Tags: measles

iHV and Barnardo’s launch new MMR vaccination film #WorldImmunizationWeek

As highlighted by Professor Helen Bedford in the February 2024 iHV podcast “Stemming the measles surge”, measles is on the rise in the UK, with 6/10 of the confirmed cases in the under 10s in England1.

At the same time, rates of MMR vaccination continue to decline2, this can be seen in the graph below, which highlights the recovery in MMR vaccination uptake, following the discrediting of the Wakefield study. However, from 2019/20 the rates start to fall again. In 2022/23, for the uptake of both doses, this had fallen to 84.5% in England, 89.5% in Wales, 90.2% in Scotland and 87.9% Northern Ireland, all of which are below the World Health Organization (WHO) target of 95%2.

There are a number of reasons why parents choose not to have their children fully vaccinated against MMR. In some cases, there is a lack of awareness of the potential severity of measles, mumps and rubella if contracted. For some parents, vaccination appointments are delivered in locations that are not easily accessible for them, with limited choice or flexibility around timings to make sure that they are available at convenient times for busy families. Some parents may also be anxious about the MMR vaccine and its side effects.

It is therefore important that all families have access to accurate information and opportunities to have their questions answered by trusted health professionals.

New Video

iHV and Barnardo’s have worked together to develop a film for families about the MMR vaccination to improve vaccine uptake. It features a real-life couple, Radhika and Manish, discussing their decision to get their son, Kabeer, vaccinated and their experience of the process. They share their initial challenges finding trusted information online, and the importance of vaccination, not only for their own child but for vulnerable family and friends at greater risk of serious complications linked to these diseases. They also strongly advise parents who may have doubts about the MMR vaccine to talk to a health professional, such as their health visitor or GP, who can provide trusted and evidence-based advice. A lovely moment in the video is hearing them describe how proud their son Kabeer was of his vaccination certificate, as he showed it to his friends at nursery.

The video is freely available on the link below, so please share with families and on your social media.

Watch iHV and Barnardo's short video on the importance of MMR vaccinations

Health visitors’ vital role

When discussing the MMR vaccination with families, as well as encouraging them to have their child/ren vaccinated, it is important to remind them that:

  • Unvaccinated children are at high risk of contracting measles, mumps and rubella – these are all potentially serious diseases that can cause significant health problems.
  • Measles can lead to pneumonia, meningitis, blindness and seizures in children; and miscarriage, stillbirth, premature birth or a baby born with a low birthweight in those who are pregnant3.
  • Mumps can cause viral meningitis, although serious complications are thankfully rare4.
  • And while rubella is rare in pregnancy, it can cause miscarriage and serious problems in the baby including with their sight, hearing, heart or brain5.
  • There is a measles surge in the UK now – it is never too late to get their child vaccinated to protect them and the wider community.

Health visitors and the wider skill-mix team have a vital role to play in improving vaccine uptake. Please use every opportunity to support families to check their child’s vaccine status, answer any questions that they might have with accurate information, and connect families to their GP, or local vaccine initiatives in your area, to promote vaccine uptake.

RCPCH resources

The Royal College of Paediatric and Child Health has some great resources about measles which you can access here.

References
  1. UKHSA (2024) News story Latest measles statistics published.
    https://www.gov.uk/government/news/latest-measles-statistics-published 
  2. Harker, R. (2024) Childhood Immunisation Statistic. House of Commons Library. Number 8556. https://researchbriefings.files.parliament.uk/documents/CBP-8556/CBP-8556.pdf
  3. NHS (2022) Measles.
    https://www.nhs.uk/conditions/measles/
  4. NHS (2021) Mumps.
    https://www.nhs.uk/conditions/mumps/
  5. NHS (2022) Rubella (german measles).
    https://www.nhs.uk/conditions/rubella/

Preparing for measles resurgence in England

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.

Key messages:

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.

MMR vaccine:

  • 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.

Under-vaccinated communities:

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.

Read Measles resurgence letter for professional organisations

Please also see:

Starting school: Is your child fully vaccinated?

As the new school year starts, with children about to start school for the first time, many parents will have a list of things needed for the big day: haircut, new shoes, school bag, etc. This is an exciting time for families. One important thing for the list is whether their child needs any vaccines. As children starting school will be mixing in larger numbers, the risk of catching infections increases.

Fortunately, although unpleasant, most of these such as cough and colds will be mild even if they are frequent! However, where numbers of unvaccinated children gather, there is also a risk of outbreaks of more serious infections.

Measles is top of the list of potentially serious infections where outbreaks are likely. This is because it is so highly infectious – considered the most infectious – and, to prevent outbreaks, very high uptake (95%) of two doses of measles, mumps, rubella (MMR) vaccine are needed. Unfortunately, this target vaccine uptake has never been met in the UK and current MMR vaccine uptake is the lowest for a decade: 2 in every 10 children in England have not had two doses of vaccine. In London, this figure is as high as ¼ of 5-year-olds entering school, while in some parts of the capital as many as a half of children are not fully vaccinated (NHS Digital 2023).

