Responding to a measles outbreak

Nurses from Public Health England describe how collaboration helped contain an outbreak of the virus

Nurses from Public Health England describe how collaboration helped contain an outbreak of the virus

Picture: Science Photo Library

On 24 November last year, the health protection team at Public Health England’s West Midlands centre was notified of a laboratory-confirmed case of measles. A child in Birmingham had been admitted to a local hospital.

As expected, the virus spread quickly, and by 27 November seven further cases had been confirmed. Although measures were taken to contain the outbreak it had already spread from the child’s immediate community into the wider community.  

National incident

At the close of the outbreak in June this year, 116 locally confirmed cases of measles had been identified. Measles outbreaks were also reported in the South East of England, the South West, Yorkshire and Humberside, and the London area; a national incident was declared. 

Measles is a highly infectious viral illness that can lead to serious complications, such as pneumonitis, secondary bacterial infection, including acute otitis media and pneumonia, and encephalitis. 

It is spread from person to person through contact with nasal and throat secretions. Symptoms include a runny nose, coughing and sneezing, sore, red eyes, high temperature and small greyish white spots on the inside of the cheeks. 

A rash develops on the head or upper neck and spreads to the rest of the body. The average incubation period is ten days, and ranges from seven to 18 days.

Rush to increase community resilience

The best prevention is the measles, mumps and rubella (MMR) vaccine, as per the national childhood immunisation schedule. 

In the West Midlands, an incident-management team was quickly convened to respond to the outbreak. This included nurse representation from all stakeholders including the health protection team, the screening and immunisation team, school-aged immunisation services and health visitors.

The health protection team instigated public health actions to prevent the immediate spread of the disease, including risk assessment of the most vulnerable, which included babies under one, pregnant women and anyone with a compromised immune system. 

Other public health actions included offering MMR vaccination and human normal immunoglobulin to anyone who came into close contact with people with measles.

Limiting the outbreak

Public awareness of the outbreak was raised by: 

  • Contacting parents of children aged one to five, inviting them to check their vaccination status and receive the vaccine if required
  • Providing information about measles to health and educational organisations
  • Providing information to people in the community
  • Engaging with local authorities where measles cases were confirmed
  • Displaying posters in local businesses to encourage MMR uptake 

MMR uptake in the affected area was increased through:

  • Developing an MMR catch-up scheme in the area
  • Urging all West Midlands GP practices to offer MMR at every opportunity
  • Visiting schools with high numbers of pupils from the affected community and offering vaccinations


Although the majority of children in the UK receive the MMR vaccination, high uptake is required to prevent the spread of measles; at least 95% uptake is recommended. 

Staff should always take advantage of an opportunity to offer immunisation, and further work should be undertaken to identify communities in which MMR vaccination rates are low. Developing networks in underserved communities can also support immunisation uptake.

Confidence is key

Various lessons were learned from the outbreak. Children should be offered MMR in a timely manner, as per the national childhood immunisation schedule. Immunisers and those advising on vaccination need to be confident about promoting MMR and challenging any misconceptions about the vaccine.

Nurses play a key role in the response to an outbreak, both promoting and administering the MMR vaccine, and should ensure they remain up-to-date with information about measles and the MMR vaccination.  


Michele Lawrence is nurse consultant, Public Health England West Midlands 



Yvonne Green is screening and immunisation manager, Public Health England West Midlands 

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