'Expect outbreaks of measles'

Primary schools should expect unprecedented outbreaks of measles as use of the MMR vaccine plummets.

A report by London's director of public health warns of the potential for the disease to re-emerge as growing numbers of pre-school children who have not been vaccinated move into primary education.

It adds that it is most likely to happen in London, which has the lowest take-up rates of the jab.

Of the 91 confirmed measles cases across the country last month, 70 were in the capital.

Because public concern over possible links between the MMR vaccine and autism began only four years ago, most children who have not received the jab are under four and most measles cases have been at nursery schools.

But the report, compiled for the Greater London Assembly, says that primary schools should be on the lookout as that group of children moves on.

Dr Sue Atkinson, director of public health for the NHS, warns of repeated outbreaks in years to come unless immunisation rates improve.

She writes in the report: "It is expected that the pattern of outbreaks will continue in London in successive winters if the current rates of immunisation coverage do not recover, although there are some signs that recovery is beginning.

"The Public Health Laboratory Service estimates that there is now potential for primary school outbreaks, and that these are most likely to occur in London." A spokeswoman for the PHLS said: "Outbreaks in primary schools are no more serious than in nursery schools - if anything older children are less at risk - but it is more likely to happen now as the current cohort of children who are less likely to be immunised gradually reach primary school age."

The report, compiled to give a London-wide perspective on the take up of the vaccine, highlights the way MMR coverage has declined over the past five years, especially in the last two - from 87 per cent in 1995 to 73 per cent in 2001. It cautions against a wholesale swap to the alternative series of three individual measles, mumps and rubella vaccines, saying it would involve repeated appointments over "a considerable period of time".

With rates of take-up already low in London's most deprived areas and immigrant communities, this would lead to a "pool of unprotected children", and create "conditions where there would be a resurgence of not just measles, but mumps and rubella, as well as all the serious complications that attend those diseases."

Current rates of MMR vaccine takeup are now beginning to show signs of increasing, it adds, thanks to education campaigns being carried out by London's 16 health authorities.