Measles and Rubella monthly report

Summary

This report provides an overview of measles and rubella cases reported routinely to ECDC through Epipulse Cases. Measles and rubella cases are reported monthly, and data presented here are for the latest complete 12 months of reporting alongside a historical comparison.

The CDTR (Communicable Disease Threats Report) provides the most recent data on cases and outbreaks based on information made publicly available by the national public health authorities or the media, including outside the EU/EEA, and complements the Measles and Rubella Monthly Report. Data presented in the two monthly reports may differ.

On February 2025 the number of cases reported to Epipulse cases were much higher than in previous months; such update is specifically linked a high number of cases reported retrospectively by Romania, and part of an ongoing outbreak as described previously in previous CDTR.

Measles in January 2025

In January 2025, 28 countries reported measles data, with 1 033 cases reported by 17 countries. There were 11 countries that reported zero cases.

The highest case counts were reported by Romania (663), Italy (74), Spain (70), France (67) and Austria (48).

Measles cases from 1 February 2024 to 31 January 2025

In the most recent 12-month period, from 1 February 2024 to 31 January 2025, 30 EU/EEA Member States reported a total of 32 265 cases of measles.

Between 1 February 2024 and 31 January 2025, of the 32 265 cases with known age, 14 556 (45.1%) were in children under five years of age; and 8 721 (27.0%) cases were aged 15 years or older. The highest notification rates were observed in infants under one year of age (1052.2 cases per million) and children aged 1-4 years (617.1 cases per million).

Of 29 481 cases (100.0% of all cases) with a known age and vaccination status, 25 503 (86.5%) were unvaccinated, 2 583 (8.8%) were vaccinated with one dose of a measles-containing vaccine, 1 304 (4.4%) were vaccinated with two or more doses, and 52 (0.2%) were vaccinated with an unknown number of doses.

Nineteen deaths (case fatality rate (CFR): 0.1) attributable to measles were reported to ECDC during the 12-month period by Romania (18) and Ireland (one).

Rubella in January 2025

Of 29 countries who routinely report rubella data to ECDC, 29 countries reported rubella data for January 2025.

A total of 12 cases were reported by three countries (Germany, Poland and Sweden) and 26 countries reported no cases.

From 1 February 2024 to 31 January 2025, 30 EU/EEA Member States reported a total of 224 cases of rubella. Data should be interpreted carefully as the majority of cases were reported by one country (Poland) and were not laboratory confirmed. Zero deaths (case fatality rate (CFR): 0) attributable to rubella were reported to ECDC during the 12-month period by any country.

ECDC recommendations

ECDC's latest advice on measles is available in the Threat Assessment Brief 'Measles on the rise in the EU/EEA: Considerations for a public health response', published in February 2024 and the recommendations remain valid.

As the number of cases is expected to rise in the near future, ECDC recommends that public health authorities take the following actions:

  • Close immunity gaps, achieve and maintain high vaccination coverage for MCV (>95% with the second dose). It is vital to ensure first and second dose vaccinations are administered on time as per national schedules among infants and children. It is also important to identify and vaccinate eligible individuals (for example, non-immune adolescents and adults) in immunisation catch-up programmes (as recommended by local and national authorities).
  • Strive towards high-quality surveillance and adequate public health capacity, especially for early detection, diagnosis, response and control of outbreaks.
  • Increase the clinical awareness of health professionals, including reminding them of the importance of checking individuals' vaccination status ahead of travel.
  • Healthcare professionals should be fully vaccinated.
  • Promote vaccine acceptance and uptake by employing specific risk communication strategies and identifying drivers of suboptimal MMR vaccine acceptance and uptake to ensure that tailored interventions are implemented in response.
  • Address barriers and engage with under-served populations. Systemic barriers that impact vaccine uptake in under-served, isolated and difficult-to-reach populations need to be monitored and addressed with targeted strategies in order to reduce inequalities in vaccine uptake.

Introduction

Measles is an acute, highly contagious viral disease capable of causing epidemics. It is a serious disease that can lead to complications and even death. Infectivity is close to 100% in susceptible individuals. Immunisation has dramatically reduced the incidence of measles in Europe, but measles cases and outbreaks continue to be reported.

Rubella is also a highly contagious viral disease, causing a generally mild illness with rash. The rationale for immunising against rubella is due to the high risk of congenital malformations associated with rubella infection during pregnancy. Congenital Rubella Syndrome (CRS) is characterised by a constellation of ophthalmologic, neurologic, cardiac and auditory anomalies. Immunisation against rubella started in Europe in the 1970s and has had a profound impact on the epidemiology of rubella and CRS.

