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In November 2017, eight confirmed measles cases were reported to Public Health England from a hospital in the West Midlands. A multidisciplinary incident management team (IMT) was established to determine the extent of the problem and coordinate an outbreak response. Between 01 November 2017 and 04 June 2018, a total of 116 confirmed and 21 likely measles cases were linked to this outbreak; just under half (43%) were aged over 15 years of age. 55 of the confirmed cases were hospitalised (48%) and no deaths were reported. At the start of the outbreak, cases were mostly individuals of Romanian origin; the outbreak subsequently spread to the wider population. Over the 8-month response, the IMT conducted the following control measures: extensive contact tracing, immediate provision of post-exposure prophylaxis, community engagement amongst specific high-risk groups, MMR awareness raising including catch-up campaigns and enhanced vaccination services at selected GP surgeries. Key challenges to the effective control measures included: language difficulties limiting community engagement; delays in diagnosis, notification and appropriate isolation of cases; limited resources for contact tracing across multiple high-risk settings (including GPs and hospitals) and lack of timely data on vaccine coverage in sub-groups of the population to guide public health action. Key results A large and challenging outbreak of measles in the West Midlands region of England occurred between November 2017 and June 2018, with 116 confirmed and 21 likely measles cases. Key challenges to effective control were community engagement in under-vaccinated populations, delays in diagnosis, notification and appropriate isolation of cases and lack of timely data on vaccine coverage in sub-groups of the population. Strong local and national oversight, co-ordination, and communication between multiagency stakeholders were essential in controlling the outbreak.

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