Targeted catch-up strategies are needed if a resurgence of measles is to be avoided said WHO, as it called for urgent action.
After a period of very low detection of measles in the WHO European Region in 2021, cases of the disease have been increasing since early 2022, highlighted a World Health Organization (WHO) spokesperson. “Persistent immunity gaps and missed doses” of vaccines due to the COVID-19 pandemic have left many people, among them an increased number of children, susceptible to this “potentially fatal disease”, the spokesperson said.
The WHO said that following large outbreaks of measles in 2018 and 2019 across the European region, with nearly 200,000 reported cases, the number of reported measles cases in the region fell in 2020 to just over 12,000. For 2021, only 159 measles cases were reported in 22 countries, however, this increased in 2022, it said, with 904 cases reported to date in 27 countries.
The UK briefly achieved measles-free status in 2016/2017, but this status was lost in 2018. According to the most recent UK Health Security Agency (UKHSA) data (September 2022), in 2021 there were two confirmed cases of measles in England and Wales. However, provisional figures showed this had increased to 24 cases for the first half of 2022.
“All countries of the region have faced challenges in maintaining immunisation coverage at pre-pandemic levels through routine service delivery of measles-containing vaccines and other vaccines in their national immunisation schedules,” explained a WHO spokesperson.
Vaccination Systems Must Be Strengthened
Vaccination coverage also differs widely both between and within countries. Some have been able to conduct catch-up activities between COVID-19 pandemic waves and maintain desirable levels of coverage. In others, routine immunisation has been interrupted or postponed for a considerable period among significant portions of the national population, the WHO pointed out.
"Everyone deserves the incredible protection vaccines provide," said Dr Nino Berdzuli, director of the division of country health programmes at WHO/Europe. "But often those who need protection most are less likely to receive it," she added. "We must strengthen our immunisation systems to address challenges to routine immunisation."
In February last year, UK data demonstrated vaccination coverage for young children had fallen in 2021 in 13 of 14 routine programmes across the UK, and that since March 2020 there had been a significant reduction in uptake of MMR, with vaccination coverage at its "lowest level for a decade".
The most recent statistics from UKHSA and NHS Digital, published in September 2022, showed that for UK children up to 5 years of age, in 2021-22:
- 89.2% of children at 24 months had completed their first dose of MMR vaccine – a decrease from 90.3% the previous year
- MMR1 coverage at 5 years was 93.4% – a decrease from 94.3% the previous year
- 85.7% of children received their second dose of MMR vaccine by their 5th birthday – a decrease from 86.6% in the previous year
The WHO target is 95% coverage, but in 2021-22 only 16 of 149 local authorities had coverage levels of 95% and above. Coverage of less than 90% was reported for 61 local authorities, including all London authorities.
Regional datashowed 7 of the 9 regions reached 90% coverage, with no region exceeding the 95% target. The North East had the highest level of coverage at 94.5% – down from 95.3% the previous year. London had the lowest level of coverage in 2021-22 at 79.9% – down from 82.4% in 2020-21.
Dr Doug Brown, chief executive of the British Society for Immunology, raised concern that the findings of the report were "extremely worrying".
Measles Elimination Setback
Around 1 in 10 children starting school were "inadequately" protected against measles, warned the UKHSA, and urged parents and guardians to ensure their children were up to date with all their routine childhood immunisations.
A study last year, commissioned by the Department of Health and Social Care (DHSC) and the UKHSA, showed that among around 2000 parents and guardians of children aged 5 and under:
- Only 38% were aware measles can rarely be fatal
- 48% were unaware that measles can lead to serious complications such as pneumonia and encephalitis
- 56% were not aware that two doses of the MMR vaccine gives 99% protection against measles and rubella
In response the UKHSA launched a campaign to remind parents and guardians to ensure their children had two doses of MMR vaccine. It warned that children faced "serious health risks" from missing vaccination, and alerted the importance of child vaccine coverage reaching the 95% level recommended by the WHO as soon as possible, to prevent the spread of serious and deadly diseases.
"This decline is a significant setback in global progress towards achieving and maintaining measles elimination and leaves millions of children susceptible to infection. In many countries around the world, as soon as pandemic response measures were relaxed, surveillance systems started detecting increasing numbers of measles cases and outbreaks," the WHO pointed out.
Helen Bedford, professor of child public health at UCL's Institute of Child Health, commented that the UK risked facing "the concerning double whammy of many children being unprotected and the inevitability of disease rates increasing.
"In this situation, as night follows day, significant outbreaks of disease are likely," she warned, and underlined that measles was a particular concern as it is so highly infectious that "any small decline in vaccine uptake results in outbreaks.
"Fortunately, it is never too late to be vaccinated. Vaccination works, is highly effective and has an excellent safety record. No child needs to face the potentially serious consequences of a vaccine preventable disease."