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Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK

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Keenan, Alex, Ghebrehewet, Sam, Vivancos, Roberto, Seddon, Dan, MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613 and Hungerford, Daniel (2017) 'Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK'. BMJ Open, Vol 7, Issue 3, e014106.

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Abstract

Objectives
There was a large outbreak of measles in Liverpool, UK, in 2012–2013, despite measles, mumps and rubella (MMR) immunisation uptake rates that were higher than the national average. We estimated measles susceptibility of a cohort of children born in Liverpool between 1995 and 2012 to understand whether there was a change in susceptibility before and after the outbreak and to inform vaccination strategy.

Design
Retrospective cohort study.

Setting
The city of Liverpool, North West UK.

Participants
All children born in Liverpool (72 101) between 1995 and 2012 inclusive who were identified using the Child Health Information System (CHIS) and were still resident within Liverpool in 2014. Primary and secondary outcome measures We estimated cohort age-disaggregated and neighbourhood-disaggregated measles susceptibility according to WHO thresholds before and after the outbreak for children aged 1–17 years.

Results
Susceptibility to measles was above WHO elimination thresholds before and after the measles outbreak in the 10+ age group. The proportion of children susceptible before and after outbreak, respectively: age 1–4 years 15.0% before and 14.9% after; age 5–9 years 9.9% before and 7.7% after; age 10+ years 8.6% before and 8.5% after. Despite an intensive MMR immunisation catch-up campaign after the 2012–2013 measles outbreak, the overall proportion of children with no MMR remains high at 6.1% (4390/72 351). Across all age groups and before and after the outbreak, measles susceptibility was clustered by neighbourhood, with deprived areas having the greatest proportion of susceptible children.

Conclusions
The risk of sustained measles outbreaks remains, especially as large pools of susceptible older children will start leaving secondary education and continue to aggregate in higher education, employment and other community settings and institutions resulting in the potential for a propagated measles outbreak.

Item Type: Article
Subjects: WA Public Health > WA 100 General works
WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services.
WB Practice of Medicine > Diagnosis > General Diagnosis > WB 293 Collections of clinical case reports
WC Communicable Diseases > Virus Diseases > Infectious Viral Skin Diseases > WC 580 Measles
WC Communicable Diseases > Virus Diseases > Infectious Viral Skin Diseases > WC 582 Rubella
Faculty: Department: Groups (2002 - 2012) > Professional Services
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjopen-2016-014106
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 18 Apr 2017 16:01
Last Modified: 06 Feb 2018 13:14
URI: https://archive.lstmed.ac.uk/id/eprint/6985

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