Overview

Whilst thought to have been eradicated in many countries, measles has made a resurgence, sparking worry among healthcare professionals and communities. But why is this seemingly preventable disease resurfacing, and what can be done to prevent it and stop its relentless advance? 

Despite the success of the measles vaccination programme, there are many factors which have led to the rise in measles cases. Let’s delve into these disease-driving determinants as we try to make sense of the return of measles, and uncover ways in which we can prevent contracting it and reduce its spread. 

What is measles?

Measles is a highly contagious disease spread by a virus through the respiratory route, meaning the inhalation of infected droplets produced by coughing, sneezing or talking can lead to infection. It initially causes cold-like symptoms such as a blocked nose, cough, sneezing and a high temperature, and white spots may be seen in the mouth, and after a few days, the characteristic measles rash will appear.¹

Measles is most common in children, and it can be very serious and even deadly if it spreads to other parts of the body. There is no specific treatment for measles, and patients are advised to rest, hydrate, and use over-the-counter medications such as ibuprofen. Therefore, prevention is crucial to prevent widespread mortality. However, since the disease is so contagious (almost everyone who comes into contact with an infected person will develop the disease), preventing its transmission can be difficult.² 

A history of measles cases

The MMR vaccine, introduced in 1988, protects against three different viral infections: measles, mumps and rubella, by mimicking infection with these viruses. This creates an immune response within your body, without experiencing the symptoms associated with these diseases, and leaves your body primed and ready to fight off these viruses when you encounter the real thing.³ 

Upon implementation, the MMR vaccine successfully reduced the spread of measles, leading to a decline in cases, and the eradication of measles in the UK was declared by the World Health Organisation in 2017. However, by 2018, transmission was re-established and cases began to surge again.⁴ 

The Covid-19 pandemic led to a decline in measles after this resurgence, due to societal restrictions and lockdowns reducing travel and socialisation, preventing the spread of many infectious diseases. However, since these restrictions have been lifted, cases have now begun to rise further following the pandemic, and a large outbreak was identified in the West Midlands in the UK in 2023. 

Why are measles cases rising?

There are four main factors thought to be contributing to the rise in measles cases.

Vaccine hesitancy

Defined as a state of indecisiveness regarding a vaccination decision, vaccine hesitancy can lead to many individuals refraining from getting vaccinated themselves, or choosing not to vaccinate their children.⁵ This can have a dramatic effect on vaccination rates and reduce the success of vaccination programmes, particularly in certain communities where vaccination is not widely accepted.⁶

MMR vaccine and autism scandal

In 1998, a study was published suggesting a link between the MMR vaccine and a predisposition to autism, which was later dispelled. This claim led to a widespread decline in public confidence in the vaccine, dramatically reducing MMR vaccination rates in the 2000s. The children who were not vaccinated during this time were therefore at a much higher risk of developing measles, and they still are today, unless they have been vaccinated since.⁷ 

Disruptions in routine immunisation programs

The COVID-19 pandemic affected healthcare systems and reduced accessibility to routine vaccination services, leading to decreased vaccine uptake, and MMR vaccine rates reduced by more than half.⁸

Increasing travel

More people are travelling internationally than ever before, and acquiring infectious diseases abroad can put communities and susceptible populations at risk of returning home. The risk is particularly apparent when travelling to a country with a higher rate of a certain disease, or to a country which has a worse vaccination status.

The global increase in international travel is thought to have contributed to an increase in the rates of many different infectious diseases, including measles. Since measles is more common in countries in Africa and Asia than in the UK, travel to these countries can lead to individuals developing measles and bringing it back to the UK, contributing to an outbreak here.⁹

Preventing measles

Getting vaccinated 

The MMR vaccine is the most effective way to prevent measles and can be 99% effective, therefore ensuring that you and your family members receive the recommended doses of the vaccine is a crucial step in protecting against measles. Whilst normally administered at a young age, if you are an adult and have not received the MMR vaccine it is not too late - contact your GP to catch up on any missing doses.³

Travel guidelines

If you are planning to travel internationally, it is important to check travel guidelines for any measles outbreaks in the destination and follow the recommendations, which may include getting the MMR vaccination if you have not already before you travel. You should not travel if you are infected with measles. 

Public awareness and education

Healthcare providers have an important role in addressing vaccine hesitancy using effective communication strategies, dispelling myths and misinformation.¹⁰ Accessibility and convenience of vaccination services can impact vaccine uptake, particularly for those who are unsure about vaccination, and reassurance from a healthcare professional can be the most effective way of encouraging them to get vaccinated.¹¹

Hygiene and avoiding contact

Good hygiene can help to prevent the spread of measles, such as washing hands thoroughly and regularly with soap and water or alcohol-based sanitiser, especially after coughing, sneezing, or touching your face.

Additionally, cover your mouth and nose with a tissue or your elbow when coughing or sneezing and dispose of used tissues properly.¹² Since measles is such a contagious disease, it is crucial that you avoid contact with infected individuals to prevent contracting the disease, and if you are infected yourself or suspect you may have measles, seek medical advice and then stay home and avoid contact with others.¹³ 

FAQs

If there is an effective vaccine, why are measles cases still rising?

Despite the effectiveness of the MMR vaccination in preventing measles, vaccine hesitancy means that the uptake of the vaccine is unfortunately not high enough to provide widespread protection. This is due to the COVID-19 pandemic, the autism links and vaccine hesitancy. Furthermore, an increase in international travel is thought to contribute to a rise in the spread of infectious diseases.⁵

What regions or populations are most affected by the recent increase in measles cases?

There has been a large outbreak declared in the West Midlands, and many cases detected in London, Yorkshire and The Humber, as of February 2024, according to the UK Health Security Agency (UKHSA).

How can I prevent getting measles?

The most effective way to prevent measles is by getting the MMR vaccine which protects against measles, mumps and rubella. It is typically administered to young children and requires two doses. However, if you are an adult and have not been vaccinated, contact your GP.³ 

Are there any alternative methods to prevent measles besides vaccination?

Practising good hygiene such as washing hands and disposing of tissues, checking travel guidance and keeping away from infected individuals can reduce your risk of contracting measles. If you are infected yourself, you should isolate to prevent the spread of the disease to others.¹²

What precautions should I take if I've been exposed to someone with measles?

Watch out for symptoms of measles, which typically appear 10 to 14 days after exposure, including a high fever, cough, runny nose, red eyes, white spots in the mouth and a characteristic rash. If you develop symptoms of measles, stay at home and avoid contact with others to prevent spreading the virus. Contact your healthcare provider for guidance on what to do next.²

Summary

Measles is a highly contagious disease that can be very serious, therefore prevention through vaccination has been the main focus to reduce cases, leading to its eradication. However, this eradication was brief, and cases have started to rise again. The main factors contributing to measles are: vaccine hesitancy, which was fuelled by the autism and MMR vaccine scandal; disrupted immunisation programmes due to the Covid-19 pandemic, and increased international travel.

To tackle the resurgence in the number of cases of measles, healthcare professionals, governments, and communities need to work together. They need to educate and encourage the use of vaccines, improve measles surveillance to isolate infected individuals and promote good hygiene to prevent the spread of measles. On an individual level, the best way you can prevent measles is to make sure you and your family are up to date in receiving the MMR vaccine.

Practising good hygiene, checking travel guidelines and avoiding contact with infected individuals are also crucial steps you can take to reduce your risk of contracting this disease. Furthermore, if you have been diagnosed with measles yourself, it is important to self-isolate to prevent it from spreading further.