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: Number of laboratory-confirmed cases of measles in Scotland by year, 1988 to 2020 (to week 52)

Line chart showing the effect of the introduction of the MMR vaccine, the measles and rubella campaign, and the introduction of the second dose of MMR.

Surveillance update for October to December 2020

As shown in Figure 2, the annual number of laboratory-confirmed measles cases has been variable, with no cases in 2015, 26 in 2016, five laboratory-confirmed cases in 2017, all of which were imported or linked to an imported case within or outwith the UK and two imported cases reported in 2018.

In 2019, 18 laboratory-confirmed cases of measles were reported. Of these, one case was acquired elsewhere within the UK, outwith Scotland; from which two further cases were subsequently identified. Seven cases were imported from outwith the UK, and resulted in two import-related cases in Scotland. The remaining six laboratory-confirmed cases of measles in Scotland were of unknown origin. However preliminary typing indicates the majority of these cases to be of the strain demonstrated for elsewhere in the UK and Europe. 

No cases of measles were reported in Scotland in 2020.

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.

Figure 2: Number of laboratory-confirmed cases of measles in Scotland by month and year, 2015 to 2020 (to week 52)

Bar chart showing the fluctuation in measles cases each year.

Measles outbreaks occurred across Europe throughout 2018 and have continued into 2019. Between January and December 2020, 2,040 cases of measles were reported to the European Centre for Disease Prevention and Control (external weblink). The EU/EEA countries with highest rate of cases in 2020 are:

  • Romania with 51.7 cases per million population
  • Bulgaria with 36.7 cases per million population
  • Belgium with 5.8 cases per million population
  • Malta with 4.1 cases per million population and
  • Ireland with 3.9 cases per million population

Ongoing measles activity in Europe and globally poses a threat to international travellers and Scotland will continue to face an elevated risk of imported cases from other counties and other regions of the UK (external weblink).

Age distribution of cases

In 2020, no cases of measles were reported.

The median age of the 18 laboratory-confirmed cases measles cases reported in Scotland in 2019 is 24 years. This compares to the median age of cases in 2016 (22 years) and 2017 (27 years). The median age of the two measles cases in Scotland in 2018 is not reported due to the potential for deductive disclosure. The age distribution of measles cases has varied over recent years but the majority of cases are observed in children and young adults.

 

Vaccination

Vaccine Uptake Statistics

Vaccine uptake statistics are published by Public Health Scotland Data and Intelligence.