Barnet, in common with all other London boroughs, now faces the likelihood of a measles
epidemic. In the last year of so the number of children and adults catching measles – the
most contagious disease that there is – has been much higher than in past years and
there have been several outbreaks, as shown in Figure 1.
Figure90 The number of reported cases of measles in Barnet in recent years
2005/06 2006/07 2007/08
reason that so many people have caught measles and the fact that we now face the very
real risk of a measles epidemic is because there are now so many children whose parents
have refused consent for them to be immunised with measles, mumps and rubella
vaccine. The ‘herd immunity’ of the population is now sufficiently low to enable each
person with measles to infect more than one other person. The problem of measles is
more widespread in other parts of London, as shown in Figure 2.
Figure 2: Notified cases of measles in London by sector and district between 1
January and 5 July 2008 Source: Health Protection Agency. Measles and MMR uptake in
Figure 3 shows how MMR immunisation rates have dropped, more so in London than in
the rest of the country.
Figure 3: MMR uptake at age 2 years for London and UK – January 1996 – March
Source: Health Protection Agency. Measles and MMR uptake in London, 2008 Cover data
and trends in vaccine uptake 2005-2008
Figure 4: Immunisation rates in Barnet by children’s fifth birthdays
Hib primary MenC
MMR 2nd dose DTaP/IPV booster
MMR 1st dose
Q3 05/06 Q4 05/06 Q1 06/07 Q2 06/07 Q3 06/07 Q4 06/07 Q1 07/08 Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09
Quarter in each year
Figure 4 shows the current achievement in immunising children in Barnet for:
first course of diphtheria, tetanus, pertussis and polio;
first dose of Haemophilus influenzae B;
first dose of measles, mumps and rubella (MMR);
second dose of MMR; and
diphtheria, tetanus and pertussis and inactivated polio booster.
This shows clearly that MMR immunisation rates in Barnet are very substantially below the
level required for safety, i.e. to avoid measles outbreaks and to avoid a measles epidemic,
although they are beginning to increase.
The relationship between diversity and deprivation and infectious disease
Data on ethnicity and religious belief are not currently routinely recorded in the context of
childhood immunisation. However, it is apparent that in the North East and North central
London area, the majority of people affected by measles have been Jewish (see Figure 5).
It is not clear why this should be and it is not apparent that this is the case in Barnet.
Figure 5: The number of reported cases of measles in North East and North Central
London in 2007/2008 by religious/ethnic group (Source: Health Protection Agency)
White: Eastern European
Any Other ethnic group
Mixed: Other Mixed
Mixed: White & Black African
Mixed: White & Asian
0 50 100 150 200 250 300
Number of reported measles cases
In common with other London PCTs, Barnet has agreed to increase all of its childhood
immunisations to 90% by 2010/2011. Figure 6 shows the trajectory for MMR, which is the
most challenging as all other childhood immunisation rates are currently in the high
eighties and thus closer to the target.
Figure 6: The trajectory for immunisation rates for MMR by the age of two years
Proportion (%) of 2-year olds with first MMR immunisation
actual estimate trajectory
2004_05 2005_06 2006_07 2007_08 2008_09 2009_10 2010_2011
Source: Barnet PCT Operating Plan
Key things that need to be done
The key activities required are:
ensuring the accuracy of immunisation records – it is apparent that a lot of children
have been immunised but the fact has not been recorded on the PCT’s child health
bolstering the immunisation call system to ensure that all children who need
immunisation (because it is due or have, apparently, been missed) are invited for
providing immunisations in various sites, e.g. GP surgeries, community pharmacies,
A&E departments, walk-in centres, children’s centres, children’s outpatient departments;
promoting immunisation widely, using social marketing techniques, to better ensure that
the right message is received; and
working with local community and religious leaders, and in schools, pre-school facilities,
children’s centres, NHS facilities and other places to promote immunisation.