Immunisation & Vaccine Preventable Diseases

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Immunisation and Vaccines

Surveillance Report

07 April 2015

Measles, mumps, rubella and whooping cough illness, routine childhood vaccine uptake and teenage booster uptake

This quarterly report presents laboratory-confirmed cases of vaccine preventable diseases measles, mumps, rubella and whooping cough for the quarter ending week 12, 2015. Due to a change in notification reporting procedure, the publication schedule of these tables is currently under review and the customary notifications tables will not be presented in this report.

A commentary on laboratory-confirmed cases of measles, mumps, rubella and whooping cough for the whole of 2014, and vaccine uptake for the whole of 2014 is also provided. Vaccine uptake figures for the childhood immunisation programme for the quarter ending 31 December 2014 and for teenage booster uptake for the preceding two school years (2012-13 and 2013-14) are presented.

Measles

In the first 12 weeks of 2015 there were no laboratory-confirmed cases of measles (Table 1). This is lower than the number of laboratory-confirmed cases in the same period in 2014 (three cases), all of which were imported.

In 2014 there were 10 laboratory-confirmed cases of measles. This number is considerably lower than the number observed in 2013 (51 laboratory-confirmed cases and 3 probable cases). There were two clusters of measles cases in Scotland in 2014, involving five cases. One cluster was in the travelling community and the other in a family setting. There were a further five single cases which were all imported. The median age of confirmed measles cases was 8.5 years (range <1 to 34 years, mean age 14.8 years). All cases were unvaccinated or partially vaccinated (those who had not received the recommended two doses of MMR vaccine).

There has been a sharp increase in measles in Europe in the last five years with a large ongoing outbreak in Germany. Measles cases are under scrutiny in Europe, as measles is targeted for elimination by the World Health Organisation (WHO). The European Centre for Disease Prevention and Control (ECDC) publishes a monthly summary of measles activity,1 for which Health Protection Scotland submits national data.

Mumps

In the first 12 weeks of 2015, there have been 242 laboratory-confirmed mumps cases reported to HPS. This is a considerable increase from the 45 laboratory-confirmed cases reported in the same period in 2014 (Table 1).

The high number of laboratory-confirmed cases reported in Scotland in the first 12 weeks is associated with an ongoing outbreak of mumps linked to cases both in the community and educational establishments. Of those laboratory-confirmed cases who had reported ages, the median age was 21 years (range <1-84 years) and 68% were in the 15-24 year age band. A possible reason for young adults being disproportionally affected is that they are often underimmunised against mumps virus as they have not routinely been offered two doses of the MMR vaccine (measles, mumps and rubella). These people may have been part of the schools catch-up campaign in 1994 in which they received the MR vaccine (measles and rubella) which does not contain a component against mumps. Correspondence with CPHMs in the affected boards owever highlighted that a significant proportion of cases had received one or two doses of MMR and the observed increase in cases may also represent poor initial immune response to the mumps component of the MMR vaccine and/or waning immunity within the fully and/or partially vaccinated population.

In 2014 there were 286 laboratory-confirmed cases of mumps which is similar to the 239 laboratory-confirmed cases seen in 2013. Laboratory-confirmed cases in 2014 had a median age of 21 years (range <1-66 years). Where age was reported, 71% of laboratory-confirmed cases were in the 15-24 year age band.

Since 2004 there has been an ongoing widespread outbreak of mumps which has affected all areas of the UK. Although cases have decreased overall since the peak in 2005, mumps cases continue to occur steadily in Scotland.

Rubella

There were no laboratory reports of rubella in the first 12 weeks of 2015 as was seen for the same period in 2014 (Table 1). For the whole of 2014 there were no laboratory-confirmed cases of rubella compared with one imported case in 2013.

There has been a resurgence of rubella cases in Europe in the last five years. Rubella cases are under scrutiny in Europe, as rubella is targeted for elimination by WHO. ECDC publishes a monthly summary of rubella activity,1 for which Health Protection Scotland submits national data.

Whooping cough (Pertussis)

Since 2012, Scotland, along with the rest of the UK, has experienced an outbreak of pertussis. In 2012 and 2013 there were 1926 and 1188 laboratory-confirmed cases respectively. Whilst this declined to a total of 504 laboratory-confirmed cases in 2014, this still remains well above the levels historically seen in Scotland over the preceding 10-year period, for example 119 and 82 confirmed cases in the whole of 2011 and 2010 respectively. In the first 12 weeks of 2015 there have been 105 confirmed cases of pertussis, similar to the corresponding period in 2014 when there had been 103.

