2 February 2024
We know that many parents and carers of children and young people with cancer will be concerned about the rise in measles cases recently.
Immunosuppressed children are at higher risk than healthy children of developing prolonged and severe measles, and of suffering complications. We have worked with the UK Health Security Agency (UKHSA) to provide the guidance below.
What is measles?
Measles is a type of virus from the paramyxovirus family.
How is measles spread?
Measles is spread through coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.
Measles is one of the most highly communicable infectious diseases. Transmission is highest amongst close contacts such as members of a household or individuals who have close contact with each other over a long period of time or students in the same classroom. However even limited exposure to a measles case should trigger an assessment of an immunosuppressed individual.
What are the symptoms of measles?
The earliest signs of measles infection include:
- high fever
- runny nose
- cough
- red and watery eyes
- koplik spots (small red spots with bluish-white centres) inside the mouth
After several days, a rash appears, usually on the face and upper neck. The rash spreads, eventually reaching the hands and feet and lasts 5 to 6 days before fading. Measles is commonly confused with other infections that can lead to a rash.
What is the current problem with measles?
There has been an increase in the number of confirmed measles cases and local outbreaks being reported across England. Children under 10 years of age have been particularly affected in the current outbreak. The coverage of the MMR vaccine has fallen to its lowest level in a decade with national uptake of the MMR in 2 year olds at 89% and in 5 year olds at 84%.
What can be done to avoid exposure to measles?
All family members and close contacts of children and young people with cancer undergoing treatment should be fully immunised against measles. This means two doses of the MMR (measles, mumps, rubella) vaccine or a reliable history of previous infection. You can arrange this through your GP.
Vaccination with 2 doses of the MMR vaccine is 99% effective in preventing clinical measles.
Can my child or young person receive the measles vaccine to protect them?
The MMR vaccine is a live vaccine and is not recommended to be given to children while on active treatment. For children who have received standard chemotherapy, the MMR vaccine can be given 3 months after completion of treatment. Please speak to your treating team about timing of vaccination.
For children who have received a stem cell transplant, the vaccine schedule is dependent on different factors so please speak to your transplant team about timing of vaccination.
Can we find out if my child or young person already has immunity to measles?
All children and young people undergoing treatment for cancer are recommended to have antibody testing for measles immunity now. This is a blood test and will likely be combined with routine blood tests during treatment. Please speak to your treating team about this.
Your child may have had a test for measles immunity before starting treatment but we know that some children lose immunity to measles during cancer treatment, even if they have been vaccinated before. Knowing whether your child or young person has immunity to measles will help guide management in case of an exposure and provide advice around school attendance.
What should I tell my child or young person’s education setting or social groups?
Make sure education settings (nursery, school, colleges) and social groups are aware of your child’s compromised immune status and that they actively promote immunisation of healthy children. They should also be aware of the need to quickly alert you if a potential contact with a case occurs.
What should I do if my child is exposed to a potential case of measles?
You should make immediate contact with your specialist team. They will then contact the local Health Protection Team to assess the situation and decide whether your child should receive intravenous immunoglobulin.
What is intravenous immunoglobulin?
Immunoglobulin is made from donated blood and contains antibodies (proteins in the body) that help the body to fight infections such as measles. Intravenous immunoglobulin may be given to your child to prevent or reduce the severity of measles if your child is exposed and does not have immunity to measles already. A preventative dose of immunoglobulin is unlikely to offer additional benefit to children who have detectable measles antibody. Your treating team will advise on whether your child should receive immunoglobulin after an exposure.
Written by Dr Jessica Bate, Consultant Paediatric Oncologist, Southampton Children’s Hospital on behalf of CCLG with the Measles Response team UK HSA