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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

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 unde...

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Autores principales: Keenan, Alex, Ghebrehewet, Sam, Vivancos, Roberto, Seddon, Dan, MacPherson, Peter, Hungerford, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387959/
https://www.ncbi.nlm.nih.gov/pubmed/28363926
http://dx.doi.org/10.1136/bmjopen-2016-014106
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author Keenan, Alex
Ghebrehewet, Sam
Vivancos, Roberto
Seddon, Dan
MacPherson, Peter
Hungerford, Daniel
author_facet Keenan, Alex
Ghebrehewet, Sam
Vivancos, Roberto
Seddon, Dan
MacPherson, Peter
Hungerford, Daniel
author_sort Keenan, Alex
collection PubMed
description 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.
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spelling pubmed-53879592017-05-03 Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK Keenan, Alex Ghebrehewet, Sam Vivancos, Roberto Seddon, Dan MacPherson, Peter Hungerford, Daniel BMJ Open Infectious Diseases 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. BMJ Publishing Group 2017-03-30 /pmc/articles/PMC5387959/ /pubmed/28363926 http://dx.doi.org/10.1136/bmjopen-2016-014106 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Infectious Diseases
Keenan, Alex
Ghebrehewet, Sam
Vivancos, Roberto
Seddon, Dan
MacPherson, Peter
Hungerford, Daniel
Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK
title Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK
title_full Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK
title_fullStr Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK
title_full_unstemmed Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK
title_short Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK
title_sort measles outbreaks in the uk, is it when and where, rather than if? a database cohort study of childhood population susceptibility in liverpool, uk
topic Infectious Diseases
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387959/
https://www.ncbi.nlm.nih.gov/pubmed/28363926
http://dx.doi.org/10.1136/bmjopen-2016-014106
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