A 30-fold rise of measles cases in 2023 warrants urgent action

The World Health Organisation (WHO) European Region is experiencing an alarming rise in measles cases. Over 30,000 measles cases were reported by 40 of the Region's 53 Member States between January and October 2023. Compared to 941 cases reported in all of 2022, this represents a more than 30-fold rise.

"We have seen in the Region not only a 30-fold increase in measles cases, but also nearly 21,000 hospitalisations and 5 measles-related deaths. This is concerning" explained Dr Hans Henri P. Kluge, WHO Regional Director for Europe. "Vaccination is the only way to protect children from this potentially dangerous disease. Urgent vaccination efforts are needed to halt transmission and prevent further spread. It is vital that all countries are prepared to rapidly detect and timely respond to measles outbreaks, which could endanger progress towards measles elimination."

Where vaccinations are missed, outbreaks can follow – affecting both young and old

In 2023 measles has affected all age groups, with significant differences in the age distribution of cases among countries. Overall, 2 in 5 cases were among children 1 to 4 years of age, and 1 in 5 cases were among adults 20 years and older. From the beginning of the year through to October, 20 918 hospitalised cases were reported, and 5 measles-related deaths were reported by 2 countries.

This resurgence of measles is largely attributed to backsliding in vaccination coverage in the countries of the Region during 2020 to 2022. The COVID-19 pandemic significantly impacted immunisation system performance in this period, resulting in an accumulation of un- and under-vaccinated children.

Resumption of domestic and international travel and removal of social and public health measures linked to the COVID-19 pandemic have increased the risk of cross-border disease transmission and spread within communities, especially in un- and under-vaccinated communities.

Cases have been reported in many countries where measles has been declared eliminated as an endemic disease. Countries that have achieved measles elimination are still at risk of large and disruptive outbreaks following importation of the measles virus from other countries if very high rates of routine childhood vaccination (at least 95%) are not sustained in all communities.

Local solutions needed to close subnational gaps in coverage

This alarming resurgence of measles cases in 2023 further emphasises the importance of identifying and addressing immunisation inequities in all countries to attain and maintain high immunisation coverage in every community. Locally tailored immunisation strategies that target the identified disparities and promote vaccine equity must be fundamental to our efforts moving forward.

However, all countries, even those that might not yet have measles transmission, must carefully assess their immunity gaps and programme weaknesses and take immediate action to address them.

Getting back on track towards Region-wide measles elimination

Elimination of both measles and rubella remains a priority goal for all countries of the Region. The cornerstones for eliminating these diseases remain high population immunity, closure of immunity gaps in the population, and elimination-standard surveillance to monitor disease occurrence and take public-health action.

To regain progress towards measles elimination, it is imperative that countries achieve and maintain over 95% coverage with 2 doses of measles-containing vaccine. Attaining high routine vaccination coverage and closing any immunity gaps must therefore remain top priorities for all countries.