1. Measles clusters in London and East of England

Measles activity in England has been at historically low levels since the MMR catch-up campaign in 2013, with 103 and 91 cases confirmed during 2014 and 2015, respectively.

However an increase in measles was observed at the end of 2015 with two identified clusters in South East England: one associated with an importation from Somalia (five confirmed); and the second following an importation from Spain (25 confirmed) between October 2015 and January 2016. These close clusters were both B3 genotype virus [1].

Since the beginning of February 2016, cases of measles have been confirmed across London and the East of England (Cambridge, Essex and Hertfordshire), predominantly in unimmunised adolescents and young adults (aged 14 to 40 years) without a history of recent travel. Many of these cases have been admitted to acute medical wards without isolation including one in intensive care. Of the 20 cases confirmed since 1 February 2016, samples from 10 cases, including cases from all four areas, have been genotyped at the UK reference laboratory in Colindale and nine are the same genotype D8 strain, indicating a common source. The other case (from London) is also a D8 genotype but of a different strain.

Many of these cases have presented to A&E departments rather than primary care and as these cases have been in older age groups without a history of travel, measles has often not been considered as part of the differential diagnosis. As a result, some of the cases have not been notified or investigated in a timely manner.

PHE Health Protection Teams should be aware of the recommendations of the National Measles Guidelines [2] on the management of all suspected cases. Public health management should proceed for all suspected cases with an epidemiological link to a laboratory-confirmed case without the need for laboratory testing. Cases without an epidemiological link should be investigated according to the guidelines. Urgent testing may be required where vulnerable contacts have been identified. Post-exposure prophylaxis should be offered to vulnerable contacts (immunocompromised individuals, infants and pregnant women) according to the Guidance for Post-exposure Prophylaxis for Measles [3].

1.1 References

Public Health England continues to monitor notifications of scarlet fever cases in England following the high levels recorded last spring. According to the second report on group A Streptococcus activity for the current 2015/16 season [1], typical seasonal increases in scarlet fever activity are being reported across England and, as of early-February 2016, activity remains elevated suggesting this may be the third year in a row with high levels of scarlet fever incidence. Invasive disease rates are above average, but remain within the upper bounds of normal seasonal levels for this time of year.