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Measles

measles rash
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. 
 
Symptoms include fever, cold-like symptoms, fatigue, conjunctivitis and a distinctive red-brown rash.
 
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.
 
Measles infection can be prevented by a highly effective and safe vaccine which is part of the measles-mump-rubella (MMR) immunisation. More information about measles is available from NHS Direct Wales On-line.
 
Take a look at our infographic 'What you need to know about measles' giving information about measles and the MMR and feel free to download and print off your own copy.
 

Who gets it and how serious is it?

Measles mainly affects young children, but can be caught at any age. Having measles once usually confers lifelong immunity to catching it again.
 
Measles can be a very serious disease and cause severe, even life-threatening, complications. In the UK, complications are quite common even in healthy people and approximately 20% of reported measles cases experience one or more complication.
 
Complications are more common among children under 5 years of age, those with weakened immune systems, children with a poor diet and adults. Catching measles in pregnancy can cause miscarriage, premature labour or a baby with a low birth weight.
 
Before the introduction of measles vaccination in 1968, around 100 children a year in England and Wales died from the disease.
 

Treatment

There is no specific treatment for measles. Treatment should be based on alleviating symptoms. As measles is caused by a virus, antibiotics are ineffective although these may be prescribed if a secondary bacterial infection develops. 
 
A doctor should be consulted if measles is suspected and anyone with measles should be closely monitored for complications. Hospital treatment may be required if serious complications develop.
 

How common is it?

Before the introduction of the first measles vaccine in 1968, there were between 160,000 and 800,000 measles notifications per year in the UK. By the mid 1980s, annual notifications had fallen to between 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 alone. A second fatality from acute measles was also reported in June 2008 in a 17 year-old youth from West Yorkshire. Over one thousand cases (1144) were confirmed during 2009 although a drop was seen during 2010 with 380 confirmed measles cases. This decrease was not sustained during 2011 during which 1086 cases of measles have been provisionally confirmed for England and Wales [ref: Health Protection Agency].
 
In Wales, there was a rapid increase in confirmed measles case during 2009. Outbreaks occurred both in Mid and West Wales and in North Wales. Cases were also reported from South East Wales. 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. During 2012 there were 116 laboratory confirmed cases of measles in Wales. 
 
From November 2012 to July 2013, Wales experienced the largest measles outbreak since the introduction of the Measles, Mumps and Rubella vaccine (MMR). Public Health Wales received 1,202 notifications from the Health Board areas of Abertawe Bro Morgannwg, Hywel Dda and Powys in South West and Mid Wales, with 88 hospital admissions and one death. 
 
A report by the agencies which responded to the outbreak can be viewed / downloaded from: Outbreak of Measles in Wales Nov 2012 – July 2013: Report of the agencies which responded to the outbreak [word icon 2013.docx, 2mb]. 
 
The Public Health Wales webpages containing information and data about the outbreak have been archived and are still available to view from http://www.wales.nhs.uk/sitesplus/888/page/66425
 
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.
 
More information about the monitoring of measles is available from the Public Health Wales Health Protection Division microsite: rates and surveillance of measles in Wales
 

Prevention

Measles can be prevented by a highly effective and safe vaccine. This is part of the measles-mumps-rubella (MMR) immunisation.
 
mmr vaccinationA complete course of the two doses will protect over 95% of children against measles, mumps and rubella. The current immunisation schedule recommends one dose to be given at around 13 months and a second dose given at between 3-5 years of age.
 
The MMR vaccine has been used for nearly 30 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. The NHS Choices website has more information about this and other vaccines.
 

Minimising impact in Wales

One important role of Public Health Wales is the collection and interpretation of data about the levels of infectious disease in the Welsh population. Key infections, including measles, are under constant surveillance, to detect significant trends, to evaluate prevention and control measures and to alert appropriate professionals and organisations to infectious disease threats.
 
The most effective method of controlling measles is by maintaining high levels of immunisation among vulnerable groups or whole populations. Public Health Wales contribute to this through the work of the Vaccine Preventable Disease Programme (VPDP) and Local Health Protection Teams (HPTs). 
 
These support WAG in setting a strategic direction for immunisation services, support LHBs in managing local services and achieving targets, and support General Practice and Trusts delivering services.
 
In addition Public Health Wales identify and follow up local cases and outbreaks of measles prevent spread of the disease amongst vulnerable people. VPDP initiates and supports interventions to increase the number of children protected against Rubella by the MMR vaccine. 
 
Currently one in eight children enter primary school not fully protected against measles (or mumps or rubella) at a time when the UK is experiencing an increasing number of measles cases. 
 
As noted above measles can lead to serious and permanent complications for those not vaccinated – the story of one mother whose daughter had measles is available on the NHS Choices website and can be viewed from the link: Rachel's Story.
 
Uptake and coverage of all recommended childhood immunisations are monitored and reported by Public Health Wales quarterly and annually at local and national levels in the COVER Reports for scheduled childhood immunisations.
 
 

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Last updated: 10 February 2014