1st November 2023
Yesterday, the UK Health Security Agency (UKHSA) issued an urgent letter regarding preparing for measles resurgence in England. Tackling this issue will require a whole system approach and health visitors have an important role to play.
The UKHSA recent measles risk assessment concluded that although the risk of a UK-wide measles epidemic is considered low, a measles outbreak of between 40,000 and 160,000 cases could occur in London, due to sub-optimal uptake of the Measles Mumps and Rubella (MMR) vaccine in the capital. Evidence also shows that, outside of London, there is a high risk of cases linked to overseas travel leading to outbreaks in specific population groups. There has been a steady rise in measles cases this year.
Health visitors can play a crucial role in increasing uptake of the MMR immunisation programme to meet the WHO target of 95% coverage with two doses of MMR vaccine by age 5 years. Achieving this target is essential to maintain measles elimination status for the UK and prevent measles outbreaks from occurring. This is a NHS Long-Term Plan (LTP) commitment and high priority within NHS England.
Raising awareness of the complications of measles and enabling access to immunisations will be important parts of the solution.
- Measles is highly infectious and can lead to serious complications, particularly in immunosuppressed individuals and young infants.
- It is also more severe in pregnancy, and increases the risk of miscarriage, stillbirth, or preterm birth.
Individuals with suspected or known measles:
- should be isolated immediately on arrival when attending health care settings to reduce the risk of other patients being exposed
- all suspected measles cases should be promptly notified by phone to the local Health Protection Team (HPT) to facilitate timely public health action.
- all healthcare workers should have satisfactory evidence of protection against measles to protect both themselves and their patients. Satisfactory evidence of protection includes documentation of having received two or more doses of a measles containing vaccine and/or a positive measles IgG antibody test. Occupational Health service should have ready access to up-to-date records to support outbreak response.
- children should receive their two doses of MMR vaccine on time at 12 months, and 3 years and 4 months.
- the MMR vaccine can be given from six months of age before travel to a high-risk country.
- patients over the age of three years and four months who do not have two recorded doses of MMR vaccine should be caught up opportunistically. There is no upper age limit to offering MMR vaccine.
- new entrants from abroad and newly registered patients should have their immunisation history checked and missing doses caught up.
- unvaccinated postnatal women should be offered any outstanding doses.
Health professionals who work with under-vaccinated communities should collaborate with local partners to raise awareness about measles with those most at risk and ensure unregistered populations can access immunisation services.
Resources including national guidelines for health professionals and free to order posters and leaflets for patients are listed in the appendix section in the full letter here.
Please also see:
- GPP – Promoting the Uptake of Childhood Immunisations
- PT – Childhood Immunisations Part 1: An introduction to childhood immunisations
- PT – Childhood Immunisations Part 2: Frequently asked questions
- RSPH toolkit – Gaining assurance of immunisation services to improve coverage rates and reduce inequalities in access and uptake: a toolkit for local systems
- Voices Blog – A Whole-system Approach to Vaccinations Must Involve Health Visitors