• London records nearly 150 cases – nearly half of which are in one local authority
  • Scale of outbreak linked to low vaccine uptake
  • One in five patients in England hospitalised

Measles is on the increase in London with infections in the first quarter of 2019 outstripping the same period last year by more than a third.

According to data from Public Health England, 149 measles infections were confirmed in London between January and March this year. Almost half of the infections were found in one north east London borough alone, with 70 laboratory-confirmed infections found in Hackney.

By comparison, London recorded 107 cases in the first quarter of 2018.

Low vaccine uptake is thought to be responsible for the spread of the disease. Parents are now being urged to make sure children are vaccinated against the disease, which can cause serious health complications, including vision problems, hepatitis, meningitis and encephalitis

London reports one of the lowest rates of uptake of the jab, and roughly two-thirds of confirmed measles cases in London were in children under 15. 

According to PHE, the highest number of cases in the first quarter of the year occurred in boroughs across north London, from Brent in north west London to Hackney in the north east. Clinical commissioning groups are working with GPs, NHS England and PHE to promote vaccine uptake.

Cases recorded in City and Hackney CCG have been associated with the area’s Charedi Orthodox Jewish community. Vaccine uptake has been “consistently lower than the rest of the borough and the rest of England,” according to PHE’s measles elimination plan published in January.

The community has endured five or 10-times higher rates of infection than the rest of Hackney, the plan said. This year appears to have followed the same pattern, though the CCG said the infections recorded in the community have significantly declined through May.

The CCG has recorded 204 likely infections from January to March this year with around a third confirmed following lab testing. Four cases have been hospitalised, according to Homerton University Hospital Foundation Trust.

PHE’s health protection team has “been working closely with City and Hackney CCG, GP practices, schools, nurseries and children’s centres to raise awareness,” the CCG told HSJ in a statement.

“The CCG also funded extra clinics across the borough and we have seen an improvement in uptake from the extra clinics and thanks to the efforts of staff within GP practices,” the CCG said.

North west London is also experiencing a measles outbreak. According to preliminary reports to London’s health protection team, 31 cases have been reported in April and May, double the number reported in the first three months of the year.

West London GPs are urging patients to phone ahead if they suspect they or their child have measles, so they do not risk exposing susceptible patients to the virus.

The city’s highly mobile and dense population, with people moving between boroughs as well as flying in and out from other countries, means infections such as measles “are imported more frequently [and] can be spread more quickly,” according to Jamie Lopez Bernal, a consultant epidemiologist at Public Health England.

“A third of children will have moved house at least once by the time they are one year old,” he said. “As children move, there has been a tendency not to register promptly with a new GP, so invitations to appointments for pre-school boosters will not go to the correct address and children may miss out.”

Measles in England

In contrast to London, England as a whole has reported fewer cases of measles so far in 2019. Last year, England recorded its largest measles outbreak since 2012, with 966 infections.

This year, there have been 231 laboratory-confirmed measles infections across England in the first quarter of the year – fewer than the 265 recorded last year.

This year’s hospitalisation rate is also lower than in 2018, with one in five patients in hospital compared with more than 30 per cent the year before.

In addition to London, PHE also identified the north west and the east of England as areas associated with outbreaks of the disease. 

Vaccine coverage across England is below the 95 per cent target. Nearly 70 per cent of this year’s measles cases are in children aged under 15

Update: this post was updated at 11:44 on 10 June to identify the London local authorities where the highest number of cases had occurred, rather than the CCGs where the highest number of cases had been recorded.