The elimination of measles and rubella as well as the prevention of congenital rubella syndrome, forms part of a global elimination goal [1]. Progress towards elimination is being monitored on an annual basis through a European Regional Verification Commission for Measles and Rubella Elimination (RVC) established in 2011 [1]. Elimination of measles and rubella requires sustained overall immunisation coverage of more than 95% and maintenance of low levels of susceptibility across all subgroups of a population [1].

Data sources and notes

This surveillance report is based on measles and rubella data from Epipulse Cases for the reporting period 1 February 2024 to 31 January 2025. The number of measles and rubella cases reported to ECDC may be subject to retrospective change.

Data are submitted on a monthly basis by 30 European Union/European Economic Area (EU/EEA) countries for measles, and 29 EU/EEA countries for rubella (Belgium does not submit rubella data to Epipulse Cases). All countries routinely report case-based data for both measles and rubella, except Belgium who reports aggregated data for measles (and no rubella data) and Poland who reports case-based measles data but aggregated rubella data.

In this report, possible, probable and confirmed cases are presented together unless otherwise specified. EU case definitions are available for measles and rubella [2], however the definition used can vary by country. A summary of each country’s surveillance system, including the case definitions used, is available in the Surveillance Systems Overview Table [3]. Cases classified as discarded (see notes) are not included in the report.

Measles and rubella data are also published each month in the ECDC Surveillance Atlas of Infectious Diseases [4], an interactive tool providing access to additional tables and graphs not included in the report.

ECDC also monitors European measles and rubella outbreaks and global measles activity through epidemic intelligence and publishes updates in the Communicable Disease Threats Report (CDTR) on a weekly basis [5]. Where available, links to recent updates published by national public health authorities in the EU/EEA can be found in this report.

Additionally, ECDC conducts risk assessments as significant outbreaks or public health events develop. A Threat Assessment Brief (Measles on the rise in the EU/EEA – Considerations for public health response) was published by ECDC in February 2024 [6]. The most recent ECDC Rapid Risk Assessment on the risk of measles transmission in the EU/EEA was published in May 2019 [7].

Measles

Measles in January 2025

In January 2025, 28 countries reported measles data, with 1 033 cases reported by 17 countries. There were 11 countries that reported zero cases.

Overall, case numbers decreased compared with the previous month, however this is subject to change in the event of a future retrospective update. The highest case counts were reported by Romania (663), Italy (74), Spain (70), France (67) and Austria (48).

Figure 1. Number of measles cases by country, EU/EEA, 1 January 2025 to 31 January 2025 (n = 1 033)

Measles cases from 1 February 2024 to 31 January 2025

In the most recent 12-month period, from 1 February 2024 to 31 January 2025, 30 EU/EEA Member States reported a total of 32 265 cases of measles, 22 961 (71.2%) of which were laboratory confirmed (Table 1). During this 12-month period, two countries (Latvia and Liechtenstein) reported zero cases. The highest number of cases were reported by Romania (27 568), Italy (1 097), Germany (637), Belgium (551) and Austria (542), accounting for 85.4, 3.4, 2.0, 1.7 and 1.7 percent of all cases, respectively (Table 1). Notification rates above the EU/EEA average of 71.0 cases per million population were reported by Romania (1446.8) (Figure 3).

Table 1. Number of measles cases by month and notification rate per million population by country, EU/EEA, 1 February 2024 to 31 January 2025

Figure 2. Number of measles cases by month and year, EU/EEA, 1 January 2013 to 31 January 2025

Figure 3. Measles notification rate (per million population) by country, EU/EEA, 1 February 2024 to 31 January 2025

Nineteen deaths (case fatality rate (CFR): 0.1) attributable to measles were reported to ECDC during the 12-month period by Romania (18) and Ireland (one) (Figure 4).

Figure 4. Number of measles deaths by month and year, EU/EEA, 1 February 2024 to 31 January 2025

Between 1 February 2024 and 31 January 2025, of the 32 265 measles cases reported by EU/EEA countries, 626 (1.9%) were recorded as being imported, meaning the source of infection (exposure) was outside the reporting country. A further 253 (0.8%) were recorded as import-related – these cases were locally acquired but part of a chain of transmission linked to an imported case. There were 2 917 (9.0%) cases that were locally acquired (not imported) and 28 469 (88.2%) with unknown importation status. Overall, there were 12 countries in which ≥50% of the total reported cases were imported or import-related. Although there is variation in the proportion of imported cases by country, the majority of cases in the EU/EEA acquired measles through local/community transmission within the reporting country.

