It’s been a while, but there’s good news and bad news about the UK measles outbreak:
Bad news: The situation is pretty much the same, with cases growing steadily in London.
Good news: The situation is pretty much the same, with cases growing steadily in London.
In other words, measles is still around, still finding opportunities to grow in the unvaccinated population, and could still explode into a bigger outbreak at any time: when it finds a large chain of unvaccinated transmission and manages to display its underlying R0 of 12-18.
But this explosion has not yet happened - whether from luck, or because even the low levels of vaccination we do have are keeping it in check. We’re running at about 80 cases confirmed a week, about half of these in London, with the spike in Birmingham now running down.
(Latest numbers from the UKHSA: note the last few data points are incomplete and will be revised upwards).
Where else should we be looking?
An oft-repeated horror movie trope is when the protagonist has seen off one monster, but then comes across some sign - broken bars on a cage, or similar - that tells them that there are likely to be more monsters lurking in the shadows, probably just behind them.
In our case, as we look at at the well-monitored measles cases and thinking they are bad but could be worse, we suddenly realise that it is not just MMR, but childhood vaccination levels of all types that have been falling for years in the UK, and especially in London. So we might worry that other long-suppressed diseases might start popping up - particularly in the youngest,
Unfortunately, this does indeed seem to be happening. Whooping cough, or pertussis, is having a hell of a moment.
However, much of the reporting on this outbreak (even that shared by people like GAVI) is focusing on the artificial suppression of transmission of pertussis during lockdowns, and interpreting the current resurgence as simply the effect of contact levels returning to “normal”.
Unfortunately, one glance at the numbers is sufficient to tell you that while a post-lockdown rebound is certainly an effect, it would be … bold to consider it to be the only factor. So when the linked article goes on to say:
“What we are seeing now is a partial return to the pre-COVID situation and not an unprecedented surge in infections. (Although the reported cases represent only a fraction of cases in the community.)”
… we are seeing a categorical statement which has - to put it mildly - not aged well.1
The factor ignored (oddly, given GAVI’s core competence) is recent vaccination levels. Whooping cough is prevented by the 6-in-1 vaccine that’s given to newborn babies at 8, 12, and 16 weeks. At least … it’s sometimes given.
In addition, since the worst effects of whooping cough are in very young children (the eight kids who died from whooping cough from January to April 2024 were all very young), the other programme is to offer vaccination to women in pregnancy, so their children are covered when they are born - protection that lasts until they can be vaccinated themselves. Unfortunately, these rates are even lower - and again, falling, especially in London.
Who’s worrying?
While the UKHSA official response is also on the “it’s just a cyclical, plus post-lockdown effect” framing, other parts of the authority appear to be more concerned by the surge in whooping cough. Their press office have started putting out personal stories to emphasise the seriousness of the disease, and the importance of vaccination (Warning - the article linked is about the death of a young child, and it does not pull any punches at all. If you’re not sure, don’t read.)
Of course, the UKHSA are trying to raise awareness because - similarly to measles - there is a heartbreakingly simple2 response to the current whooping cough situation: get the 6-in-1 vaccine back over 95% coverage, and - to be safe - get maternal vaccination back into 80% rates or above.
While we are looking around, it’s also worth considering the other diseases that the 6-in-one vaccine prevents. Of all the things we could do without in the UK right now, diptheria, tetanus, Hib and hep B are right up there.
All are beaten however, by the last childhood disease we rely the 6-in-1 vaccination to prevent: polio.
To be fair, this statement was made in late December 2023, when this was not so clear. There is also the fact that the rates in the mid and late 2010s seem to have had significantly lower rates of pertussis than pre-2012, an effect that is not fully understood - it cannot be fully accounted for by vaccination levels.
Simple is not the same as easy.
Read this with my 14 week old asleep on me and feeling incredibly grateful that I was vaccinated against whooping cough in pregnancy and that the baby has had two rounds of 6 in 1 herself.
Anecdotally, the experienced nurse who vaccinated her said she has more and more parents decline the jabs every year, and that they can rarely give her a reason for that decision when asked.
I have a feeling (but no evidence) that we may be seeing the effect of older children who have not had the 6-in-one vaccine introducing whooping cough to households with new babies. So catching up with missed 6-in-one vaccines maybe as important as the uptake rate in new babies themselves.
It would be great if midwifes where willing and able to discuss vaccination of the complete household with women in pregnancy and offer the vaccines at any appointment for any child that is brought to the appointment.