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Measles

measles virus

General information


Measles is an acute highly infectious viral illness caught through direct contact with an infected person or through the air via droplets from coughs or sneezes. Almost all who are infected develop symptoms.
 
Boy with typical measles rash: photo courtesy of CDC400,000 children die from measles each year, the majority of which live in developing countries. It is the leading cause of blindness in African children. There number of children dying from measles has fallen over the last 10 years thanks to worldwide efforts to immunise young children.
 
Typical symptoms include fever, cough, conjunctivitis and a rash. In the UK, complications are quite common even in healthy people and approximately 20% of reported measles cases experience one or more complication.
  
Complications include ear infections, vomiting and diarrhoea, pneumonia, meningitis, encephalitis, serious eye disorders, heart and nervous system problems and a progressive and fatal brain infection called subacute sclerosing panencephalitis (SSPE) sometimes many years after the first bout of measles. Death occurs in 1 in 2500 to 1 in 5000 cases of measles.
 
Complications are more common among children under 5 years of age, those with weakened immune systems, children with a poor diet and adults.
 
There is no treatment but measles infection can be prevented by a highly effective and safe vaccine which is part of the measles-mump-rubella (MMR) immunisation.
 
Measles is one of a number of notifiable diseases in the UK. Any doctor who suspects that a patient has measles is required by law to report it.
 
General information about measles is available on the Public Health Wales main website at: http://www.wales.nhs.uk/sitesplus/888/page/43749
  
More information about measles is available from the following websites:
 

Epidemiology


Measles has been notifiable in England and Wales since 1940, and notifications varied between 160,000 and 800,000 cases per year, the peaks occurring in two-year cycles.
 
Before the introduction of measles vaccination in 1968, around 100 children a year in England and Wales died from the disease.
 
Measles notifications fell from 1968 until by the late 1980s, annual notifications had fallen to between just 50,000 and 100,000.
  
Following the introduction of MMR vaccine in October 1988 and the achievement of coverage levels in excess of 90%, notifications of measles fell progressively to the lowest levels since records began and the spread of measles was effectively halted by the mid 1990s.
 
However, 2006 saw an increase in the number of confirmed cases and the first reported death from measles in the UK for 14 years. This increase continued throughout 2007 and 2008 has seen the highest number of cases reported since the current method of monitoring the disease was introduced in 1995. During 2008, there were 1,370 cases of confirmed measles in England and Wales with 39 in Wales. A second fatality from acute measles was also reported in June 2008 in a 17 year-old youth from West Yorkshire. 
 
In Wales, there was a rapid increase in confirmed measles case during 2009. Outbreaks were reported in all three areas of Wales in this year. However, 2010 saw a marked decrease in measles in Wales with only eight confirmed cases although 19 cases were confirmed during 2011 with an outbreak reported in the Ceredigion area [see news item: Rising numbers of measles cases in Wales (27 June 2011)]. During 2012, there were 116 laboratory confirmed cases of measles in Wales. 
    
The rise in the cases of measles may be attributable to the lower uptake of the MMR vaccine in recent years in the wake of negative publicity surrounding unfounded claims of a link between MMR and autism. Numerous studies undertaken on the vaccine worldwide have provided no evidence for the supposed link and confirmed the safety of MMR. 
 
 

Measles in Wales: 1996-2012


Number of confirmed cases of measles in Wales from 1996-2012
 
        Confirmed measles in Wales 1996-2012
Source: Health Protection Agency, February 2013 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733778332 and http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211. Numbers, particularly for 2012, may rise due to the delay in receiving some reports.
 
Number of confirmed measles cases and rate per 100,000 in Wales: 1996-2012
  
Year
Number of laboratory-confirmed cases
Rate of confirmed measles per 100,000 population
1996
0
0
1997
0
0
1998
1
0.03
1999
0
0
2000
1
0.03
2001
3
0.10
2002
3
0.10
2003
44
1.50
2004
10
0.34
2005
0
0
2006
4
0.13
2007
13
0.44
2008
39
1.30
2009
159
5.30
2010
8
0.27
2011
19
0.63

2012

116

3.86

Source: Health Protection Agency, February 2013 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733778332 and http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211.
Numbers for 2012 may rise due to the delay in receiving some reports.
 
Confirmed cases of measles in Wales by age 1996-2012 
 
 
Age in years
Year
<1
01-04
05-09
10-14
15-19
20-24
25-29
30-34
>=35
Not known
Total
1996
0
0
0
0
0
0
0
0
0
0
0
1997
0
0
0
0
0
0
0
0
0
0
0
1998
0
0
0
0
0
0
0
0
1
0
1
1999
0
0
0
0
0
0
0
0
0
0
0
2000
0
0
1
0
0
0
0
0
0
0
1
2001
0
0
0
1
2
0
0
0
0
0
3
2002
1
1
1
0
0
0
0
0
0
0
3
2003
1
19
12
5
3
1
1
1
1
0
44
2004
1
4
4
0
0
0
1
0
0
0
10
2005
0
0
0
0
0
0
0
0
0
0
0
2006
0
2
1
1
0
0
0
0
0
0
4
2007
0
7
5
1
0
0
0
0
0
0
13
2008
0
7
8
11
6
4
1
2
0
0
39
2009
13
37
49
36
7
9
3
1
3
1
159
2010
0
2
3
0
0
0
0
0
2
0
8
2011
2
2
4
4
3
2
1
0
1
0
19

2012

9

15

24

38

14

2

4

4

5

1

116

Source: Health Protection Agency, February 2013 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733778332 and http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211.
Numbers for 2012 may rise due to the delay in receiving some reports.
 
