Incidence Rates of Measles in London

By Katie Cummings

Measles became endemic to England in the 18th century. In 1859, the Medical Officer of Health for St James’s, Westminster stated that when one person died from measles then ten more contracted the disease. He recorded that it was highly contagious and was spread easily to others, especially small children. This is very evident in multiple reports that I found while researching measles in the London’s Pulse reports. The reports of incidence that I found were ones of children, different suburbs, infection rates, death rates, the measles in London versus the measles in Germany, number of cases before and after the vaccine, and the seasonal incidence that occurs with measles.

The first report that I looked into by the MOH for Shoreditch in 1931 indicated that measles was responsible for 12 percent of all deaths of children under 5 years of age, in that year. The incidence rate was often much higher among children than adults. This was interesting because they talked about the multiple ways in which the public health department was intervening in the school system and with the incidence rate in children.

On this same topic the report from St Pancras in 1910 stated that the largest group that was at risk for fatality from ages 0-1, 1-2, 2-3, 3-4, 4-5, was the 1-2 year old group, but the largest group that was at risk at the time for measles attacks were the 2-3 year old group. These two reports were made before a vaccine became available. When comparing areas of England there are multiple reports that compare the suburban areas like Shoreditch to urban areas like London. This report indicated that over the years of 1922-1931 there were larger amounts of deaths in London over Shoreditch. However, when comparing the death rate per population, London’s death rate by measles was significantly lower due to the ratio of the population, all of this data was also recorded before the vaccine was available. It is significant that they included the population in one of the data groups because there was then a comparison in terms of per 1000 people.

The next reports that I looked at were ones that compared different infectious diseases in a broad range of age groups. Looking at the 1966 report from Ealing the medical officers record the rates of infection that occurs in scarlet fever, whooping cough, measles, dysentery, and meningococcal infection across all ages. Measles was by far the largest group of infectious disease with a total of 611 cases for females and 603 cases for males. Comparing this to the second largest group of dysentery at 144 for females and 150 for males. Measles was the highest rate in all ages except for that of dysentery for ages 10 and over.

There were two different kinds of measles throughout the 19th and 20th centuries in England, the measles and the German measles. One of the health reports from Lambeth in 1926 recorded the incidence and death rates of measles and German measles at this time. German measles would now be considered the disease Rubella, which is a milder form of the measles virus but behaves similarly. The reports from this time show the incidence and death rates across different areas being much higher for measles at 16.55 incidence rate and a 0.21 death rate compared to German measles at 0.71 incidence rate and a 0.003 death rate. This was significant because due to the data the different medical boards decided that it would be beneficial to have more accommodations in their hospitals for the measles cases.

According to the MOH report from Wandsworth in 1970 and many other sources we are able to see a general trend in the data that measles incidence rises and falls with alternate years, this report did show a general trend of decreasing due to the implementation of a vaccine in 1966. As you can see in the image below of the measles cases in England and Wales from 1940-2007 there is a dramatic decrease in the case numbers once the vaccine is introduced. When looking at the report from Bromley 1972 you can see two different trends. We see the general decrease in cases as the vaccine is implemented, in 1965 the number of cases notified was 5,119 versus 7 years later the number of cases identified were 853. We also see the pattern that there are alternating years of increased infection rates, in 1965 there were 5,119 cases and then in 1966 there were 1,236 cases and then in 1967 it increased again at 4,299, this is a common theme among the infection of measles. Overall, there is a large amount of data that was recorded at this time period across multiple areas of England. This was extremely important because it allows us to make inferences about infection and who it is infection. This helps public health in terms of aspects of the ways in which they can control the disease and reduce the transmission in infectious diseases, like measles.

Primary Sources: Medical Officer of Health Reports

Shoreditch 1931

St Pancras 1910

Lambeth 1926

Southall 1962

St Pancras 1882

Lambeth 1896

Ealing 1966

Wandsworth 1970

St. James 1859

Bromley 1972

Secondary Sources

Anderson, Grenfell, and May. “Oscillatory Fluctuations in the Incidence of Infectious Disease and the Impact of Vaccination: Time Series Analysis.” Journal of Hygiene 93, no. 3 (1984): 587-608.

Barkin, Roger M. “Measles mortality: a retrospective look at the vaccine era.” American journal of epidemiology 102, no. 4 (1975): 341-349.