Table 3.

Outbreak responses in Birmingham, Leeds and Liverpool

City	Outbreak -first cases	Outbreak size	Outbreak response approaches
Birmingham	November 2017–May 2018 (outbreak confirmed closed end June 2018). First cases reported in Romanian and Romanian Roma communities. Cases presented to A&E and primary care settings	116 confirmed cases. 20 probable cases	– Door-to-door vaccination (health visitors and screening and immunisation team going to the homes of known cases and their contacts) – Media communication – GP incentivisation scheme – Extra GP sessions – School-based immunisation (focusing on schools in the outbreak areas with lowest MMR update) – Heightening awareness of measles/measles management in healthcare services
Leeds	First cases reported in Romanian and RomanianRoma communities. First cases linked to a primary school, and wider spread linked to exposure in hospital settings	36 confirmed cases. In total, around150 confirmed, probable and possible cases	– Vaccination in a primary and secondary school (within a week of first disease notifications) – GPs inviting/reminding parents/guardians about missed vaccinations – GPs organised an extra clinic in one of most affected postcode areas – Door-knocking approaches, trying to encourage registration at general practice – Vaccination through community centre linked to a school – Training of front-line staff working with the communities – Media communication
Liverpool	First cases reported in Romanian and Romanian Roma communities	22 confirmed cases	– Mobile vaccination vans (supported by a Roma community worker) – Offer of meal and vaccination in community centre (facilitated by the community centre manager)