Uptake of the MMR vaccine in southeast London is among the lowest in the UK. Just over 60% of children aged 2 years in the boroughs of Lambeth, Southwark, and Lewisham had received a first dose of MMR vaccine by the end of the first quarter of 2003. Provisional data suggest there were 66 cases of measles reported in the second quarter.
Lead author, Eithne MacMahon from Guy's and St Thomas' Hospital NHS Trust, London, UK, comments: "The reappearance of measles in the community poses a severe threat to vulnerable immunocompromised individuals, including recipients of transplants. Without a substantial increase in the uptake of MMR vaccination, difficult challenges lie ahead. Measles is a notoriously infectious disease and will spread easily among those who are non-immune. Immunocompromised individuals may manifest only a non-specific illness without rash, which makes rapid diagnosis difficult and may delay measures to prevent further spread.
She concludes: "In this era of waning herd immunity [decreasing immunity in the general population], there is a need for renewed awareness of measles as a cause of non-specific, respiratory, or neurological symptoms in immunocompromised individuals. Special vigilance is needed in those individuals who have not had natural measles, are unvaccinated, or are only suboptimally protected after a single dose of vaccine. In view of our two cases, clinical colleagues should be alerted to the possibility of atypical presentations of measles in immunocompromised patients."
Contact: Anita Knowles, Director of Communications, Guy's and St Thomas' Hospital NHS Trust, Lambeth Palace Road, London SE1 7EH, UK; T) 44-0-20-7922-8120; E) anita.knowles@gstt.sthames.nhs.uk.
Journal
The Lancet