The Covid-19 pandemic caused for several years a reduction in the reports of many infectious diseases, which led to apparent increases in the subsequent years that, in reality, reflected a return to the usual levels. However, in the case of measles in Europe, current data has not only matched, but have exceeded the records prior to the global health crisis.
According to the annual measles report prepared by the European Center for disease Prevention and Control (ECDC), in 2024 35,212 cases were notified in the countries of the European Union and the European Economic space (EU/EEE), compared to the 3,973 registered in 2023. This represents an increase of almost 787% in just one year.
This strong increase cannot be explained solely by the alteration of the health system during the pandemic, since it represents the highest figure of the last 20 years in the region. In fact, only Latvia and Liechtenstein did not report cases in 2024. In addition, the rate of infections reached 77.4 cases per million inhabitants, well above the 27.2 cases per million registered in 2019. According to Valentín Pineda, a member of the vaccine advice committee of the Spanish Pediatrics Association (AEP), the main reason behind this rebound is clear: Low vaccination coverage.
A prominent example is Romania, which concentrated approximately 87% of the total infections in the region, with 30,692 reported cases. In that country, the coverage of the first dose of vaccine fell to 78%, and the second dose barely reached 62% in 2023, the last year with available data. Luis Buzón, spokesman for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), emphasizes that the European situation must be analyzed individually by country, since in Spain, for example, vaccination coverage is around 96% and has remained stable.
Why is it so worrying?
Unlike Romania, where many contagios occurred in children between one and four years old, in Spain the most affected group were adults over 30, representing 38.5% of cases, probably due to incomplete vaccination schemes in their childhood. It should be noted that, unlike vaccines such as coughing, immunization against measles does not usually lose efficacy over time.
Measles is one of the most contagious diseases known. Scientists measure it with the R0 index, which indicates how many people can infect a single case. While the Coronavirus omicron variant has an estimated R0 between 8 and 9, that of measles can reach up to 18. In the absence of specific treatments, vaccination remains the only effective tool to stop its spread.
The ECDC report reveals that 87% of those affected were not vaccinated, a percentage that rises to 90% in children from one to four years. Only four countries in the region managed to reach the recommended vaccination threshold to contain the progress of the disease. In addition, in eight countries reductions in vaccination rates for both doses were detected. Therefore, the ECDC recommends not only to strengthen child immunization, but also launch campaigns aimed at adolescents and adults who have not completed their vaccination pattern.
More hospitalizations and deaths
The impact of the increase in cases is also reflected in hospitals: 79% of measles patients in 2024 required income, compared to 55% in 2019. Among the most common complications are pneumonia, otitis average and encephalitis.
Although measles mortality is not as high as that of other infectious diseases, in 2024 23 deaths were recorded in the EU/EEE, compared to only three in 2023. Of those deaths, 22 occurred in Romania. “It is incredible that there have been this number of deaths having such an effective vaccine,” Pineda laments.
Another concern indicated by experts is that most outbreaks originate from local transmission, not for imported cases. In Spain, although there is a significant number of infections from abroad, in many neighboring countries vaccination levels are so low that they favor the internal circulation of the virus.
The ECDC insists on the need to strengthen cooperation between countries to share information and avoid cross -border transmission. In addition, he advises to make medical reviews before undertaking trips, even within the European space, to ensure that vaccines, including measles, are up to date.
