Introduction

Measles has reappeared in the United Kingdom, with 449 confirmed cases to the end of May 2006 compared with 77 in 2005, and the first death since 1992.¹² Cases are occurring in inadequately vaccinated children and in young adults, leading to concerns that endemic measles could re-emerge. But, as with smallpox, measles could be eradicated. It has been eliminated in the Americas since 2002. The World Health Organization has set 2010 as the target for elimination in the European region, where 29 000 cases were reported in 2004.3 Much ground will have to be regained in the United Kingdom if the 2010 target is to be met.

We review the uptake of the combined measles, mumps, and rubella (MMR) vaccine in the United Kingdom and Europe, and identify susceptible groups. As clinical experience of measles has declined, doctors in the United Kingdom may not consider the diagnosis nor recognise a case. We also therefore consider the diagnosis, management, and control of measles infection.

Measles epidemiology and transmission

Measles is caused by a single stranded RNA virus of the genus Morbillivirus from the paramyxovirus family.4 It is among the most contagious of diseases,5 with a basic reproductive number (R₀) of 15-20 (box 1).6 The virus remains transmissible in the air or on infected surfaces for up to two hours, obviating the need for direct person to person contact.⁵⁷ Although genetic drift of the viral RNA is documented,4 measles has only one serotype, and both infection with wild type virus and appropriate immunisation confer longstanding immunity.7 Despite this, measles remains a leading cause of vaccine preventable death worldwide. In 2004 an estimated 454 000 deaths were due to measles.5 Mortality from measles is highest in children aged less than 12 months8 and in …