Measles cases are on the rise and, thanks to an immunisation gap and large scale public events such as music festivals, the disease no longer just affects children

The number of people affected by measles is on the rise, and although usually considered to be a childhood illness, measles is affecting people of all ages.

According to Public Health England (PHE), a significant number of cases, linked to music festivals and other large scale public events, have occurred in teenagers and young people since June 2016. This follows an increase in measles over the last year, with 234 cases confirmed between January and June, compared with 54 for the same period in 2015. So what iscausing this rise and what can be done to stop the spread?

Immunisation gap

Measles used to cause millions of deaths each year in the UK, but it isn’t as common as it once was because most people are now vaccinated. The measles, mumps and rubella (MMR) vaccine is routinely offered in England as part of the NHS Childhood Immunisation Programme to babies at around 12 months old. A second dose is offered at around three years and four months of age. Uptake is high – more than 90 per cent receive one dose by the age of two and nearly 95 per cent by five years (the World Health Organization’s target). The percentage of children having the second dose by five years is 88.3 per cent.

The uptake in Wales, Scotland and Northern Ireland reaches the WHO’s 95 per cent target for two year olds.

Although vaccination rates are high, they dropped sharply in the wake of now-discredited claims of links with autism in 1998. Some children had single jabs, which don’t seem to be as effective, while others had none, and it’s taken around a decade for rates to recover. Children who missed their MMRjab at this time are extremely vulnerable to infection.

In 2013, the MMR catch-up programme targeted 10-16 year olds who were unimmunised or partially immunised, but some children in this age group stillhaven’t had one or both of the vaccinations. In April 2016, PHE called for all parents to get their children vaccinated, or for them to take it up as soon as possible if they hadn’t had it at the scheduled time. And in August 2016, PHE reminded young people again to make sure they are vaccinated.

There are around 24,000 children in England each year (2,000 a month) who are not receiving the vaccination from 12 months and who remain susceptible to the diseases that the vaccine protects against.

“Coverage of MMR is now at historically high levels, but measles is highly infectious and can spread easily among communities that are poorly vaccinated,” says Dr Mary Ramsay, head of immunisation at the Health Protection Agency. “It can affect anyone who is susceptible, including toddlers in whom vaccination has been delayed. Older children who were not vaccinated at the routine age, who may now be teenagers, are at particular risk of becoming exposed.”

Rapid spread

Measles spreads easily through coughs and sneezes. It has a long incubation period and isn’t always diagnosed straight away, which gives it plenty of opportunity to spread, especially at public events. PHE data reveals that 38 suspected measles cases were reported in young people who attended events in June and July 2016.

According to Dr Andrew Raffles, consultant paediatrician at The Portland Hospital for Women and Children, the measles virus can remain active and contagious for up to two hours in the air and on surfaces. “After exposure, the incubation period lasts seven to 14 days,” he says. “Patients then develop a high fever with cough, stuffy and runny nose, sneezing and conjunctivitis. A red, flat rash, which usually starts on the face and then spreads to the rest of the body, typically begins three to five days after the start of symptoms. After a few days, spots can develop on the lining of the mouth – called Koplik’s spots – and the presence of these helps to make the diagnosis.”

There’s usually no treatment for measles, other than oral rehydration, healthy food and medicine to lower a fever. In healthy children, measles is rarely serious, but it can lead to severe complications, especially in young people and adults.

Preventative measures

The most effective way to avoid measles is to have the vaccination. Concerned customers should check with their GP that they have received two doses of the MMR vaccine and should also be aware of the symptoms. NHS Choices recommends that infected people should avoid work or school for at least four days from when they first develop the measles rash – this applies to attending public events as well.

“The cases we have seen recently have been confirmed mainly in adolescents and young adults,” says Dr Kevin Brown, deputy director of the Virus Reference Department at PHE. “It’s important to be aware that it’s never too late to have the vaccine.”

If someone has not received two doses of the vaccine in the past – or they’re unsure – their should speak to their GP. “There’s no harm in receiving an additional dose where there is uncertainty,” says Dr Brown, who advocates remaining alert to symptoms of the disease. These include cold-like symptoms, sore red eyes, a high temperature or a red-brown, blotchy rash. Customers who experience these symptoms should seek medical attention, but must phone ahead before they visit their GP surgery so that arrangements can be made to prevent others from being infected.

Anyone who has been in close contact with someone who has measles and hasn’t had two doses of the vaccine, or hasn’t had measles, should see a GP – even if they don’t have symptoms. This is particularly important for babies, people with low immunity and pregnant women. Women who are planning a pregnancy should also check their MMR immunisation status.