New strategy on elimination of measles and rubella

Author: Adrian O'Dowd
New strategy on elimination of measles and rubella
A new strategy led by Public Health England (PHE) has been launched to maintain the elimination status of measles and rubella and congenital rubella syndrome (CRS) across the UK.

The strategy, developed by PHE and supported by partners across the NHS and the devolved administrations, is built on the experience of 50 years of measles vaccination and 30 years of the measles, mumps and rubella (MMR) immunisation programme.

It is estimated that since the introduction of the measles vaccine, 20 million cases and 4,500 deaths have been prevented the UK. In addition, it is estimated that rubella vaccination has prevented an estimated 1.4 million cases of rubella, 1,300 CRS births, and averted 25,000 terminations.

However, PHE said its own analysis showed that immunity levels within some age groups across the UK – especially young people aged 15 to 20 – were well below the levels needed to prevent measles from spreading and it was a highly infectious disease.

Although the World Health Organization (WHO) confirmed that the UK eliminated rubella in 2015 and measles in 2016, that only means the diseases are no longer native to the UK and does not mean they have been completely wiped out. With their existence in other countries and recent large measles outbreaks across Europe, imported infections are a risk to the UK.

PHE said that in 2016 and 2017, uptake of the first dose of the MMR vaccine in five-year-olds in the UK exceeded 95% for the first time. However, two doses of MMR vaccine are required to ensure full protection from measles and uptake of the second dose of MMR in five-year-olds is currently 88% - well below the 95% WHO target.

The new strategy says partners in the local health economy need to work together to continue to increase uptake of the MMR vaccine in all children, and address immunity gaps across the population by catching up teenagers and young adults who missed out on the vaccine when they were younger.

It includes various recommendations to maintain measles and rubella elimination that cover four main areas:
  • achieve and sustain over 95% coverage with two doses of MMR vaccine in the routine childhood immunisation programme
  • achieve over 95% coverage with two doses of MMR vaccine in older age groups
  • strengthen measles and rubella monitoring
  • ensure easy access to evidence-based information for health professionals.
The strategy says that the routine national immunisation programme will be strengthened by stakeholders working collaboratively to address gaps in funding, commissioning, delivery and quality assurance of immunisation training as well as gaps in workforce planning.

PHE also wants local areas to investigate and address national decline in the MMR 1 coverage in people born since 2011-12. To do this, local teams should develop a measles and rubella elimination action plan in partnership with local stakeholders that should include analysis of any barriers to achieving the 95% target for MMR 1 and MMR 2.

Local teams should then agree on how to tackle these barriers by working with GP practices which will look at the accessibility of immunisation clinics, appointment times, locations, and waiting lists.

There should also be opportunistic MMR check and offer at all contact points in primary care.

Dr Mary Ramsay, head of immunisation at PHE, said: “Our achievements to date are a testament to the hard work of health professionals in the NHS. But, if we wish to build on our successes, and sustain measles and rubella elimination for future generations action needs to be taken now.”