Measles in Europe Highest in 25 Years

The World Health Organization (WHO) has announced that measles cases in the European region are at the highest they have been for the past 25 years and accounted for one third of all measles cases globally in 2024. The total number reported for 2024 was 127,350, double that reported in 2023 and the highest since 1997, according to an analysis by the WHO and the United Nations Children’s Fund (UNICEF).

“Measles is back, and it’s a wake-up call,” said Hans Henri Kluge, MD, WHO regional director for Europe, in a press release. “Every country must step up efforts to reach undervaccinated communities,” he warned. “The measles virus never rests, and neither can we.”

Measles in the region had generally been declining since 1997, when around 216,000 cases were reported, reaching a low of 4440 cases in 2016. However in 2018 and 2019, there was a resurgence, with reported cases around 89,000 and 106,000, respectively, and numbers rose again in 2023 and 2024.

The WHO region comprises 53 countries in Europe and Central Asia, where preliminary data suggests there have been 38 deaths. However, more than half of the reported cases required hospitalization, the WHO said.

Globally, 359,521 cases of measles were reported in 2024, making the European total just over one third (35.4%) of those worldwide. The WHO blamed falling vaccination rates and said that children younger than 5 years accounted for more than 40% of reported cases.

“The measles virus is exceptionally contagious and can reappear at any time, even in countries that have eliminated the disease,” explained Dragan Jankovic, MD, MSc, technical officer for vaccine-preventable diseases and immunization at the WHO Regional Office for Europe. 

Healthcare Workers Are Defense Frontline

Speaking with Medscape Medical News, Jankovic said that healthcare workers were “the frontline in our efforts to protect all children and adults from this deadly disease.” Vaccination provides the only protection against measles, for which there is no treatment, he said.

Jankovic urged those at the primary healthcare level to be alert to suspecting measles even in the early stage of the disease, before a rash appears; especially if there are measles cases reported in the community and if some of the patients they are seeing are not vaccinated against measles.

Health workers are “critical for detection and reporting of suspected and especially confirmed cases,” he said, both routinely and in the event of outbreaks. Therefore the WHO encourages every health worker to become familiar with the early signs of measles, including mild fever and redness in the eyes; to investigate and report every suspected case; and to ensure heightened infection and control measures to prevent transmission in healthcare settings. 

‘Measles Is Back’

Also speaking with Medscape Medical News, Sabrina Bacci, MD, MSc, head of vaccine-preventable diseases at the European Centre for Disease Prevention and Control (ECDC), agreed that the data for 2024 suggest “measles is back.” She said that, while there was a period of unusually low measles activity during the early stages of COVID-19 pandemic measures, an uptick in reported measles cases was noticeable in 2023. By 2024, the data “clearly indicate ongoing circulation of the virus in the region,” and “at a level we have not seen for a few years,” she said.

This was notwithstanding that all EU/EEA countries include the measles, mumps, and rubella (MMR) vaccine in their childhood vaccination programs. ECDC data show that 80% of those diagnosed with measles in these countries during 2024 were not vaccinated. The latest data show that between early 2024 and early 2025, 32,265 people were diagnosed with measles in the EU/EEA, with a peak during the first 6 months of 2024, Bacci said.

More Cases Likely in Spring

Bacci warned that “we can expect to see more reports of measles in spring of 2025,” due to the seasonality of the disease. “Historical case numbers reported by EU/EEA member states show a pattern of periodic outbreaks followed by years of relatively fewer cases.” There is no reason to expect this pattern to change unless vaccination coverage across the EU/EEA is sustainably increased in a way that at least 95% of the vaccine-eligible population receive two doses of the MMR vaccine, she added.

Although measles can affect all age groups, it is classically thought of as a childhood disease. However, the latest ECDC monthly report showed that 27% of cases in the recent outbreak were in those older than 15 years. Within that group, 15- to 19-year-olds and those older than 30 were the most affected, Bacci said.

ECDC Recommendations

Bacci said the ECDC recommendations are:

• Public health authorities should increase awareness about measles among healthcare providers.
• Healthcare workers need to be updated on the local epidemiologic situation as well as the clinical presentation of measles (eg, age shift to young adults) to ensure that all cases are diagnosed.
• Protocols for the management of cases of fever with rash in hospitals and GP practices should be reviewed and implemented to avoid nosocomial transmission of measles.
• Checking and updating vaccination against measles should be a routine practice during travel medicine consultations and general health checks prior to travelling, including those travelling within the EU/EEA.
• Measles should be considered in the diagnostic process for patients post-travel, irrespective of their age and travel destination, when they present with symptoms such as fever and rash.
• Healthcare professionals should be fully vaccinated.

Generally, she advised healthcare professionals to be mindful of typical measles symptoms: high fever; cough; runny nose; red, watery eyes; and a characteristic red rash that usually starts at the hairline and spreads down to the rest of the body.