Sociodemographic inequalities in the epidemiology and vaccine uptake within a large outbreak of measles in Birmingham, England, 2023 to 2024

Measles disproportionately affects under-vaccinated communities, and inequalities in vaccination coverage exist in the United Kingdom (UK). In Birmingham, England, 406 confirmed measles cases were notified to the UK Health Security Agency between 13 October 2023 and 12 April 2024. Public health case management system data and primary care vaccination data were used to describe the epidemiology of the outbreak. Cases had a median age of 5.5 years (interquartile range (IQR): 1-13); 53% (214/406) were male, 45% (183/406) female and sex was unknown for 2% (9/406). Most cases (89%; 362/406) were unvaccinated. While 78% (315/406) of cases occurred in the city's most deprived areas (quintile 1), none did in the least deprived. The measles rate per 100,000 was 47.6 in quintile 1 vs 13.8 in quintile 3. Across ethnicities, the rate was 86.3 in Black African vs 10.8 in White British. Increases in vaccination rates between the outbreak period and an equivalent prior non-outbreak period seemed higher in most deprived populations (0.5% in quintile 1 vs 0.3% in quintiles 5). Variations, however, were observed between ethnic groups. In this large outbreak, measles disproportionately affected individuals from socioeconomically deprived backgrounds and ethnic minorities. In underserved communities, continued tailored services and vaccinations are required.