PHE London North East and North Central London Health Protection Team
Ground Floor, South Wing
Fleetbank House, 2-6 Salisbury London EC4Y 8JX
T +44 (0)20 3837 7084
F +44 (0)20 3837 7086
www.gov.uk/phe
22nd August 2016
Dear Colleagues (GPs, Practice Nurses and Health Visitors),
Re: Increase in measles cases, London Borough of Tower Hamlets
Following on from the PHE London Letter regarding measles (May 2016); I am writing to let you know of an increase in measles cases specifically within the London borough of Tower Hamlets over recent weeks.
Since the beginning of 2016 Tower Hamlets has had 36 reported cases (12/100K), of which 10 are confirmed. Figure 1 below illustrates how notifications in the borough have been reported over recent weeks.
Figure 1. Measles notifications in residents of the London Borough of Tower Hamlets (01/01/2016 – 21/08/2016)
Cases are split evenly with 18 males and 18 females; the age band with the highest number of cases is the 0-4 yrs group. In response to the number of measles cases, we are recommending the following measures to protect you, your patients and your staff:
1. Reduce the number of susceptible people:
Opportunistic immunisation of any healthy person with two doses of MMR vaccine according to the schedule is important and should be carried out. There is no upper age limit, and extra doses of MMR will NOT cause problems in immunocompetent individuals. Promotional materials for MMR can be downloaded or ordered through the Department of Health website1.
2. Minimise spread to other patients:
Whenever possible we suggest placing signage in your surgery waiting areas advising patients with a rash illness to report to reception. PHE posters are available to download online. Should patients with a fever and rash attend during surgery when other patients are in the waiting room, they should be directed to a side room.
Advise any patient with a rash, especially if preceded by a fever, to telephone the surgery before turning up unannounced. Please make sure your receptionists know that ALL patients with a fever and rash should attend at the end of surgery to minimise the risk of transmission to others.
3. Urgent notification:
Please contact the NENCL Health Protection Team as soon as you suspect or become aware of a suspected case of measles. We run an out of hours service if you see a patient outside normal working hours. As you know, the window of opportunity for effective prevention of further cases in contacts is strictly limited to 72 hours following exposure, and cases will already have been infectious for a few days before the onset of their rash.
4. Staff safety:
Protection of healthcare workers (HCWs) is especially important in the context of their ability to transmit measles, mumps or rubella infections to vulnerable groups. While they may need MMR vaccination for their own benefit, on the grounds outlined above, they also should be immune to measles, mumps and rubella for the protection of their patients.
Ideally assessment of HCWs should be done through occupational health services.
Satisfactory evidence of protection would include documentation of having received two doses of MMR, or positive antibody tests for measles and rubella (Green Book 2006).
Unless a HCW has evidence of immunity (previous immunisation with two doses of MMR or documented positive IgG antibodies on serological testing to measles and rubella) they should be offered two doses of MMR for their own protection. Refusal of immunisation should be documented.
I hope this information will be of help. Please feel free to contact us if you have any questions.
Yours faithfully
Kemi Olufon
Health Nurse Specialist
1 NHS. Measles. Don’t let your child catch it.leaflet Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213839/dh_124026.pdf
Department of Health. Publications order line. Available from https://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf
Public Health England. Measles posters. Available at: https://www.gov.uk/government/publications/think-measles-poster-for-young-people and https://www.gov.uk/government/publications/think-measles-poster-about-measles-in-young-people