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What are the numbers?

By mid March the total number of confirmed cases since 1 October 2023 was 733. An initial outbreak in the West Midlands has now been followed in other regions including London, the north west, Yorkshire and the Humber, and the East Midlands. Figures from the UKHSA show that the majority (63%) of the cases were in children aged under ten years and 30% aged over 15 years. UKHSA warns that unless urgent action is taken, it is likely the virus will spread rapidly to other regions where MMR vaccination uptake is low. And the issue is not confined to the UK – there was a 30-fold increase in cases in Europe in 2023, according to the World Health Organization.

What are the factors behind the rise?

Official figures show uptake of the vaccine is at its lowest level in more than a decade. This low participation is thought to be the main reason behind the rise in cases, despite the UK having been declared measles-free in 2016. On average, the proportion of children who start school having had both MMR doses has dropped to about 85%, according to UKHSA. The recommended rate to halt spread is 95%.

Misinformation that leads to vaccine hesitancy, and a perception among some sections of the public that measles is not a serious disease, are likely to be influential.

What advice should nurses communicate to parents who are worried?

Open University lecturer in children and young people’s nursing Liz King comments: ‘I have colleagues who work in A&E and they’re usually the first ones to see these children come in unwell. They report that it is frustrating for them because it’s so preventable.’

Queen’s Nurse and immunisation specialist Helen Donovan says it is important to keep supporting people to get their vaccination. ‘It just needs to have that constant pressure from all of us to keep those vaccine services going. You can’t take your foot off the pedal,’ she adds.

Dr King and Ms Donovan say they strongly encourage parents to have their children vaccinated as soon as possible by contacting their GP surgery. ‘This is the key message. It’s a good vaccine, it’s free, safe, effective and and it’s never too late – everyone should make sure they get their two doses,’ says Ms Donovan.

What are the symptoms of measles and what should I look out for?

The first symptoms can be cold-like, such as a fever, red and watery eyes, cough, runny nose and sneezing. Small white or grey spots, called Koplik’s spots, can then develop inside the cheeks and back of the lips. A rash usually appears a few days after the first symptoms. It starts on the face and behind the ears, before spreading to the rest of the body.

It appears brown or red on white skin but can be harder to detect on black or brown skin.

Nurses assessing patients with darker skin tones should expose the torso fully and use adequate lighting to see the rash, which could be red or slightly purple in colour.

How does measles spread and how infectious is it?

The virus is highly contagious. It spreads through coughing or sneezing and can lead to severe illness, with roughly 20-40% of infected children requiring hospital admission, the UKHSA says.

The European Centre for Disease Prevention and Control estimates 90% of non-immune people exposed to someone with the virus will contract it, and every person who has the virus can infect between 12 and 18 people.

Care and symptom management of children with measles

People presenting with suspected measles should be isolated immediately and kept away from immunocompromised individuals and other vulnerable people. The local health protection team should be notified immediately and staff should seek advice on management if the person has a measles-like rash and is in one of the at-risk groups, states the National Institute for Health and Care Excellence. The UKHSA guidance also sets out how to manage symptoms in these patients. For other adults, the advice is the same as for children, including staying off work for at least four days from onset of rash. Patients should be advised to seek urgent medical advice if they develop any complications (see left).

Which population groups are particularly at risk of contracting measles?

Groups at increased risk of infection include infants who are under the age of one and too young to be immunised, pregnant women or trans men or non-binary individuals who are pregnant, unvaccinated people, those who are immunosuppressed or living with chronic conditions.

Children usually get their first MMR vaccination at the age of one, followed by a second dose at three years and four months.

Are there any infection-control measures that I should take if caring for a patient with measles?

Newly published NHS England infection control guidance on measles states all staff should follow standard infection control and transmission-based precautions as set out in the national infection prevention and control manual for England. Patients with suspected measles should be isolated immediately and prioritised for assessment and treatment.

Nurses caring for patients with measles should wear personal protective equipment including gloves, apron or gown, mask and goggles or a visor to keep themselves and others safe. R

R Dr King says: ‘Like any child or any patient that comes in with an infection, you have to start instigating barrier nursing. If there is a pregnant member of staff on shift, you have to think about what you’re going to do with them or anyone else that is immunodeficient. There are ramifications because you’ve now potentially got a child who’s very ill and contagious.’

Should I continue to go to work if someone in my own family has measles?

If you are vaccinated or immune because you have previously contracted the virus, you are not likely to get it. Guidance from UKHSA says management of close contacts depends on whether the individual is immune and/or vaccinated.

The guidance recommends any unvaccinated or non-immune staff exposed to the virus should be sent home. The amount of time they are sent home for varies depending on how long they have been exposed to the virus.

The guidance says: ‘[They] should be excluded from work from the fifth day after the first exposure to 21 days after the final exposure.’ For example, if an unvaccinated or non-immune nurse were exposed to measles for three days, they would be excluded from work from day six to day 24.

NHS England guidance adds that, if appropriate, personal protective equipment including respiratory protective equipment is worn during face-to-face contact with a patient who has measles, the staff member is not considered to have been exposed. Those who can prove they have been immunised can continue to work normally, but should report to their occupational health team if they develop symptoms or a fever between seven days after the first exposure and 21 days after the last exposure.

Any staff member who develops a rash should be excluded from work until four days after its onset, the guidance adds.

For more information and to see this article online, go to rcni.com/measles-surge