Measles

Key disease facts

Measles is a highly infectious viral disease which can lead to serious complications such as pneumonia and encephalitis (inflammation of the brain). In addition, measles infection damages and suppresses the whole immune system. This means that people who have had measles are more likely to catch other infectious diseases. This effect can last for as much as three years after they recover from measles (see 'More Information' below).

In high income regions of the world such as Western Europe, measles causes death in about 1 in 5000 cases, but as many as 1 in 100 will die in the poorest regions of the world. Worldwide, measles is still a major cause of death, especially among children in resource-poor countries. In 2016 about 90,000 people died of measles. This was the first year on record when global measles deaths fell below 100,000 a year. However, in 2017 global measles deaths rose by over 20% to 110,000 deaths - over 300 deaths a day. This increase was due to gaps in vaccination coverage. See the World Health Organization report .

Over the last twenty years vaccination has dramatically reduced the number of deaths from measles. Since 1990 (when measles killed 872,000 people), it is estimated that over one in 5 of all child deaths averted have been due to measles vaccination. Since a measles vaccine was introduced in the UK in 1968, Public Health England estimates that 20 million measles cases and 4,500 deaths have been averted in the UK.

Current measles risks in the UK and Europe

Between 2001 and 2013 there was a sharp rise in the number of UK measles cases, and three people died. Numbers of cases have fallen since 2013, but rates of measles are still higher than they were in the late 1990s. In 2018 there were 966 laboratory confirmed measles cases in England - nearly four times as many as the total number confirmed in 2017 (259 cases). The majority of measles cases have been in people who are not vaccinated, especially young people aged 15 and over who missed out on MMR vaccination when they were younger. About 30% of those infected have been admitted to hospital.

At the moment most UK measles cases are linked to travel in Europe. Measles cases have also been linked to music festivals and other large public events. Public Health England is advising people to check that they are vaccinated against measles before they travel abroad or go to large public events in the UK or elsewhere.

Numbers of measles cases are currently high in several European countries. There were over 82,500 measles cases in Europe in 2018 . This is more than three times as many as in 2017, and 15 times as many as in 2016. In 2016 and 2017 there were 49 deaths from measles in Europe, and 2018 saw another 72 deaths. Some countries have reported that over 60% of measles cases have been hospitalised. There have been particularly serious outbreaks in Serbia, Ukraine, Georgia, Greece, Romania, Italy, and France, with over 40% of cases in Europe occurring in adults over the age of 20. See the regular reports from the European Centre for Disease Prevention and Control.

Travellers have brought a number of measles cases into the UK recently, and these are expected to continue. All travellers are advised to check that they are up to date with MMR vaccination before they travel. If you are travelling with a baby, the MMR vaccine can be given from six months of age before travelling to a country where measles is a risk or where an outbreak is taking place. See the Travel Health Pro website for more information.

What are the symptoms?

Measles usually starts with cold-like symptoms, red eyes and sensitivity to light, a high temperature, and greyish-white spots in the mouth and throat. A red-brown rash usually appears a few days later, spreading from behind the ears to the rest of the body.

A child with measles will have to spend about five days in bed and could miss two weeks of school. Even in developed countries such as the UK, around one in every 15 children with measles will develop more serious complications. These can include:

ear infection (otitis media) in about 8% of measles cases (about 1 in 12 people)
pneumonia in up to 6% of measles cases (up to 1 in 16 people)
diarrhoea in about 8% of measles cases (about 1 in 12 people)
encephalitis (inflammation of the brain): 1 case for every 1000-2000 cases of measles. Encephalitis can lead to brain damage.

In countries like the UK, measles causes death in about 1 in 5000 cases. See Roald Dahl's account of the death of his daughter Olivia from measles encephalitis in 1962.

In rare cases, measles can lead to a condition called SSPE (subacute sclerosing panencephalitis). SSPE is a persistent viral infection, a devastating complication of measles which leads to a progressive destruction of the central nervous system. It causes dementia, loss of motor control, epilepsy and eventually death. A recent US study has suggested that SSPE may be more common than previously thought. See the video below: 'SSPE - a serious complication of measles: Sarah Walton's story'.

How is it passed on?

