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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) for review and evaluation on an annual basis.
The elimination verification process is based on evidence documented by each Member State to show whether interruption of endemic transmission of measles and/or rubella at national level has been achieved and, if not, that a national plan has been developed to address this.
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 from the last known case, due to complete interruption of endemic virus transmission
- 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 2015 and this has been maintained since that time. For measles the UK initially achieved WHO measles elimination status in 2017, based on data from 2014-2016. However, based on measles cases in 2018, the WHO has concluded that the transmission of measles virus has been re-established in the UK. See Tables 1 and 2.
Table1. Measles elimination indicators and status, 2010 to 2018, UK
|Year||MMR vaccine coverage 1st dose (%)||MMR vaccine coverage 2nd dose (%)||Measles cases||Incidence per million||WHO status|
|2010||91.9||83.6||407||6.09||endemic transmission[footnote 3]|
|2011||93.1||85||1112||15.99||endemic transmission[footnote 3]|
|2012||94.2||86.5||2052||32.15||endemic transmission[footnote 3]|
|2013||94.7||88.9||1853||28.91||endemic transmission[footnote 3]|
|2014||94.6||89||96||1.5||interrupted endemic transmission[footnote 4]|
|2015||94.8||89.3||90||1.1||interrupted endemic transmission[footnote 4]|
|2018||95.2||87.8||1250||17.1||re-established transmission of measles virus[footnote 3]|
As history teaches us, elimination can only be achieved 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.
Table 2. Rubella elimination indicators and status 2010 to 2018, UK
|Year||MMR vaccine coverage 1st dose (%)||MMR vaccine coverage 2nd dose (%)||Rubella cases||Incidence per million||WHO status|
|2010||91.9||83.6||12||0.14||interrupted endemic transmission[footnote 7]]|
|2011||93.1||85||6||0.11||interrupted endemic transmission[footnote 7]|
|2012||94.2||86.5||61||0.75||endemic transmission[footnote 6]|
|2013||94.7||88.9||7||0.11||interrupted endemic transmission[footnote 7]|
|2014||94.6||89||1||0.02||interrupted endemic transmission[footnote 7]|
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
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. ↩