Measles makes a deadly comeback in Europe as vaccination gaps widen

Measles makes a deadly comeback in Europe as vaccination gaps widen

A dramatic increase in measles cases across Europe in 2024, driven by low vaccination rates and widening immunity gaps, has strengthened urgent calls for immunization and disease surveillance.

Country reports from Austria, Belgium, Bulgaria, Croatia, Cyprus, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden.

Did you know that unvaccinated people have a 90% chance of becoming infected with the measles virus if exposed to it? In 2024, measles cases rose across Europe, reaching the highest levels seen in decades. A current report from theEuropean Center for Disease Prevention and Control (ECDC)Discussed this alarming increase in measles cases, the factors contributing to outbreaks, and the urgent strategies needed to prevent future epidemics.

measles

Seasonal resurgence: After three years of disrupted patterns, measles cases in 2024 followed a classic seasonal curve peaking in the spring and early summer, a pattern not seen since the Covid-19 pandemic.

Measles is one of the most contagious infectious diseases and spreads easily through airborne respiratory droplets. A single infected person can spread the virus to 12 and 18 others. Vaccination efforts since the 1960s have greatly reduced measles worldwide, but the measles virus continues to cause significant illness and death, particularly in young children. Global estimates suggest that measles still causes nearly 140,000 child deaths each year.

Although immunization coverage is generally high across Europe, localized gaps remain, leaving some populations vulnerable to outbreaks. Studies suggest that achieving and maintaining at least 95% two-dose vaccine coverage is critical to preventing the spread of measles.

However, vaccination coverage has fluctuated, particularly during the coronavirus disease 2019 (Covid-19) pandemic, when healthcare disruptions and, in some countries, vaccine failures led to gaps in immunity. Furthermore, the influx of cases from countries where measles remains endemic continues to pose a threat to disease control efforts in Europe. The report specifically shows that Romania experienced a sharp decline in first and second dose coverage between 2022 and 2023, while Austria showed an improvement in second dose coverage.

The current report

The 2024 annual epidemiological report on measles is based on data retrieved from the Epipulse case system on March 20, 2025. Epipulse provides improved data collection and analysis of communicable disease cases, exceeding the capabilities of the older European surveillance system. The report used cases reported by the 30 EU Union (EU) and EEA Economic Area (EEA) countries.

Romanian immunization crisis: First-dose vaccine coverage fell by almost 10% between 2020 and 2023, leaving young children unprotected in Europe's most vulnerable nation.

Surveillance relied primarily on comprehensive, passive reporting systems for national populations, and data submissions follow standard EU case definitions adopted between 2008 and 2018. Immunization coverage estimates were obtained from the World Health Organization's Global Health Observatory datasets (UNISF (UNICEFL) (UNICEFF) and Immunization Coverage Estimates).

The report also used ECDC's surveillance atlas of infectious diseases and monthly reports of measles and rubella cases. Data on cases, vaccination status, outcomes, hospitalizations and complications were collected and analyzed to identify trends, seasonality, age group distribution, vaccination gaps and import status.

Age-specific attack and vaccination rates were calculated, and case importations were classified based on travel history and exposure outside the reporting countries. Hospitalization and complication data were used to assess the severity of cases and outcome status, including death, whenever available.

Additionally, historical trends in measles vaccination coverage, notification rates, and cross-country comparisons were incorporated to identify emerging vulnerabilities and inform recommendations for public health interventions. The report also finds that eleven EU/EEA countries have implemented mandatory measles vaccination policies, which may contribute to disparities in coverage and age-specific vulnerability.

Key Findings

The report found that measles cases increased dramatically in the EU/EEA in 2024, with over 35,000 cases reported, almost ten times higher than the number of cases in 2023. Romania alone accounted for 87% of all cases.

Additionally, notification rates exceeded pre-pandemic levels, reaching 77.4 cases for every million people. Infants under one year old were the most affected group, with an infection rate of 1,175.4 per million, followed by children between 1 and 4 years old.

About 87% of reported cases involved people who were not vaccinated. More alarming was the finding that 90% of children aged one to four were not vaccinated, revealing significant immunity gaps in a critical age group. The report also highlighted that gaps in immunity exist among older children and adults, with several countries reporting that most cases occur in people over 30 years old. This suggests a history of under-representation in these populations. For example, in France, Italy, Spain and Poland, the majority of measles cases in 2024 occurred in adults aged 30 and over, while in Romania most cases were in young children.

Hospital hotspots: Among the 24,529 hospitalized cases, 82% were unvaccinated, including 739 fully vaccinated people, highlighting the rare but real occurrence of breakthrough infections.

Hospitalizations were also high, with 79% of cases requiring hospital care, predominantly among unvaccinated children. In fact, about 82% of hospitalized cases were unvaccinated, and about 80% of those who developed complications such as pneumonia or encephalitis were also unvaccinated, further underscoring the risks faced by those without protection. In addition, complications such as pneumonia and encephalitis have been frequently reported.

It was also found that deaths from measles increased sharply, with 23 deaths - 22 in Romania alone - compared to just three in 2023. Infants and young children represented the majority of these deaths. Additionally, the number of imported cases had also increased, particularly from Europe, highlighting the ongoing risks of cross-border transmission.

Despite the existence of long-standing vaccination programs, coverage for the first dose fell slightly to 93.9% and for the second dose to 88.8%. Only four countries met the target of greater than 95% coverage for the second dose of measles immunization in 2024. The report further notes that only three countries achieved greater than 95% coverage for the first and second doses in 2023.

The researchers noted that information on vaccination status was incomplete for some age groups, and non-mild cases may have been reported, which may have underestimated the true incidence.

Conclusions

In summary, the ECDC's 2024 epidemiological report found a worrying resurgence of measles in Europe, highlighting the serious consequences of immunity gaps and suboptimal vaccination coverage.

For infants and young children, urgent action is needed to rebuild community protection through vaccination campaigns, targeted outreach and strengthening surveillance to prevent a further resurgence of measles. Strengthening digitized immunization information systems and international cooperation to prevent cross-border transmission are also highlighted as key strategies in the report. The report also highlights the importance of targeted catch-up campaigns for overlooked cohorts, particularly among youth and adults. It highlights how national differences in MMR policies—such as the timing of vaccine doses and catch-up programs—may partially explain differences in age-specific susceptibility across the region.

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