease and we are seeing surges in disease outbreaks where the MMR uptake may be low – the factors for this are likely to be multifactorial.

“The Department of Health guidance states that MMR vaccines are offered routinely to eligible children via their GP surgery, and all children aged one year to three years and four months should be offered the vaccine as part of their routine vaccinations.  Older children and adults should contact their GP practice if they have had one or no doses of the vaccine.  Pregnant women can have the vaccine at their GP surgery after their baby is born if they don’t have two documented doses.  Some adolescents and young adults are offered their missing doses of MMR vaccine with their other teenage booster vaccines.”

Prof Stuart Neil, Professor of Virology, and Head of Department of Infectious Diseases, King’s College London, said:

What is the current situation – what do we know from data and evidence?

“At the moment there have been over 200 reported measles cases as notified to UKHSA, mostly children in the West Midlands, which is much higher than we would expect.  This will include sustained transmission in multiple areas so this could well be a considerable underestimate.  This will mean we will see a lot more cases.

How worrying is the situation?

“This is very worrying.  Measles is a nasty disease.  It causes a profound suppression of the immune system during infection that can lead to serious consequences.  Measles infection can lead to permanent physical damage such as deafness, and in rare cases, lethal damage to the nervous system and brain.  It is a leading cause of infection-related disability and death in children.

“Measles is highly infectious.  While we have a very good protective vaccine, the MMR, a child needs two doses (at ages one and three).  Because it is so infectious, vaccine coverage needs to be 95%.  In the areas reported, it has dropped to 85% and in parts of London coverage is as low as 50% in young children.  This means there is no herd immunity sufficient to prevent significant measles outbreaks.

Do we know why this outbreak has happened?

“Unfortunately, this is because vaccine uptake has been too low in at-risk populations.

Are MMR vaccination levels low, and if so do we know why or is it complicated?

“It is complicated.  Vaccine uptake has fallen across the board over the pandemic partly because of hesitancy to go to the doctors during it.  This hesitancy has been fuelled in recent years by fabricated disinformation, falsely linking MMR to autism, as well as misrepresentation of the COVID vaccine data by high profile figures, which has contributed to poor MMR uptake in at-risk groups.”

Prof Sir Andrew Pollard, Ashall Professor of Infection and Immunity, Director of the Oxford Vaccine Group, Department of Paediatrics and Pandemic Sciences Institute, University of Oxford, said:

“The situation is very worrying indeed.  Many children are at risk because vaccination rates have fallen in London and in pockets across the country.  The mortality rate is from 1 in 3000 to 1 in 5000 in high income countries but much higher in low income countries.  The clock is ticking to get children who have missed doses vaccinated before this virus kills.”

Dr Ronny Cheung, RCPCH Officer for Health Services, said

“It is worrying but not all that surprising to see another measles outbreak within the UK.  The fact remains that vaccination coverage for children under the age of 5 is now the lowest it has ever been in the past 10 years and outbreaks for diseases like measles are now more likely than ever.

“Measles is a unique challenge to child health services due to its highly contagious and dangerous nature.  Measles is much more contagious than COVID-19.  Outbreaks during winter are especially difficult, as the health service is already struggling with high surges in RSV and influenza, as well as circulating Covid-19 and Group A Strep.  We simply cannot afford to add another infection to the mix.

“NHS England recently published its vaccination strategy, which focuses on addressing challenges around accessibility and includes proposals to provide flexible and convenient vaccination services.  This is an extremely welcome development but we are concerned that implementation plans for this strategy are not nearly as ambitious as we need them to be.  The current aim is full implementation by 2025/26.  Two years seems an unacceptably long wait.  We’re already arriving late to this work and are feeling the effects of low uptake, particularly in the MMR vaccine.  This is urgent – we must get to work straight away.”

Prof Helen Bedford, Professor of Children’s Health, UCL Great Ormond Street Institute of Child Health, said:

“I am very concerned about the recent increases in measles cases.  Measles is a nasty disease with serious complications and can kill even in a high income country.  Unfortunately, this increase in cases was predictable and is due to less than optimum vaccine uptake for many years.  It is particularly challenging keeping measles at bay because it is so highly infectious.  To do this requires a sustained uptake of 95% of two doses of MMR vaccine.  Even a small decline in uptake increases the risk of having outbreaks.

“Over 25 years ago, MMR vaccine uptake fell because of highly publicised but subsequently discredited research suggesting a link with autism.  Unsurprisingly, given the intense media coverage at the time, many parents preferred not to have their children vaccinated.  Those children are now young adults.

“Over the years, the number of unvaccinated people has accumulated in the population, enabling measles to take hold and spread quickly within communities.  We have also seen a small decline in vaccine uptake year on year for the past 10 years and now have the lowest uptake of MMR vaccine for a decade.  These declines in uptake were exacerbated during the pandemic for a variety of reasons with some parents afraid to attend clinics for fear of catching covid¹ or because they were not clear that routine vaccination services were continuing.

“It is too easy to blame anti-vaccine sentiment for the measles outbreaks.  Although some mistrust of vaccines may play a small part, research shows that parental vaccine confidence remains high.  While we need to be aware of anti-vaccine sentiment, it is not by any means the whole story.  However, the pandemic, with new vaccines introduced and vaccination constantly discussed, may have resulted in the public having more questions about vaccination: its safety, effectiveness and, for a disease like measles which had become rare in the UK, its necessity.  Asking questions about vaccination is to be encouraged, but we need trained staff to do this, and the NHS and General Practice are under significant pressures, with cuts to funding and staffing.  Despite these pressures it is vital that parents and/or young people seek answers to their questions.  Vaccination has an excellent safety record and is the only effective means of preventing the serious consequences of measles infection.”

