London School of Hygiene & Tropical Medicine

More than 200 cases of measles have been reported in Merseyside and unless vaccination uptake increases the evidence suggests outbreaks are likely to occur elsewhere due to inadequate immunisation coverage.

Kim Mulholland, professor of child health and vaccinology at the London School of Hygiene & Tropical Medicine, said: "The current outbreak of measles in the Merseyside area is a timely reminder that Britain, like other European countries, remains susceptible to measles outbreaks.  

"Over half of the 200+ cases were under five years of age, which is not surprising given that more than 10% of British children under five are not vaccinated against measles.  

“This provides more than enough susceptible children to sustain outbreaks, which will continue while immunisation coverage is inadequate and measles continues to circulate in other parts of the world."

Measles spreads quickly among children and adults who are not vaccinated, and can lead to serious complications and, on rare occasions, death. Symptoms include fever, cough, a runny nose, red eyes and a red rash.

Professor Mulholland explores the current state of affairs in tackling the disease on a global scale in a newly-published article in the New England Journal of Medicine.

He pointed out that measles was well controlled between 2000 and 2008 but since 2008 the “measles genie seems to have slipped out of the bottle in many regions”. 

Cases have increased in Africa and Europe due to declining international interest and support, while the effects of people’s failure to vaccinate their children on grounds of religious or philosophical beliefs or unwarranted fears has also been felt.

An innovative tool to monitor public confidence in immunisation programmes has been developed by a research group at the School led by Dr Heidi Larson in a bid to detect and respond to early signals of waning confidence in vaccines, before public concerns spread and lead to vaccine delays or refusals. The system builds on lessons learned from the northern Nigerian boycott of polio vaccination in 2003-2004.

Prof Mulholland highlighted the fact that measles elimination efforts are “inextricably linked” with polio eradication and argued that future action on measles will depend on successful control with the current strategies, and completion of the polio eradication effort.

He said: “Polio eradication remains an elusive target, although there is growing optimism that it may eventually be achieved. If and when that occurs, the overall financial costs plus the opportunity costs will have exceeded the initial estimates many times over — a point that is not likely to be lost on funding agencies. These figures will be essential for calculating realistic costs of measles eradication, which should be analysed and weighed against the substantial future health and economic benefits such an initiative could bring.”

Prof Mulholland concluded that, in the shorter term, until measles control is achieved globally, countries like the UK and US, which have controlled measles reasonably well, "can anticipate more small outbreaks among susceptible groups due to imported measles virus".

Measles in the 21st Century, E. Kim Mulholland, M.D., Ulla Kou Griffiths, M.Sc., and Robin Biellik, Ph.D. New England Journal of Medicine. N Engl J Med 2012; 366:1755-1757, May 10, 2012