What we know
What information do we have about the Eastern Board area?
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What is happening in the Eastern Board area?

Measles, mumps and rubella are viral illnesses, which nearly all children caught before the introduction of vaccination.  Although often mild they have the potential to cause serious complications in children, which can occasionally lead to death.  Rubella if caught by pregnant woman often causes severe abnormality or death of the developing foetus.  An estimated 450,000 people, the majority of them children, died from Measles in 2004 (the last year for which figures are available from WHO).  Younger children (particularly those under one) and immunosuppressed children are particularly at risk from measles, but even healthy older children may suffer severe complications.

Mumps, measles and rubella (MMR) vaccine was introduced in 1988, with a second dose (at pre-school age) introduced in 1994.  Two doses of vaccine provides excellent protection against the three diseases, and measles and rubella have both become uncommon in Northern Ireland (see below for information about mumps). 

Following the publication of an article in the Lancet in 1998 which suggested a link between MMR vaccine and the development of autism and/or bowel disease in children, MMR uptake rates fell.  Despite considerable subsequent research which has shown that there is no such link, and almost universal professional support for MMR vaccine, very low uptake rates have resulted in outbreaks of measles in young children in England, Wales and Dublin.  As a result of the outbreak in Dublin in 2000, three children died.

All three diseases are notifiable, and throughout the UK, salivary tests are requested on notified cases in order to confirm the diagnosis and thus monitor the effectiveness of vaccination.   This is particularly important as many viruses can give illnesses similar to measles and rubella.

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The Child Health System records information from GP practices on all childhood vaccinations, including MMR, and produces information on uptake.  This information is collated by CDSCNI as COVER/KORNER data on a quarterly basis. 

Uptake of first MMR vaccination by the age of 2 years in the Eastern Board has fluctuated between 87.1% - 89.5% in the four quarters from Jan 2004 - Dec 2005.

Many parents are delaying first MMR vaccination.  This is reflected in the uptake figures for first MMR at 5 years in the Eastern Board, which is high (94% for the quarter ending March 2005).  This delay leaves children at risk when they are more vulnerable to severe measles disease.  Delaying first MMR vaccine also has an adverse effect on second MMR uptake rates which are now around 83%.  This cumulatively results in considerable numbers of inadequately protected children.                  

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Measles, mumps and rubella are notifiable diseases ie clinicians suspecting the disease are statutorily required to report them.  Clinicians, usually GPs, are then requested to obtain saliva to confirm whether the patient actually has the disease.  MMR vaccination has been very successful in reducing the numbers of cases of measles with no confirmed cases of measles in EHSSB in 2003.  Equally there have been no confirmed cases of rubella, and no cases of congenital rubella in 2003.   This success story is at risk if low rates of MMR uptake persist.

An increase in cases of mumps started in Eastern Board area in mid-2003.  In 2004 there were 243 cases notified, with high rates of salivary confirmation.  A marked decrease was noted after the summer break in 2004.  This was followed by a very large and rapid rise in the early weeks of 2005, with 892 cases notified up to end of March 2005 and the year ending with a total of 1908 confirmed cases.

Most cases are teenagers and young adults who have received only one, or no, doses of MMR, leaving them incompletely protected against the disease.  This age-group (between 14 and 23) are too old to have been offered two doses of MMR but too young to have been in contact with mumps in the past, as mumps had become so uncommon.  Many of these teenagers have received measles-rubella vaccine in 1994.

Those attending schools and colleges/universities are more likely to be in contact with mumps, and many educational establishments have had outbreaks.

Although the low current uptake of MMR in young children is not the cause of this outbreak (which is due to mumps being introduced to a large cohort of young people who have not been offered two MMRs), younger children who are not up-to-date with their MMRs are at risk of mumps infection if they are in contact with it.  This adds to the importance of protecting young children with MMR currently.

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