The United Kingdom Has Lost Its Measles Elimination Status

There is a difference between a disease being eliminated and a disease being eradicated. Eradication means that there are no more cases of the disease anywhere in the world. The only human disease that had been eradicated through vaccination is smallpox. Polio is near eradication, and it has been eliminated from almost all countries in the world. Elimination means that there are no more locally-acquired cases or outbreaks of the disease.

Recently, measles has made a comeback in countries around the world where it was eliminated. Cases imported by un-vaccinated people have triggered local outbreaks in places around the United States, the United Kingdom, Europe, Asia and Africa. Today, the World Health Organization and Public Health England have announced that measles is no longer considered eliminated in the United Kingdom. The United States and other developed nations where measles was once considered eliminated might be next.

In a blog post dated August 19, 2019, Public Health England announced the decision of the World Health Organization to strip the United Kingdom (UK) o their elimination status with regards to measles. According to the blog post:

“The UK initially achieved WHO measles elimination status in 2017, based on data from 2014-2016.

However, in 2018, there was a marked increase in the number of confirmed measles cases, with 991 confirmed cases in England and Wales, compared with 284 cases in 2017. Furthermore, the same strain of measles virus (called B3 Dublin) was detected for more than 12 months across 2017 and 2018. Based on this, WHO determined that the UK could no longer be consider as ‘eliminated’ and that transmission of measles had been re-established.”

The rest of the blog post tells us things that we already know: not enough children are fully covered by the MMR (measles, mumps, rubella) vaccine, intercontinental travel has brought measles back to the UK from places where measles is highly endemic and a decreased confidence in all vaccines, not just the MMR. Of course, there is a plan to solve this, but it very much depends on public sentiment about science in general and vaccine science in particular. As a small-yet-vocal number of people and organizations continue to spread misinformation about vaccines, enough erosion in herd immunity is happening that measles is now being transmitted at a local level in the UK.

Soon, the United States is going to reach the proposed date for a review of its elimination status, around the first week of September. At that time, the World Health Organization and public health authorities in the United States will have to look very carefully at the situation in places like New York City, the State of Washington and other places where measles has recently been epidemic. More cities have recently declared their first measles cases in decades, signaling that measles may be being transmitted locally within the United States and not transported in from a place where measles is active.

Public health authorities need to take this as a (somewhat) late wake-up call. The MMR is not the only vaccine that is being refused by a small-yet-significant number of people, and the MMR also protects against mumps and rubella. If rubella (aka German measles) makes a comeback, we’re looking at many children being born with congenital abnormalities ranging from debilitating to deadly. Those are just two of over a dozen serious illnesses that could cause a lot of disease and a lot of death in children if vaccines continue to be rejected by more and more people.

Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: https://www.linkedin.com/in/renenajera Feel free to follow me on Twitter: @EpiRen

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