The situation is such in London that UKHSA has advised that, based on current vaccine uptake, there is the potential for an outbreak of between 40,000 and 160,000 cases (UKHSA 2023). These numbers make it inevitable that there would be many hospital admissions for measles, with complications such as pneumonia and encephalitis as well as deaths. Although large outbreaks are less likely in the country as a whole, there is this possibility where there are pockets of susceptible children, young people and adults.

So, what can be done? Fortunately, we have the means to prevent measles outbreaks through MMR vaccination. It is easy to check children’s vaccination status, by either looking at their red book or, if not available, checking with the GP surgery. Where vaccines are missing, they can be caught up at the GP surgery. Even though vaccines may have been missed at younger ages, for most there is no upper age limit, they can be caught up at any age. This does not require starting the course all over again – they just need the missing vaccines. Older children and young adults are also recommended to have had two doses of MMR vaccine, particularly those who are starting university in the next few months. This is particularly important as many young people missed out on their vaccines when they were young, and we have seen many cases of measles in recent outbreaks in this age group when disease is often more severe.

Don’t forget to also remind parents about the pre-school-booster vaccine. Usually offered at 3 years 4 months along with the second dose of MMR vaccine. This boosts immunity to diphtheria, tetanus, whooping cough and polio through the early school years and is an important part of the vaccine schedule.

Professor Helen Bedford – Professor of Children’s Health, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health

References

Also see:

Parent Tips

  • PT – Childhood Immunisations Part 1: An introduction to childhood immunisations
    This Parent Tip provides some useful information on the childhood vaccination programme, explaining how vaccines work, how they are regulated and why it is important to ensure that your baby receives all the recommended immunisations.
  • PT – Childhood Immunisations Part 2: Frequently asked questions
    It is natural to have questions about your baby’s immunisations. This second part of our Parent Tip series on immunisations provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers FAQs on getting your baby immunised and what to expect, including information on things such as soothing your baby during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Good Practice Points

  • GPP – Promoting the Uptake of Childhood Immunisations
    The immunisation programme in the United Kingdom (UK) is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information.

iHV supports call for children’s immunisations to be up to date

New campaign warns parents and guardians of serious risk to children’s health from measles and reminds them to ensure their children are protected by taking up two doses of MMR vaccine.

 

The Institute of Health Visiting supports the call by the UK Health Security Agency (UKHSA) and the NHS for parents and guardians to ensure that their children are up to date with the measles, mumps and rubella (MMR) vaccine, and all other routine childhood immunisations, as the latest data shows MMR vaccination uptake has dropped to the lowest level in a decade.

In a new campaign drive, parents and guardians are being reminded that, during the pandemic, the NHS has continued to provide routine childhood immunisations and they are crucial in protecting children against preventable diseases.

Since the start of the COVID-19 pandemic, in March 2020, there has been a significant drop in the numbers getting their children vaccinated against MMR and other childhood vaccines at the right time.

Coverage for the two doses of MMR vaccine in five year olds in England is currently 85.5%, well below the 95% World Health Organisation’s target needed to achieve and sustain measles elimination. Coverage of the first dose of the MMR vaccine in 2 year olds has dropped below 90%. This means that more than 1 in 10 children under the age of 5 are not fully protected from measles and are at risk of catching it.

Alison Morton, Executive Director at the Institute of Health Visiting, said:

“It is very worrying that more than 1 in 10 five-year-olds are not fully protected against measles. Measles is highly infectious (much more than COVID) and can make children very ill indeed. During the pandemic, the measures we have all taken to protect ourselves and our communities from infection resulted in a reduction in measles. However, this does not mean it has disappeared. Measles is waiting in the wings and it only takes a small fall in vaccine uptake for us to start having outbreaks. Fortunately, it is never too late to have the MMR vaccine, two doses are needed to give best protection. The vaccine is also very safe.

“Parents can check their child’s red book to see if they have had their two doses. If they have not, or it is not clear, parents should contact their GP practice and book an appointment. Combatting measles will take a whole system approach and health visitors are ideally placed to support parents to access the vaccine for their child, and also answer their questions if they are unsure or have concerns.”

Measles is highly contagious, so even a small decline in MMR uptake can lead to a rise in cases. As international travel resumes, it is more likely that measles will be brought in from countries that have higher levels of the disease and so it is important that we recover MMR vaccination rates to help prevent a rise in cases.

Measles can lead to complications such as ear infections, pneumonia, and inflammation of the brain which require hospitalisation and on rare occasions can lead to long term disability or death. Since the introduction of the measles vaccine in 1968 it is estimated that 20 million measles cases and 4,500 deaths have been prevented in the UK.

