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 30 June 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. Eleven cases have been reported between the 1 January and 30 June 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 April to June 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.  

Between 1 January and 30 June 2019, 10 confirmed cases and one epidemiologically linked case of measles were reported. Six of these cases were imported and were linked to travel within England, other parts of Europe and South-East Asia. A further three cases arose from the importations representing three separate clusters. The remaining two cases were part of a cluster and the source of infection could not be determined but was likely to be import related. Most transmissions occurred in a family setting among unvaccinated contacts, with one additional transmission in the community and another in a school setting. Seven cases were not previously vaccinated, two had received two doses of MMR and two had an unknown vaccination status. In highly vaccinated populations, such as Scotland, rarely, individuals who have received two doses of MMR vaccine can develop symptoms following exposure to a measles case, but symptoms are usually attenuated and individuals are unlikely to be as infectious. No sustained further transmission occurred in Scotland highlighting the success of the MMR vaccination programme and the importance of maintaining high vaccine uptake in Scotland. 

Throughout 2018, measles outbreaks occurred across Europe and they have continued into 2019. Between January and June 2019, 10,077 cases of measles were reported to ECDC. Overall, the number of cases decreased in June compared to April and May with decreases noted in France, Bulgaria, Poland, Lithuania and Spain. According to the ECDC the countries with the most cases reported up to June 2019 are:

  • France with 2028 cases
  • Italy with 1332 cases
  • Poland with 1190 cases
  • Bulgaria with 1032 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. fitfortravel shows increased activity in Europe and globally. This suggests 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 30 June 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 and 2019, cases were reported in the spring and 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 is not shown due to the potential for deductive disclosure of these cases. The median age of the 11 measles cases in 2019, reported up to June 2019, is 19 years. 

Vaccination

Vaccine Uptake Statistics

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