1 Bell, S., Clarke, R., Paterson, P. and Mounier-Jack, S., 2020. Parents’ and guardians’ views and experiences of accessing routine childhood vaccinations during the coronavirus (COVID-19) pandemic: A mixed methods study in England. PloS one, 15(12), p.e0244049.

Comments sent out on Tuesday 16 January 2024:

Dr David Elliman, Community Paediatrician, Great Ormond Street Hospital, said:

“In the first 11 months of 2023, there were 209 laboratory confirmed cases of measles.  This is not a surprise.  Last year UKHSA predicted there would be tens of thousands of cases or even more if no action was taken.  In London, because of the low uptake of vaccine, it was predicted that there could be between 40,000 and 160,000 cases.  As between 1 in 1,000 to 1 in 5,000 people getting measles will die, we could see dozens of deaths from an easily preventable disease.  On top of this would be many more hospital admissions, as we have sadly seen in the Midlands, and people left with long term problems.

“Blaming the low levels of vaccination on so-called anti-vaxers is lazy and dangerous, because it diverts attention from more important issues.

“The first priority should be to ensure that parents know when their child should be immunised and make it easy for it to be done.  There is no upper age limit for administration of the vaccine.  The second dose can be given any time from 18 months onwards.  It will be routine to do so from next year and is already done so in some parts of South London.

“Second should be to recognise that parents understandably have questions about vaccinations, possibly more since COVID.  Most, given time to talk to a trusted healthcare professional such as their practice nurse, health visitor or GP, will be reassured.  This does take time, but is frequently well rewarded.

“There are very few parents who do not want their children immunised.  Although we may disagree with them, and I do profoundly, using pejorative terms is not appropriate.

“Due to the success of the UK immunisation programme, many parents will have no first-hand experience of measles, let alone severe measles.  This means that for most people measles is something you read about.  It would be a great tragedy if we have to learn from the sad deaths of children, before the disease is taken seriously.  We can prevent that, but we have to recognise it could mean more work by already hard pressed healthcare workers.  However, it will save work and lives in the near future.”

Dr Doug Brown, Chief Executive, British Society for Immunology, said:

“Measles is a highly infectious disease and cases are currently on the rise in England due to vaccination rates not being high enough to stop its spread.  The Childhood Vaccination Coverage Statistics for England in 2022-23 showed that only 84.5% of children receive the second MMR vaccine dose by age 5 – well below the 95% level recommended by the World Health Organization (WHO).  Lower levels of vaccination mean that harmful diseases can spread within our communities, infecting people who have not been vaccinated, including vulnerable individuals who are unable to have vaccinations.  The best possible protection available against this serious illness is vaccination and it is never too late to get vaccinated.  We encourage parents to ensure their children are up to date with their MMR vaccines and catch up on any missed ones as soon as possible.  The recently published NHS Vaccination Strategy has strong ambitions for building up community vaccination services that will be important in tackling low vaccination rates and we call for its urgent implementation to help to stop measles outbreaks and protect our communities.”

Prof Helen Bedford, Professor of Children’s Health, UCL Great Ormond Street Institute of Child Health, said:

“Measles is a potentially very serious infection.  At best measles makes people feel very ill with a high temperature, sore eyes, a cough and a rash.  However, it also can lead to complications including ear infections, pneumonia and fits.  About 1 in 1000 people with measles develop inflammation of the brain (encephalitis) and even in high income countries like the UK, about 1 in 5000 die from the infection.  Measles is often more severe in adults.  Apart from managing the symptoms of measles, there is no treatment.

“We are hearing that there is currently an increase in cases of measles particularly in the West Midlands.  These are spreading fast because measles is highly infectious.  Unfortunately, this is no surprise as over the years large numbers of individuals have accumulated in the population who have no immunity because they have not been vaccinated.  Two doses of MMR vaccine are needed for best protection against measles and over the age of 18 months, a gap of only 4 weeks is needed between doses.  There is no upper age limit for vaccination so if you or your loved ones have missed out, now is the time to get that protection.  We can stop this infection in its tracks with vaccination.”

Declared interests

Prof Mike Tildesley: “None.”

Dr Mariam Molokhia: “Dr Molokhia works as a GP and researcher at King’s and has published widely on medicine prescribing. She has received funding from the Department of Health and Pharma for drug safety studies.”

Prof Stuart Neil: “No conflicts of interest.”

Dr Ronny Cheung: “Ronny has received honorarium from Pfizer to attend an expert panel on their maternal RSV vaccine. Nothing else, and definitely nothing on measles or MMR.”

Prof Sir Andrew Pollard: “Director of the Oxford Vaccine Group at Oxford university and chair of the Joint Committee on Vaccines and Immmunisation.”

Dr David Elliman: “I have no conflicts of interest to declare.”

Dr Doug Brown: “Dr Doug Brown is a Trustee of the Association of Medical Research Charities.”

Prof Helen Bedford: “No conflicts of interest.”

For all other experts, no reply to our request for DOIs was received.