Of the 32 265 cases with known age, 14 556 (45.1%) were in children under five years; 8 721 (27.0%) cases were aged 15 years or older. The highest notification rates were observed among infants under one year of age (1052.2 cases per million) and children aged 1-4 years (617.1 cases per million) (Table 2).

Table 2. Notification rate of measles cases (per million population) by age group, EU/EEA, 1 February 2024 to 31 January 2025

Figure 5. Number of measles cases by time (year and week) and by age group, EU/EEA, reported between 1 February 2024 and 31 January 2025

A total of 4 115 cases (12.1%) had an unknown vaccination status (Figure 6). The proportion of cases with unknown vaccination status was highest in adults above 30 years of age (1335 of 4 115 cases; 33.0%). Of 29 941 cases (100.0% of all cases) with a known age and vaccination status, 25 792 (86.1%) were unvaccinated, 2 723 (9.1%) were vaccinated with one dose of a measles-containing vaccine, 1 334 (4.5%) were vaccinated with two or more doses, and 52 (0.2%) were vaccinated with an unknown number of doses.

Among 10 886 cases reported in the ages 1–4 years (the target age group of the first, and in certain countries second, dose[7]), 9 002 (82.7%) were unvaccinated, 1 082 (9.9%) were vaccinated with one dose of a measles-containing vaccine, 43 (0.4%) were vaccinated with two or more doses and 757 (7%) were vaccinated with an unknown number of doses.

Figure 6. Number of measles cases by age group and vaccination status, EU/EEA, 1 February 2024 to 31 January 2025

Figure 7. Proportion of measles cases by vaccination status and age, by country, EU/EEA, 1 February 2024 to 31 January 2025

Infants under one year are particularly vulnerable to measles and its complications. They are best protected by a high level of herd immunity as the first dose of a measles-containing vaccine is given after 12 months of age in most EU/EEA countries [8].

Measles vaccination coverage in many countries remains suboptimal. Sustained coverage of at least 95% for two doses of a measles-containing vaccine at all subnational levels is recommended [1]. However, the latest WHO–UNICEF estimates of national immunisation coverage (for 2023) show that only four EU/EEA countries (Hungary, Malta, Portugal and Slovakia) reported at least 95% vaccination coverage for both the first [9] and second [10] doses in 2023 (Figure 8; Figure 9; Table 3). If the elimination goal is to be reached, many countries need to make sustained improvements in the coverage of their routine childhood immunisation programmes as well as closing immunity gaps in adolescents and adults who have missed vaccination opportunities in the past [1].

Figure 8. Vaccination coverage for first dose of a measles-containing vaccine, EU/EEA, 2023 (Source: WHO, WUENIC)

Figure 9. Vaccination coverage for second dose of a measles-containing vaccine, EU/EEA, 2023 (Source: WHO, WUENIC)

Table 3. Vaccination coverage by dose, country and year, EU/EEA, 2019 to 2023 (Source: WHO, WUENIC)

Rubella

Rubella in January 2025

Of 29 countries who routinely report rubella data to ECDC, 29 countries reported rubella data for January 2025.

Overall, case numbers increased compared with the previous month, however this is subject to change in the event of a future retrospective update.. A total of 12 cases were reported by three countries (Germany, Poland and Sweden) and 26 countries reported zero cases.

Rubella cases from 1 February 2024 to 31 January 2025

From 1 February 2024 to 31 January 2025, 30 EU/EEA Member States reported a total of 224 cases of rubella, 28 (1.0%) of which were laboratory confirmed (Table 4). During this 12-month period, 21 countries (Croatia, Czechia, Denmark, Estonia, Greece, Spain, Ireland, Cyprus, Luxembourg, Hungary, Malta, Netherlands, Austria, Portugal, Romania, Slovenia, Slovakia, Finland, Norway, Iceland and Liechtenstein) reported zero cases. The highest number of cases were reported by Poland (186), Germany (28), Sweden (three), Italy (two) and Latvia (two), accounting for 83.0, 12.5, 1.3, 0.9 and 0.9 percent of all cases, respectively (Table 4). Notification rates above the EU/EEA average of 0.5 cases per million population were reported by Poland (5.1) and Latvia (1.1).

Data from Poland should be interpreted with caution, as only 10 out of 256 cases (3.90%) were laboratory confirmed.

Zero deaths (case fatality rate (CFR): 0) attributable to rubella were reported to ECDC during the 12-month period by any country.

