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Measles and rubella can be eliminated and congenital rubella infections prevented by achieving high uptake of the combined measles, mumps and rubella (MMR) vaccine in national childhood immunisation programmes. All Member States of the World Health Organization (WHO) European Region have a longstanding commitment to eliminating measles and rubella and this is a core goal of the European Vaccine Action Plan 2015 to 2020. In the UK the MMR vaccine is offered to all children at 1 year of age, with a second dose given at 3 years and 4 months.
Public Health England is responsible for collating and submitting evidence every year, on behalf of the devolved administrations (England, Wales, Scotland and Northern Ireland), to the UK national verification committee (NVC) and the WHO Regional Verification Commission for Measles and Rubella Elimination (RVC).
The following essential criteria are required to verify elimination of measles and rubella in the UK:
- the absence of endemic measles and rubella cases for a period of at least 12 months
- the presence of a high-quality surveillance system that is sensitive and specific enough to detect, confirm and classify all suspected cases
- genotyping evidence that supports the interruption of endemic transmission
The WHO confirmed that the UK achieved elimination status for rubella in 2016 and for measles in 2017. See Tables 1 and 2.
Elimination means that measles is no longer native (not endemic) to the UK. It does not mean that measles has disappeared. We continue to see measles cases, however further spread is limited and the chain of transmission in the population dies within a few weeks or months. This is only possible when MMR vaccine uptake in the community is very high and has remained high for many years.
Table1. Measles elimination indicators and status, 2010 to 2017, UK
|Year||MMR vaccine coverage 1st dose (%)1||MMR vaccine coverage 2nd dose (%)1||Measles cases2||Incidence per million||WHO status|
|2014||94.6||89||96||1.5||interrupted endemic transmission4|
|2015||94.8||89.3||90||1.1||interrupted endemic transmission4|
Table 2. Rubella elimination indicators and status 2010 to 2017, UK
|Year||MMR vaccine coverage 1st dose (%)1||MMR vaccine coverage 2nd dose (%)1||Rubella cases5||Incidence per million||WHO status|
|2010||91.9||83.6||12||0.14||interrupted endemic transmission6]|
|2011||93.1||85||6||0.11||interrupted endemic transmission6|
|2013||94.7||88.9||7||0.11||interrupted endemic transmission6|
|2014||94.6||89||1||0.02||interrupted endemic transmission6|
This measles blog by Dr. Vanessa Saliba explains why we are still seeing measles cases in the UK even though we have eliminated it. As history teaches us, elimination can only be sustained going forward by maintaining and improving coverage of the MMR vaccine in children and by using all opportunities to catch up older children and adults who missed out when they were younger.
a suspected case that meets the laboratory/epidemiological/clinical criteria for measles (definitions have changed over time) ↩
the absence of endemic measles cases in a defined geographical area for a period of at least 12 months, in the presence of a well-performing surveillance system. Regional elimination can be declared after 36 or more months of the absence of endemic measles in all Member States ↩ ↩2
a suspected case that meets the laboratory/epidemiological/clinical criteria for rubella (definitions have changed over time). ↩
the absence of endemic rubella cases in a defined geographical area for a period of at least 12 months, in the presence of a well-performing surveillance system. Regional elimination can be declared after 36 or more months of the absence of endemic rubella in all Member States ↩ ↩2 ↩3 ↩4
continuous transmission of indigenous or imported rubella virus that persists for a period of 12 months or more in a defined geographical area. ↩