Measles

Background

Measles is a rash illness resulting from infection with the measles virus. It can affect people of all ages but infants less than one year of age and those who are immunocompromised are at increased risk of complications and death. It's one of the most communicable diseases with one case having the potential to infect another 12 to 18 individuals through airborne transmission and respiratory droplets in susceptible populations.

MMR is the combined vaccine that protects against measles, mumps and rubella and is the most effective strategy for preventing the transmission of measles.

For more information on measles, visit the NHS Choices website.

Guidance

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Publications

Data and surveillance

Before vaccination, measles was a very common childhood disease in Scotland and deaths attributable to measles were substantial. Following the introduction of measles vaccine in 1968 and the subsequent introduction of the MMR vaccine in 1988, the incidence of the disease has decreased dramatically. However, as Figure 1 shows, outbreaks still occur in under immunised populations.

Figure 1 is a line chart showing the number of laboratory reports of measles by year from 1988 to 31 March 2019. The figure shows an increase in the number of measles cases in 1994 in which 526 cases were reported. The number of cases decreased to 23 in 1995 and remained low and stable until 2008 in which the number of cases increased slightly but remained stable until 2015 where no cases were reported. 26 cases were reported in 2016 and five cases were reported in 2017. Two cases were reported in 2018. Three cases have been reported between the 1 January and 31 March 2019. The graph is also annotated with information showing when measles vaccinations were introduced with the MMR vaccine introduced in 1988, the MR campaign initiated in 1994 and the second dose of MMR added to the schedule in 1996.

Surveillance update for January to March 2019

As shown in Figure 2, in the last four years, the number of laboratory confirmed measles cases each year has been variable, ranging from no cases in 2015 to 26 in 2016. In 2017, five laboratory confirmed cases were reported all of which were imported or linked to an imported case within or outwith the UK.  

Two imported confirmed case of measles were reported to Health Protection Scotland in 2018. Between 1 January and 31 March 2019, three confirmed cases of measles were reported. Two of these cases were imported and had a history of travel within Europe with the third case being a known close contact of one of the imported cases. No further transmission occurred highlighting the success of the MMR vaccination programme and the importance of maintaining high uptake in Scotland. 

Throughout 2018, measles outbreaks occurred across Europe and they have continued into 2019. Between January and March 2019, 3789 cases of measles have been reported to ECDC. The countries in which the most notable increases in cases have occurred between January and March 2019 have been:

  • France with 628 cases
  • Poland with 520 cases
  • Lithuania with 332 cases
  • Bulgaria with 236 cases

The WHO has highlighted that measles incidence in the European region is the highest in a decade mainly driven by sub-optimal immunisation coverage. The increased activity in Europe highlights that the risk of an importation of measles into Scotland remains high. 

Figure 2 is a bar chart showing the number of laboratory reports of measles by month from 2014 to 31 March 2019. The graph shows the number of cases of measles fluctuates each year. In 2016, measles cases were reported throughout the year and in 2017, cases were reported in the summer months.

 

Age distribution of cases

The age distribution of measles cases has been variable for the past five years but Figure 3 shows the majority of cases are in children and young adults. For 2016, the median case age was 22 years, compared to nine years in 2014 and 15 years in 2013. The median age of the five measles cases in Scotland in 2017 was higher than previous years at age 27 years. The age of the two measles cases in Scotland in 2018 and the three cases up to March 2019 is not shown due to the potential for deductive disclosure of these cases.

Figure 3 presents a box plot of the age of measles cases each year from 2013 to 2017. The graph shows the median age of measles cases varies each year and is between 10 and 30 years.   The range of ages of measles cases is wide each year with the youngest cases being less than one year old and the oldest cases being aged between 40 and 50 years.

Vaccination

Vaccine Uptake Statistics

Vaccine uptake statistics can be found on the Information Services Division website.