Table 4. Number of rubella cases by month and notification rate (per million population) by country, EU/EEA, 1 February 2024 to 31 January 2025

Figure 10. Rubella notification rate (per million population) by country, EU/EEA, 1 February 2024 to 31 January 2025

The latest WHO–UNICEF estimates of national immunisation coverage show that 15 EU/EEA countries reported at least 95% vaccination coverage for the first dose of a rubella-containing vaccine in 2023 [11]. Sustained vaccination coverage of at least 95% for at least one dose of a rubella-containing vaccine at all subnational levels is recommended to achieve elimination [1].

References

  1. World Health Organization Regional Office for Europe (WHO/EURO). Eliminating measles and rubella in the WHO European Region: integrated guidance for surveillance, outbreak response and verification of elimination. Copenhagen: WHO Regional Office for Europe; 2024. Available from: https://www.who.int/europe/publications/i/item/9789289060783

  2. European Centre for Disease Prevention and Control (ECDC). EU case definitions [Internet]. Stockholm: ECDC; 2024 [cited 29 January 2024]. Available from: https://www.ecdc.europa.eu/en/all-topics/eu-case-definitions

  3. European Centre for Disease Prevention and Control (ECDC). Surveillance systems overview for 2022 [Internet]. Stockholm: ECDC; 2024 [cited 29 January 2024]. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-systems-overview-2022

  4. European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases – Measles [Internet]. Stockholm: ECDC; 2024 [cited 29 January 2024]. Available from: https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=335

  5. European Centre for Disease Prevention and Control (ECDC). Communicable disease threats reports [internet]. Stockholm: ECDC; 2024 [cited 29 January 2024]. Available from: https://www.ecdc.europa.eu/en/publications-and-data/monitoring/weekly-threats-reports

  6. European Centre for Disease Prevention and Control (ECDC). Threat assessment brief: Measles on the rise in the EU/EEA – Considerations for public health response. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/threat-assessment-brief-measles-rise-eueea-considerations-public-health-response

  7. European Centre for Disease Prevention and Control (ECDC). Risk assessment: Who is at risk for measles in the EU/EEA? Identifying susceptible groups to close immunity gaps towards measles elimination – 28 May 2019. Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/en/publications-data/risk-assessment-measles-eu-eea-2019

  8. European Centre for Disease Prevention and Control (ECDC). Vaccine Scheduler [Internet]. Stockholm: ECDC; 2024 [cited 29 January 2024]. Available from: http://vaccine-schedule.ecdc.europa.eu

  9. World Health Organization (WHO). WHO-UNICEF estimates of MCV1 coverage [Internet]. Geneva: WHO; 2023 [cited 2 August 2024]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/measles-containing-vaccine-first-dose-(mcv1)-immunization-coverage-among-1-year-olds-(-)

  10. World Health Organization (WHO). WHO-UNICEF estimates of MCV2 coverage [Internet]. Geneva: WHO; 2023 [cited 2 August 2024]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/measles-containing-vaccine-second-dose-(mcv2)-immunization-coverage-by-the-nationally-recommended-age-(-)

  11. World Health Organization (WHO). WHO-UNICEF estimates of RCV1 coverage [Internet]. Geneva: WHO; 2023 [cited 2 August 2024]. Available from: https://immunizationdata.who.int/pages/coverage/rcv.html?CODE=AUT+BEL+BGR+CYP+HRV+CZE+DEU+DNK+EST+GRC+ESP+FIN+FRA+HUN+IRL+ITA+LVA+LUX+MLT+NLD+NOR+POL+PRT+ROU+SWE+SVK+SVN+ISL+LTU&YEAR=

Notes

The European Surveillance System collects a ‘date used for statistics’, which is a date chosen by the country for reporting purposes. This date may indicate onset of disease, date of diagnosis, date of notification or date of laboratory confirmation, depending on reporting practices in the respective countries. All data presented in this report are based on the ‘date used for statistics’. In addition, when reporting data on measles, rubella and other vaccine-preventable diseases to Epipulse Cases, countries may update previously reported data. This means that the date of retrieval can influence the data presented in this report, as later retrievals of data relating to the same period may result in slightly different numbers. The data for this report were retrieved on 10 March 2025.

In this report and in the ECDC Surveillance Atlas of Infectious Diseases[4], interactive tool offering the possibility of downloading data, a Member State will be listed as having not reported data for a particular month if they do not have a reporting period in Epipulse Cases that covers the entire month. As such, if a Member State either reports no data for a month or some cases in a month but with an incomplete reporting period, the entire month is considered to have missing data. Similarly, if no cases occurred in a Member State in a given month this needs to be reported to Epipulse Cases in order for zero cases to be included in these surveillance outputs.

Cases classified as discarded were suspected cases where subsequent investigation revealed a negative laboratory test, or confirmation of an alternative aetiology, supported by epidemiological and/or virological evidence.