Measles surveillance and epidemiology

Epidemiology

Measles has been notifiable in England and Wales since 1940, and notifications varied between 160,000 and 800,000 cases per year, the peaks occurring in two-year cycles.

Before the introduction of measles vaccination in 1968, around 100 children a year in England and Wales died from the disease.

Measles notifications fell from 1968 until by the late 1980s, annual notifications had fallen to between just 50,000 and 100,000.

Following the introduction of MMR vaccine in October 1988 and the achievement of coverage levels in excess of 90%, notifications of measles fell progressively to the lowest levels since records began and the spread of measles was effectively halted by the mid-1990s.

However, 2006 saw an increase in the number of confirmed cases in the UK as whole and the first reported death from measles in the UK for 14 years. This increase continued throughout the following years, during 2012 there were 2,030 cases of confirmed measles in England and Wales with 118 in Wales.

Between November 2012 and July 2013, a large outbreak of measles occurred in Wales. The outbreak was centred around the Swansea area, but affected a number of other areas in Mid and West Wales. During the outbreak there were 447 cases of measles confirmed from the Mid and West Wales area, 64 cases were admitted to hospital and there was one death.

The outbreak was a consequence of low historic levels of MMR vaccination uptake in the area, temporally associated with media reports of MMR side-effects which have since been proven to be unfounded and inaccurate.

During a catch-up campaign which was implemented in 2013 in response to the outbreak more than 77,000 doses of MMR vaccine were given and this has reduced the potential for further outbreaks of this size in Wales. Analysis of data from this outbreak found that a two dose course of MMR vaccine was 99% effective in protecting against measles.

Since the outbreak in 2012/13, there has been a decrease in the number of cases of measles in Wales, although cases and smaller outbreaks have still occurred.

In 2016 there were 52 confirmed cases of measles in England in Wales linked to music and arts festivals between June and October.

Measles in Wales: 1996-2023

Chart showing the rate per 100,000 population and number of confirmed cases of measles in Wales from 1996-2023

Rate per 100,000 population and number of confirmed cases of measles in Wales from 1996-2024

* There were an additional 12 clinically compatible, untested cases.

** Data as at 31/07/2024.

UKHSA & Public Health Wales measles laboratory confirmations
Year	Number of cases	Rate per 100,000 population
1996	0	0
1997	0	0
1998	1	0.03
1999	0	0
2000	1	0.03
2001	3	0.10
2002	3	0.10
2003	44	1.50
2004	10	0.34
2005	0	0.00
2006	4	0.13
2007	13	0.43
2008	39	1.29
2009	159	5.23
2010	8	0.26
2011	19	0.62
2012	118	3.84
2013	506	16.82
2014	22	0.71
2015	0	0.00
2016	19	0.61
2017	21	0.67
2018	20	0.64
2019	11	0.35
2020	0	0.00
2021	0	0.00
2022	0	0.00
2023	9*	0.29
2024	17**	0.54

Confirmed cases of measles in Wales by age 1996-2024

Year	<1	1-4	5-9	10-14	15-24	25-34	35+	Unknown	All ages
1996	0	0	0	0	0	0	0	0	0
1997	0	0	0	0	0	0	0	0	0
1998	0	0	0	0	0	0	1	0	1
1999	0	0	0	0	0	0	0	0	0
2000	0	0	1	0	0	0	0	0	1
2001	0	0	0	1	2	0	0	0	3
2002	1	1	1	0	0	0	0	0	3
2003	1	19	12	5	4	2	1	0	44
2004	1	4	4	0	0	1	0	0	10
2005	0	0	0	0	0	0	0	0	0
2006	0	2	1	1	0	0	0	0	4
2007	0	7	5	1	0	0	0	0	13
2008	0	7	8	11	10	3	0	0	39
2009	13	37	49	36	16	4	3	1	159
2010	0	2	3	0	0	0	2	0	8
2011	2	2	4	4	5	1	1	0	19
2012	9	15	25	39	16	8	6	0	118
2013	31	48	48	164	152	34	29	0	506
2014	2	4	2	3	8	1	2	0	22
2015	0	0	0	0	0	0	0	0	0
2016	1	2	1	5	8	0	2	0	19
2017	2	4	2	8	3	2	0	0	21
2018	2	2	2	1	5	7	1	0	20
2019	2	1	1	0	2	1	4	0	11
2020	0	0	0	0	0	0	0	0	0
2021	0	0	0	0	0	0	0	0	0
2022	0	0	0	0	0	0	0	0	0
2023	1	5	1	1	0	0	1	0	9
2024	4	8	0	2	1	1	1	0	17

Confirmed measles cases in 2019-2023 by quarter of onset

Quarter	% of 2020 year total	% of 2021 year total	% of 2022 year total	Number of cases in 2023	% of 2023 year total	Number of cases in 2024	% of 2024 year total
Jan-Mar	-	-	-	0	-	2	11.8
Apr-Jun	-	-	-	0	-	15	88.2
Jul-Sep	-	-	-	6	66.7	-	-
Oct-Dec	-	-	-	3	33.3	-	-

Sources of surveillance data for Wales

Measles is one of a number of notifiable diseases. Doctors in Wales have a statutory duty to notify a 'Proper Officer' of the Local Authority of suspected cases of measles based on clinical symptoms, usually before diagnosis has been confirmed by laboratory testing. Reported notifications of measles usually far exceed the actual numbers of confirmed cases. Other rashes are often mistaken for measles.

Salivary samples are requested from all patients in Wales (and England) with suspected measles if confirmation hasn't been obtained by other means (i.e. a hospital blood test if the patient is an in-patient). Salivary samples are sent to UKHSA in Colindale for confirmation of measles infection.

These are the data that are used to produce the trends graph and accompanying data tables on this website.

It should be noted that during the measles outbreaks in 2009 and 2012/13 in Wales virological confirmation through laboratory testing was not undertaken for all clinically presumed measles cases.

Immunisation against measles

Measles can be prevented by a highly effective and safe vaccine. This is part of the measles-mumps-rubella (MMR) immunisation with a first dose at around 13 months and a second dose (booster) around three and a half years. Young adults and teenagers who have missed out on MMR vaccination as children are also encouraged to get immunised.

A complete course of the two doses will protect over 95% of children against measles, mumps and rubella.

The uptake of MMR (and other childhood) vaccination in Wales is recorded in the COVER (Coverage of Vaccination Evaluation Rapidly) report. This is published on both a quarterly and annual basis.

More information about the MMR vaccine.