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Volume 2 No 32; 8 August 2008

 

MMR catch-up programme announced

The Chief Medical Officer has announced an urgent vaccination programme to reduce the risk of a measles epidemic in the United Kingdom (UK)[1]. The need for the programme has been underpinned by research and modelling - conducted by the HPA and based on data supplied to the COVER programme [2] - indicating that, after many years of sub-optimal vaccination coverage, around 1.9 million school children and 300,000 pre-school children were incompletely vaccinated against measles in England. This suggests that, in many areas of the country, the number of susceptible children has now reached a level where measles transmission could be sustained. The potential therefore exists for an outbreak of between 30,000 and 100,000 cases of measles, with school age children in London being most affected [3].

Cases of measles have also increased this year, with a total of 656 cases confirmed so far in England and Wales with onset dates to the end of June 2008 (figure 1). A total of 450 (69%) cases are in London, but with significant numbers also confirmed in South East (27), East of England (37), North West (49), Yorkshire and Humberside (41), and South West (26) regions. Major outbreaks have been associated with communities with historically low vaccine coverage but large numbers of cases are also now being reported from schools in London. Most cases (494/656, 75%) are in children aged between one and 18 years, with around 95% in those without documented vaccination (figure 2). Cases are mainly associated with an identical genotype D4 measles strain that has now been circulating in the UK for over a year (MVs/Enfield.GBR/14.07).

In response to the predicted epidemic and the increase in measles cases, the CMO recommends that Primary Care Trusts take action to undertake catch-up programmes to immunise children who have not received a full course of vaccination.

Based on the current epidemiology, the first priority is to offer MMR to those aged 13 months to 18 years who have not received MMR vaccine. This group should be called for vaccination before the end of October this year.

Subsequently, primary school children who have received a single dose of MMR vaccine should be called, followed by those of secondary school age. Young adults over 18 years who are leaving school to go to higher education should then be targeted. The Department of Health is supporting PCTs by providing additional funding, supplies of MMR and information materials.

Figure 1. Confirmed cases of measles by month of onset, England and Wales: January 2007 up to 30 June 2008

 

Figure 2. Confirmed cases of measles by age, England and Wales: January to June 2008

References

1. Public Health Link CEM/CMO/2008/12: MMR catch-up programme [online]. London: Department of Health, 6 August 2008. http://www.info.doh.gov.uk/doh/embroadcast.nsf/vwDiscussionAll/
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2. COVER (Cover of Vaccination Evaluated Rapidly): a programme for evaluating childhood immunisation. See: http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1204031507699?p=1204031507699

3. Choi YH, Gay N, Fraser, Ramsay M. The potential for measles transmission in England . BMC-Public Health 2008 (in press).

Salmonella Enteritidis PT12 in England, Wales and Northern Ireland: an update

The identification of a suspected outbreak in Salmonella Enteritidis PT 12 infections in all regions in England and Wales has been reported previously [1], including a summation of case reports up to 30 July 2008. The decision was taken on 21 July to carry out follow-up investigations and a descriptive epidemiological summary on case reports between 30 July and 7 August is given below.

Between 21 July (when the investigation began) and 7 August, 78 cases of fully-sensitive S. Enteritidis PT 12 were identified and reported to the HPA Laboratory of Gastrointestinal Pathogens (LGP).

Cases have a median age of 30 years (range: three months to 91 years) and are distributed across all age groups. Most cases were in the age ranges 10-29 years and 50-59 years (figure 1). Forty three (55%) were female and 35 (45%) male. Over the period, three (4%) cases had a positive travel history, 10 (13%) cases were hospitalised, and there were no deaths.

Figure 1. S. Enteritidis cases (21 July to 07 August 2008), age and gender distribution (n=78)

Table 1 S. Enteritidis cases (21 July to 07 August 2008), regional distribution

Country/Region

Number of cases

East Midlands

8

East

6

London

3

North East

2

North West

8

South East

9

South West

7

West Midlands

14

Yorkshire and Humberside

16

England subtotal

73

Wales

4

Northern Ireland

1

Total

78

References

1. HPA. Suspected outbreak of Salmonella Enteritidis phage type 12 infections in England and Wales, Health Protection Report [serial online] 2008;2(31):news. Available at http://www.hpa.org.uk/hpr/archives/2008/hpr3108.pdf