Confirmed measles cases in 2009-2012 by quarter of onset
 
 

2009

2010

2011

2012

Quarter
number of confirmed cases

% of total for year 

number of confirmed cases

% of total for year 

number of confirmed cases

% of total for year 

number of confirmed cases

% of total for year 

Jan-Mar

21

13

0

0

0

0

37

32

Apr-Jun

116

73

5

63

14

74

25

22

Jul-Sep

19

12

3

37

4

21

4

3

Oct-Dec

3

2

0

0

1

5

50

43

Total

159

100

8

100

19

100

116

100

Source: Health Protection Agency, February 2013 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733778332 and http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1223019390211.
Numbers for 2012 may rise due to the delay in receiving some reports.
 
 

Sources of surveillance data for Wales


Measles is one of a number of notifiable diseases. Doctors in Wales have a statutory duty to notify a 'Proper Officer' of the Local Authority of suspected cases of measles based on clinical symptoms, usually before diagnosis has been confirmed by laboratory testing. Reported notifications of measles usually far exceed the actual numbers of confirmed cases. Other rashes are often mistaken for measles.
  
Before 2011, these data were compiled into the statutory weekly Statutory Notifications of Infectious Diseases (NOIDs) report by the Health Protection Agency (HPA) Centre for Infections in Colindale, North London. The NOIDS reports are available to download from the HPA website. Since July 2010 the proper officers in Wales are obliged to disclose notifications made to them to Public Health Wales NHS Trust instead of NOIDS although in practice, many notifications in Wales are still also passed to NOIDS for completeness.
 
Additionally, notifiable diseases rates for Wales are also compiled by our database, CoSurv. This data is used to generate the interactive information for measles on this website.
 
Salivary samples are requested from all patients in Wales (and England) with suspected measles if confirmation hasn't been obtained by other means (i.e. a hospital blood test if the patient is an in-patient). Salivary samples are sent to the HPA Centre for Infections (CfI) in Colindale for confirmation of measles infection. The HPA are responsible for collating data and reporting the numbers of confirmed cases of measles (both from salivary testing and from serum samples) for Wales and England.
  
These are the data that are used to produce the trends graph and accompanying data tables on this website.
 
It should be noted that during the measles outbreaks in 2009 in Wales virolgical confirmation through laboratory testing was not undertaken for all clinically presumed measles cases.
 
 

GP surveillance of measles in Wales 


A volunteer sample of 44 general practices in Wales (covering over 10% of the population of Wales) have reported cases of measles, mumps, rubella, shingles, chicken pox, pneumonia and influenza each week to CDSC Wales since 1986.
 
Data items are: age, sex, disease, practice, year and week. Data is analysed by time, person, place and feedback is by weekly news-sheet to participating practices and public health professionals in Wales and Europe. Rates are presented as cases per 100 000 practice population.
 
The latest GP surveillance newsletter and the GP newsletter archive can be viewed from the link: GP Surveillance Newsletter
 
 

Immunisation against measles


Measles can be prevented by a highly effective and safe vaccine. This is part of the measles-mumps-Child receiving the MMR vaccination to protect against measles, mumps and rubellarubella (MMR) immunisation with a first dose at around 13 months and a second dose (booster) around three and a half years. Young adults and teenagers who have missed out on MMR vaccination as children are also encouraged to get immunised.

The uptake of MMR (and other childhood) vaccination in Wales is recorded in the COVER (Coverage of Vaccination Evaluation Rapidly) report. This is published on both a quarterly and annual basis.  Use the link below to access all COVER reports from 2003-2011.
A complete course of the two doses will protect over 95% of children against measles, mumps and rubella.
 
The MMR vaccine has been used for nearly 40 years (it was introduced in the US in the 1970s), is currently used in over 100 countries, and more than 500 million doses have been given. Studies from around the world have shown MMR to be a highly effective vaccine, with an excellent safety record.
  
More information about the MMR vaccine is available from the NHS Choices website: http://www.nhs.uk/Conditions/MMR/Pages/Introduction.aspx
 
 

Requests for further surveillance data


If further surveillance data for measles in Wales is required, it may be possible to provide it on special request. Please use the surveillance data request form provided from this link.
 
 

Links to other measles surveillance


 


Last updated: 09/04/2013