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 is a line chart showing the number of laboratory reports of measles by year from 1988 to 2018. The figure shows an increase in the number of measles cases in 1994 in which 526 cases were reported. The number of cases decreased to 23 in 1995 and remained low and stable until 2008 in which the number of cases increased slightly but remained stable until 2015 where no cases were reported. 26 cases were reported in 2016 and five cases were reported in 2017. Two cases were reported in 2018.    The graph is also annotated with information showing when measles vaccinations were introduced with the MMR vaccine introduced in 1988, the MR campaign initiated in 1994 and the second dose of MMR added to the schedule in 1996.

Surveillance update for 2018

As shown in Figure 2, in the last four years, the number of laboratory confirmed measles cases each year has been variable, ranging from no cases in 2015 to 26 in 2016. In 2017, five laboratory confirmed cases were reported all of which were imported or linked to an imported case within or outwith the UK.  Two confirmed case of measles were reported to Health Protection Scotland in 2018. These were in unvaccinated individuals with history of travel within and outwith Europe. No further transmission occurred highlighting the success of the MMR vaccination programme and the importance of maintaining high uptake in Scotland.  

Throughout 2017, measles outbreaks occurred across Europe and they continued into 2018. The countries most affected between December 2017 and November 2018 have been:

  • France with 2,921 cases
  • Greece with 2,634 cases
  • Italy with 2,548 cases
  • Romania with 1,346 cases
  • UK with 984 cases

Overall, there has been a decrease in measles activity in Europe including England which experienced increased incidence of measles with a number of outbreaks throughout the country in the spring and summer months. The outbreaks in Europe and England show that the risk of an importation of measles into Scotland remains high.  

Figure 2 is a bar chart showing the number of laboratory reports of measles by month from 2014 to 2018. The graph shows the number of cases of measles fluctuates each year. In 2016, measles cases were reported throughout the year and in 2017, cases were reported in the summer months.

 

Age distribution of cases

The age distribution of measles cases has been variable for the past five years but Figure 3 shows the majority of cases are in children and young adults. For 2016, the median case age was 22 years, compared to nine years in 2014 and 15 years in 2013. The median age of the five measles cases in Scotland in 2017 was higher than previous years at age 27 years. The age of the two measles cases in Scotland in 2018 is not shown due to the potential for deductive disclosure of the two cases.

Figure 3 presents a box plot of the age of measles cases each year from 2013 to 2017. The graph shows the median age of measles cases varies each year and is between 10 and 30 years.   The range of ages of measles cases is wide each year with the youngest cases being less than one year old and the oldest cases being aged between 40 and 50 years.

Surveillance form

View the enhanced measles surveillance form

Vaccination

Vaccine Uptake Statistics

Vaccine uptake statistics can be found on the Information Services Division website.