Young infants are the group most likely to develop complications from infection with Bordetella pertussis, which can require hospital treatment and in severe cases be fatal. In response to the increase in pertussis and in order to protect young infants in the first few weeks of life before they are old enough to start the routine childhood immunisation programme at eight weeks, a vaccination programme was introduced in October 2012 to offer pertussis vaccination to all pregnant women between 28 and 38 weeks gestation (inclusive). Vaccination of this group aims to boost immunity in the pregnant woman which is passed across the placenta to the unborn child and should provide protection during early weeks of life. In 2012 there was a total of 140 laboratory-confirmed cases of pertussis in infants under one year of age. This declined to 19 cases in 2013 and 20 cases in 2014 among demonstrating the positive impact of this programme in reducing the incidence of pertussis in young infants. As pertussis continues to circulate in Scotland, immunisation of pregnant women continues to be important. The immunity young infants will receive from the mother is only short term protection for the first few weeks of life, therefore it is important that infants are vaccinated as part of the routine childhood schedule in order to provide longer term protection.

Childhood vaccines uptake

Vaccine uptake remains generally high in Scotland. Quarterly uptake figures for children reaching ages 12 months, 24 months and five years by 31st December 2014 are shown in Tables 2, 3 and 4 respectively. Annual uptake of primary immunisation showing trends over time in uptake at 24 months is shown in Figure 2 and for uptake at five years in Figure 3. These are prepared by NSS ISD (National Services Scotland – Information Services Division) and were released on March 27 2015.2 There is further commentary on these uptake figures in the ISD statistics publication.

For the final quarter of 2014, uptake rates by 24 months of age for completing primary courses of diphtheria, tetanus, pertussis, polio, Hib (Haemophilus influenzae type B), MenC (meningococcal serogroup C) and PCV (pneumococcal conjugate vaccine) across Scotland remain high and stable between 93% and 98%. Uptake of one dose of MMR (measles, mumps and rubella vaccine) by 24 months was 95.4% (compared with 95.7% in the preceding quarter). Uptake rates for the two booster vaccines by 24 months (Hib/MenC and PCV given at 12 and 13 months of age) were 95.5% for the Hib/MenC booster and 95.3% for the PCV booster (96.0% and 96.0% respectively for the preceding quarter). See Table 3 and Figure 1.

For those reaching five years of age, uptake of at least one dose of MMR was 97.3% (compared with 97.7% in the preceding quarter) and remains above the 95% target for children receiving at least one dose by the age of five (i.e. before starting school) (Table 4, Figure 2). Uptake of two doses of MMR (MMR2) was 93.8% (down from 93.9% in the preceding quarter). This remains below the 95% uptake target.

For the whole of 2014, uptake rates of primary courses of immunisation given to those under one year remain high and stable around 96-98%. Uptake rates for the cohort of children reaching 24 months of age during 2012 are shown in Figure 1 and exceed the target of 95%. Uptake of MMR1 by 24 months has varied widely over the last decade due to unfounded concerns about the vaccine. MMR1 uptake levels reached a low in 2003 but have since recovered to the same levels as achieved in the mid-1990s. Booster doses of Hib/MenC and PCV given at 12-13 months were introduced into the schedule in 2006. Uptake of these boosters has risen since they were introduced and reached their highest level in 2013.

For uptake at five years, coverage with one dose of MMR remains above the target of 95% (see Figure 2). Uptake of two doses of MMR has increased across 2014 and reached its highest level in 2014, although is still under the target uptake of 95%. Uptake of pre-school booster (diphtheria, tetanus, pertussis, polio) remains high at 94.5%. Uptake rates for this booster and for MMR2 continue to increase as children age. There is further commentary on these uptake figures in the ISD statistics publication which accompanies this statistical release.2

Teenage booster uptake

These data are prepared by NSS ISD and were released on 16 December 2014.2 There is further commentary on these uptake figures in the ISD statistics publication. The teenage booster is given to children aged 13-14 years in school year S3. The teenage booster is a single dose of Td/IPV (tetanus, diphtheria and polio) 3-in-1 vaccine and completes the five-dose course to provide maximum protection against each of these diseases.

Teenage booster vaccine uptake data are presented for years 2012-13 and 2013-14. Data for school year S3 and S4 is shown, with data for S4 giving an indication of the number of missed doses from S3 which are given in the following school year. Figure 3 indicates that uptake in S3 is stable at around 84% and that further doses are given in S4 with an estimated 87% uptake after S4.

References

  1. European Centre for Disease Prevention and Control (ECDC). Measles and rubella monitoring reports. Available from: http://ecdc.europa.eu/en/healthtopics/measles/epidemiological_data/Pages/measles_surveillance_reports.aspx. (accessed 2 April 2015).
  2. NSS ISD. Child health web page with links to all vaccine uptake data. Available from: http://www.isdscotland.org/Health-Topics/Child-Health/Publications/index.asp. (accessed 2 April 2015).
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Author(s): Prepared by: Ross Cameron and Alison Smith-Palmer, Immunisation Team Vol: 49 No: 14 Year: 2015 Page:

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