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Following a school-based measles-rubella vaccination campaign in November 1994, enhanced surveillance of measles, including IgM antibody testing of oral fluid from clinically diagnosed case-patients, was introduced in England and Wales. Between 1995 and 2001, 665 cases of measles were confirmed, including 371 (56%) confirmed only by IgM detection in oral fluid. Two hundred thirty-nine cases (36%) were sporadic and 426 (64%) were associated with 61 clusters. Fifty-four (23%) of the 239 sporadic cases and 26 (43%) of the 61 clusters were associated with a probable or possible importation of infection from overseas, and a wide variety of genotypes were identified in each calendar year. The effective reproduction number for measles over the period was estimated to be below 0.7. These data suggest that most measles in the United Kingdom is acquired following limited transmission from an imported infection, and they confirm that measles elimination has been achieved and sustained over this period.

We describe the epidemiology of the first nationwide outbreak of measles infection in the UK since the implementation of a mass vaccination campaign. Notifications of infectious diseases, interview and postal questionnaire identified 293 clinical cases, 138 of which were confirmed by salivary IgM, measles virus isolation and PCR. Twelve were epidemiologically linked to confirmed cases. The outbreak began in London, after contact with measles infection probably imported from Italy. Measles genotyping determined by sequence analysis confirmed spread to other unimmunized anthroposophic communities in the north, south west and south coast of England. Only two cases had been vaccinated against measles infection, and 90% of cases were aged under 15 years. Measles virus can selectively target non-immune groups in countries with high vaccine uptake and broader herd immunity. Without harmonization of vaccination policies and uniform high coverage across Europe, the importation and spread of measles virus amongst non-immune groups may prevent the elimination of measles.

Three hundred nine mumps virus (MuV) strains detected in the United Kingdom during 1995-2002 were characterized by partial sequencing of the small hydrophobic gene and were shown to belong to at least 6 different genotypes. A strain representing a new genotype was isolated from a seminal fluid specimen. Identical strains belonging to genotypes G and C were found to circulate for up to 3 years. One genotype H strain reappeared after an absence of 4 years. Distinct lineages (G1-G7) within genotype G were recognizable in the present study, and this level of characterization proved to be very useful for tracking MuV importations and subsequent transmission. We propose, here, a preliminary standardization of international nomenclature for genetic characterization of MuV strains, to facilitate future molecular epidemiological studies of mumps. Oral fluid (OF) specimens (n=1441) were used to detect both anti-MuV IgM and MuV genome, and the results indicate that OF specimens can be used successfully for diagnosis and have the potential to play a valuable role in diagnosis and surveillance of mumps.

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