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January 2019

Strategy to address falling uptake of MMR

UK public health organisations have published a new strategy to ensure a future that is free of measles, rubella and congenital rubella syndrome.

Public Health England and its counterparts in Scotland, Wales and Northern Ireland have developed a strategy to tackle falling uptake of MMR vaccine, especially for the second dose.

Average uptake across the UK is 88%, well short of the WHO target of 95% needed to achieve population immunity.

PHE says there is a risk that the UK will lose its measles elimination status unless steps are taken to address vaccination ‘gaps’. This is considered vital as measles and rubella remain endemic in many other countries and, with current large measles outbreaks across Europe, imported infections pose a ‘very real threat’.

The four components of the strategy are:

1. Achieve and sustain coverage with two doses of MMR in the routine childhood programme (<5 years) at 95% or higher

2. Achieve 95% or higher coverage of MMR vaccine in older children through opportunistic and targeted catch-up

3. Strengthen measles and rubella surveillance through rigorous investigation and testing of at least 80% of all suspected cases with the oral fluid test (OFT)

4. Ensure easy access to high-quality, evidence-based information for healthcare professionals and the public

The strategy emphasises the importance of addressing gaps in funding and commissioning immunisation programmes, workforce planning and the capacity of the primary care workforce, in particular, practice nurses.

To improve delivery of the MMR programme in primary care, the strategy calls for additional catch-up elements to be added to the GP contract and relevant indicators to be added to QOF. It recommends opportunistic MMR checks and offer at all points of contact in primary care – ‘making every contact count’ and assessment of immunisation clinic access – such as appointment times, locations and waiting lists.

Since the introduction of the measles vaccine in 1968 it is estimated that 20 million cases and 4,500 deaths have been prevented. From 1970 to 2017, it is estimated that rubella vaccination has prevented 1,300 cases of congenital rubella syndrome and 25,000 terminations of pregnancy. The childhood rubella vaccination programme has averted 1.4 million cases of rubella.

Young people between the ages of 15 and 20 years are most susceptible to measles infection, and London is the most vulnerable region with immunity targets not reached in many age groups, including younger children of primary and secondary school age.

The National Immunisation Team is to develop a marketing campaign targeted at this age group to encourage them to check their status and take up MMR through primary care, and will also develop MMR resources for schools and school immunisers, and work with universities to support MMR checks and offer of immunisation for students.

WHO names vaccine reluctance or refusal as top ten threat

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.

The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.

In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.

Public Health England, Public Health Wales, Public Health Agency, Health Protection Scotland. UK Measles and Rubella elimination strategy 2019, January 2019.