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Measles: Europe sees record number of cases and 37 deaths so far this year

BMJ 2018; 362 doi: (Published 20 August 2018) Cite this as: BMJ 2018;362:k3596

Rapid Response:

Re: Measles: Europe sees record number of cases and 37 deaths so far this year

I am not surprised by the cynicism expressed by Dr Anand regarding public reporting and presentation of measles cases in Europe and the UK. The contempt has now spread to ordinary members of the public, particularly our young persons in the UK, most of whom will at some point, have had their schooling adversely affected by autistic fellow pupils and those with ADHD, a condition now recognised as part of the ‘spectrum’. Thinly spread ‘special needs’ resources has resulted in many of these pupils being educated in mainstream classes without any extra support, putting pressure on both teachers and pupils. Inevitably, the education of some pupils has suffered as a result.

With measles cases, Public Health England apparently has two opposing agendas. The UK public health agencies are all keen to retain the WHO measles elimination status granted in 2017. (1) At the same time they are determined to increase measles vaccination rates.
“The World Health Organization Regional Office for Europe [3] has confirmed that the UK has maintained its measles and rubella elimination status in 2017. This is a huge achievement and a testament to all the hard work by our health professionals in the NHS to ensure that all children and adults are fully protected with two doses of the MMR vaccine.”

In order to ‘ensure’ older children and adults are ‘fully protected with two doses of the MMR vaccine”, PHE has apparently resorted to scare tactics. Mysteriously, this same agency has published two separate sets of measles surveillance numbers for the first quarter of 2018. (2 & 3)

January –March 2018 (2):-
Notified 1202 :Tested 748 (62.2%): Positive 91(12.2%)
January –March 2018 (3):-
Notified 1201: Tested 750 (62%): IgM Pos 175: PCR pos 72
Other pos 3: Tested Locally 15: Total 265.

According to the PHE accompanying blurb (3):
“Recent infection is confirmed by measuring the presence of IgM antibodies or detecting viral RNA (by PCR) in these samples.
Samples that have been confirmed positive for measles or rubella are further sequenced and entered on the WHO global Measles Nucleotide Surveillance (MeaNS) or the Rubella Nucleotide Surveillance (RubeNS) system respectively which are hosted at the National Reference Laboratory. Genotyping and further characterisation of measles and rubella is used to support investigation of transmission pathways and sources of infection.”

This suggests samples are first tested for the presence of IgM antibodies. Oral fluid samples testing positive for measles, are then further tested for measles RNA strain for the reasons above. If that is the case then those 72 measles positive cases sent for RNA strain typing appear to have been counted twice in the final total, grossly inflating the number of cases. (3) The similarities in the numbers notified and tested in the two tables suggests the same data sets were used in both tables.

Curiouser and curiouser. The number of measles cases testing IgM positive in Table 1 for the second quarter of 2018 appears as 239 cases. This is also presented as the TOTAL number of cases in the same table, suggesting for the second 2018 quarter, IgM positive measles cases also sent for RNA testing were not counted twice in Table 1. (1)
April –June 2018.
Notified 1763: Tested 1161: IgM Pos 239: PCR pos 120
Other pos 48: Tested Locally 14: Total 239.

Conversely, the PHE blurb below Table 1 states the total number of positive measles cases to be 421, the sum of all the measles cases testing positive. (239 IgM + 120 PCR+ 48 other positives+ 14 tested locally)
This total, with regional breakdown numbers is repeated in Table 2. (1)

I am not disputing the veracity of the actual laboratory test results, but the way in which they have been presented seems confusing and misleading, not only to ordinary members of the public like myself, but to medical professionals and politicians too. Perhaps a representative of PHE would like to explain?

1. Laboratory-confirmed cases of measles, mumps and rubella (England): April to June 2018 Health Protection Report Volume 12

2. Measles cases confirmed by oral fluid IgM antibody tests and/or PCR in each quarter compared to the number of notified cases. January to March 2018

3. Laboratory confirmed cases of measles, mumps and rubella, England: January to March 2018 Health Protection Report Volume 12 Number 19 Advanced Access report 1 June 2018

Competing interests: No competing interests

17 September 2018
Jennifer Allan
By Dundee, Scotland