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Nearly 45-fold increase in measles cases in Europe last year

The World Health Organization has called for urgent vaccination efforts to prevent further spread of measles after announcing an “alarming” 30-fold rise in cases across Europe.

The World Health Organization has called for urgent vaccination efforts to prevent the further spread of measles after an “alarming” rise in cases across Europe.

The outbreak is attributed largely to an accumulation of susceptible children who missed routine immunisation doses during the Covid-19 pandemic. Some 42,200 people were infected in 2023, compared to 941 during the whole of 2022.

Last week, the UK Health Security Agency (UKHSA) declared a national incident, signalling a growing public health risk, after an outbreak in Birmingham. It said that further outbreaks of measles will spread to other towns and cities unless urgent action is taken to increase Measles, Mumps and Rubella (MMR) vaccination uptake in areas at greatest risk.

As of 18 January, there have been 216 confirmed cases and 103 probable cases in the West Midlands since 1 October 2023. Around 80% of cases have been seen in Birmingham, with about 10% in Coventry, the majority being in children aged under 10 years.

Professor Dame Jenny Harries, Chief Executive of UKHSA, said: “Colleagues across the West Midlands have worked tirelessly to try to control the outbreak, but with vaccine uptake in some communities so low, there is now a very real risk of seeing the virus spread in other towns and cities.

“Immediate action is needed to boost MMR uptake across communities where vaccine uptake is low. We know from the pandemic that the communities themselves, and those providing services within them, will have the knowledge to best support local families to understand the risks of measles, to learn more about the vaccines that can protect them and to enable innovative vaccine delivery approaches. We need a long-term concerted effort to protect individuals and to prevent large measles outbreaks.”

Why should we be worried about a measles outbreak?

Measles spreads very easily among those who are unvaccinated, especially in nurseries and schools. It can be a very unpleasant illness and in some children can be very serious, leading to hospitalisation and tragically even death in rare cases. People in certain at-risk groups including babies and young children, pregnant women, and people with weakened immunity, are at increased risk of complications from measles.

Over 99% of those who have 2 doses of the MMR vaccine will be protected against measles and rubella. The vaccine also provides protection against mumps, which can be very painful with complications including inflammation of the ovaries and testicles, and in rare cases, the pancreas. Although mumps protection is slightly lower, cases in vaccinated people are much less severe, highlighting the importance of the MMR vaccination.

Dr Hans Henri P. Kluge, WHO Regional Director for Europe, added:  “Measles is highly infectious, but fortunately, can be effectively prevented through vaccination. WHO will continue to support the current outbreak response as well as long-term strengthening of the immunization programme to prevent future outbreaks.”

Updated guidance for clinicians

The UKHSA has updated its measles guidance and says that clinicians are required to notify all suspected measles cases as soon as possible to their local health protection team (HPT), both as part of surveillance and so that timely public health management can be undertaken.

Vulnerable contacts (such as immunosuppressed individuals, young infants and pregnant women) should be considered for post-exposure prophylaxis (PEP) to reduce the risk of complications where possible. Where there are large numbers of cases and contacts, the priority for public health action is to identify and assess the risk to immunosuppressed individuals, even after limited exposure or when exposed to cases of breakthrough measles.

For immunocompetent vulnerable individuals, local HPTs should prioritise contact tracing efforts to those most likely to have had close prolonged exposure.

Individuals in this group (immunocompetent, vulnerable individuals, for example, pregnant women) do not need to be identified and risk assessed if the index case is a presumed breakthrough measles.

It adds that susceptible healthy contacts, including unimmunised children and adults,are unlikely to benefit from post-exposure vaccination, unless offered rapidly following exposure. Healthy contacts who work with vulnerable individuals, in particular health care workers, can be a source of transmission and need urgent assessment and possible exclusion from work.

Vaccination of unimmunised contacts should confer benefit against future exposures and will also provide protection against mumps and rubella infections. In outbreak settings, such as schools, mass vaccination of susceptible individuals should be considered to prevent tertiary transmission.

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