New research commissioned by the Department of Health and Social Care and the UKHSA, conducted by Censuswide, shows that many parents are not aware of the risks that measles poses to their unvaccinated children.

Out of 2,000 parents and guardians of children aged five and under:

  •  Almost half (48%) are not aware that measles can lead to serious complications such as pneumonia and brain inflammation
  • Only 4 in 10 (38%) are aware measles can be fatal
  • More than half of parents (56%) are not aware that two doses of the MMR vaccine gives 99% protection against measles and rubella

Children are offered two doses of the MMR vaccine by their registered GP surgery – the first when they turn 1-year old and the second at around 3 years and 4 months, before they start nursery or school. The NHS has continued to prioritise routine vaccinations throughout the pandemic, however some parents who haven’t had their child vaccinated against MMR said this was because they didn’t realise the NHS was still offering appointments, or they didn’t want to burden the NHS.

Go to NHS website to find out more about the MMR vaccine

Read full UKHSA/NHS news story

 

MMR vaccination call following high numbers of measles cases

Public Health England (PHE) is calling for all parents to get their children vaccinated against measles, mumps and rubella (MMR) when the vaccine is offered, or for them to take it up now if they didn’t have it at the scheduled time.

In the first quarter of 2019, there were 231 confirmed cases of measles. This figure is slightly lower compared to the same quarter last year. As measles is highly infectious, anyone who has not received two doses of MMR vaccine is at risk, particularly unvaccinated people travelling to countries where there are currently large outbreaks of measles. The recent measles cases are mainly occurring in under-vaccinated communities, particularly those with links to other countries with ongoing measles outbreaks. There has also been some spread into the wider population, such as those who may have missed out on the MMR vaccine when they were younger.

In the final quarter of 2018 94.9% of eligible children aged five received the first dose of MMR. To achieve herd immunity for measles at least 90-95% of the population need to be fully protected. One dose of the MMR vaccine is about 90-95% effective at preventing measles. After a second dose the level of protection is around 99%. Coverage of the second dose is at 87.4% for children aged five. PHE is therefore urging those who have only had one dose to ensure they are fully vaccinated with two doses.

This quarter, 795 cases of mumps have also been confirmed. No new cases of rubella were reported.

The MMR vaccine is given on the NHS as a single injection to babies as part of their routine vaccination schedule, usually within a month of their first birthday. A second injection of the vaccine is given just before starting school, usually at 3 years and 4 months. The vaccine is also available to all adults and children who are not up to date with their two doses. Anyone who is not sure if they are fully vaccinated should check with their GP and those planning to travel to Europe should check NaTHNaC travel health advice.

Outbreaks of measles

Public Health England (PHE) has issued a press release highlighting recent measles outbreaks that are linked to ongoing large outbreaks in Europe, with Romania, Italy and Germany being the worst affected countries.

PHE calls on anyone travelling to Romania, Italy and Germany this Christmas to ensure they are up to date with their MMR jab

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 delivery.

Members of the Romanian community and unimmunised individuals travelling to Romania, Italy and Germany are at particularly high risk of acquiring measles. Experience from recent outbreaks shows that, despite living in the UK for a number of years, many individuals infected with measles were unvaccinated, and that families are often not registered with a GP practice.

PHE is asking health professionals to note the following:
Individuals with suspected or known measles:

  • should be isolated immediately when attending health care settings to reduce the risk of other patients being exposed
  • recent travel to countries with ongoing measles outbreaks like Romania, Italy and Germany increases the likelihood of a measles diagnosis
  • all suspected measles cases should be promptly notified by phone to the local Health Protection Team (HPT) to facilitate timely public health action

MMR vaccine:

  • children should receive their two scheduled doses of MMR vaccine on time at the ages of 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
  • postnatal women should have their MMR status checked and offered any outstanding doses
  • all health professionals should make sure they are fully protected against measles, mumps and rubella

Under-vaccinated communities:
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.

Measles resources

Measles resources including national guidelines for health professionals and free to order posters and leaflets for patients are :

National guidelines

Free copies of PHE leaflets and posters can be ordered through the Health and Social Care Orderline: https://www.orderline.dh.gov.uk/ecom_dh/public/contact.jsf Alternatively, you can call 0300 123 1003.

Please share PHE measles outbreaks letter

PHE: Measles outbreak awareness resources

Public Health England has recently published new posters and leaflets for use by health professionals and community engagement groups to raise awareness of measles.

Posters and leaflets includes information on vaccination and symptoms of measles. These are available for download only from Gov.uk.

Go to Gov.uk to download posters and leaflets

New Measles and MMR resources

Public Health England has recently published new posters and leaflets designed to raise awareness of measles in young people and healthcare workers. The attached document outlines each of the three resources.

New Measles and MMR resources

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