Measles is spread through water droplets, coughed or sneezed by infected individuals. People who have measles are infectious from when the first symptoms appear until 4 days after the rash appears. NHS advice for anyone who thinks they may have measles is to stay at home and call their GP or NHS 111. This reduces the risk of measles being spread to vulnerable people such as young babies and people with weakened immune systems.

Measles is one of the most infectious diseases; if a child who is not immunised comes into contact with someone who has measles, it is very likely that they will catch the disease and risk developing serious complications. The diagram below shows how measles would spread through a group of 100 unvaccinated people. In this situation, up to 90 susceptible individuals would catch the virus and up to 7 would develop complications. (www.cdc.gov)

In a group of 100 susceptible people (e.g. not vaccinated against measles) up to 90 susceptible individuals would catch the virus and up to 7 would develop complications.

Videos about what protection is available

The recommended way to protect your child is vaccination with the MMR vaccine. In the short film below, experts talk about measles and its complications, and the importance of the MMR vaccine.

Measles and the MMR vaccine

https://www.youtube.com/embed/gvJIQaXMCxY?wmode=opaque&controls=&rel=0

A life changed by measles: Sarah Clow's story

Sarah Clow fell seriously ill with measles when she was five and was left with lasting disabilities including deafness, partial sight and learning difficulties. Her mother Audrey talks about the impact this has had on Sarah and the whole family. Thanks to Rockhopper TV for the original footage.

Sarah was not vaccinated against measles as a child because she had had eczema. Advice on this has now changed; current advice is that children with eczema can safely receive the MMR vaccine and other vaccines.

A life changed by measles

SSPE - a serious complication of measles: Sarah Walton's story

Sarah Walton caught measles when she was 11 months old, and at the time recovered well. Twenty four years later, however, she fell ill and was diagnosed with subacute sclerosing panencephalitis (SSPE). This is a rare but devastating complication of measles which leads to a progressive destruction of the central nervous system. In this video Sarah’s mother Jo talks about the impact that SSPE has had on Sarah and the people around her.

For more information about the egg allergy issues raised in the video, click here.

SSPE - a serious complication of measles

More information about the disease

How measles damages the immune system

As well as causing serious disease, the measles virus attacks the white blood cells that protect us against other diseases. During any infection by bacteria or viruses, our immune system makes antibodies to fight the disease. For many diseases, an 'immune memory' is then created in special white blood cells called T lymphocytes. If we come into contact with that disease again, these cells will 'remember' it and react quickly to fight it, so that we do not become ill. However, measles infection destroys these special white blood cells, wiping out our immunity to diseases we have already had. This makes it much more likely that people who have had measles will catch other infections, even ones they have had before. Research published in 2015 found that it can take the body up to three years to recover from this damage. Before a measles vaccine was available, it is estimated that measles was the direct or indirect cause of over half of all childhood deaths from infectious disease.

Measles cases in the UK

The graph below shows reported numbers of measles cases in the UK between 1940 and 1995. Before a vaccine existed, there were often hundreds of thousands of measles cases every year. In 1967, the year before a vaccine was first introduced, there were 460,407 suspected cases of measles in the UK, and 99 people died from the disease. By the end of the 1980s, vaccination had brought these figures down to around 10,000 suspected cases a year, with one or two deaths, and since then measles cases have fallen still further.

Click here for an accessible text version of this graph

Source: Public Health England

However, the number of children receiving the MMR vaccine dipped in the 2000s, and as a result there have been several outbreaks of measles in the UK.

Two children in the UK have died of measles since 2006; neither had been given the MMR vaccine.
In 2012 there were 2,016 cases of measles.
In the first six months of 2013 there were 1,287 cases of measles. 257 of these people were admitted to hospital, including 39 with serious complications such as pneumonia, meningitis and gastroenteritis.
During the measles outbreak in Wales in 2013, a young man died of measles complications.

See the Public Health England page on measles deaths for full details of measles deaths since 1980.

The graph below shows the numbers of measles cases in England between 1996 and 2018 (confirmed by laboratory testing). Numbers of cases fell in 2014 and 2015, but rose again in 2016, with 531 measles cases reported - more than five times as many as the total number of cases in 2015. Numbers of cases fell in 2017, but rose again in 2018 (see 'Key disease facts' above).