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Summary
This report provides an overview of measles and rubella cases reported to ECDC through Epipulse Cases. Measles and rubella cases are reported monthly, and data presented here are for the latest complete 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.
Measles in February 2025
In February 2025, 30 countries reported measles data, with 821 cases reported by 14 countries. There were 16 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 (527), France (79), Spain (75), Italy (66) and Germany (18).
Measles cases from 1 March 2024 to 28 February 2025
In the most recent 12-month period, from 1 March 2024 to 28 February 2025, 30 EU/EEA Member States reported a total of 28 791 cases of measles.
Between 1 March 2024 and 28 February 2025, of the 28 791 cases with known age, 12 816 (44.5%) were in children under five years of age; and 7 880 (27.4%) cases were aged 15 years or older. The highest notification rates were observed in infants under one year of age (928.4 cases per million) and children aged 1-4 years (542.6 cases per million).
Of 26 669 cases (100.0% of all cases) with a known age and vaccination status, 22 992 (86.2%) were unvaccinated, 2 378 (8.9%) were vaccinated with one dose of a measles-containing vaccine, 1 213 (4.5%) were vaccinated with two or more doses, and 50 (0.2%) were vaccinated with an unknown number of doses.
Fourteen deaths (case fatality rate (CFR): 0.0) attributable to measles were reported to ECDC during the 12-month period by Romania (14) (Figure 4).
Rubella in February 2025
Of 29 countries who routinely report rubella data to ECDC, 28 countries reported rubella data for February 2025.
Overall, case numbers decreased compared with the previous month, however this is subject to change in the event of a future retrospective update.. A total of 10 cases were reported by three countries (Germany, Poland and Sweden) and 25 countries reported no cases.
From 1 March 2024 to 28 February 2025, 30 EU/EEA Member States reported a total of 49 cases of rubella. 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. The latest news item on measles was published in March 2024. 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 children. It is also important to identify and vaccinate eligible individuals (for example, non-immune adolescents and young 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, including 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 March 2024 to 28 February 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 February 2025
In February 2025, 30 countries reported measles data, with 821 cases reported by 14 countries. There were 16 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 (527), France (79), Spain (75), Italy (66) and Germany (18).
Figure 1. Number of measles cases by country, EU/EEA, 1 February 2025 to 28 February 2025 (n = 821)
Measles cases from 1 March 2024 to 28 February 2025
In the most recent 12-month period, from 1 March 2024 to 28 February 2025, 30 EU/EEA Member States reported a total of 28 791 cases of measles, 19 992 (69.4%) 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 (24 215), Italy (1 064), Germany (591), France (572) and Belgium (556), accounting for 84.1, 3.7, 2.1, 2.0 and 1.9 percent of all cases, respectively (Table 1). Notification rates above the EU/EEA average of 63.3 cases per million population were reported by Romania (1270.8) (Figure 3).
Table 1. Number of measles cases by month and notification rate per million population by country, EU/EEA, 1 March 2024 to 28 February 2025
Figure 2. Number of measles cases by month and year, EU/EEA, 1 January 2013 to 28 February 2025
Figure 3. Measles notification rate (per million population) by country, EU/EEA, 1 March 2024 to 28 February 2025
Fourteen deaths (case fatality rate (CFR): 0.0) attributable to measles were reported to ECDC during the 12-month period by Romania (14) (Figure 4).
Figure 4. Number of measles deaths by month and year, EU/EEA, 1 March 2024 to 28 February 2025
Between 1 March 2024 and 28 February 2025, of the 28 791 measles cases reported by EU/EEA countries, 624 (2.2%) were recorded as being imported, meaning the source of infection (exposure) was outside the reporting country. A further 262 (0.9%) were recorded as import-related – these cases were locally acquired but part of a chain of transmission linked to an imported case. There were 2 851 (9.9%) cases that were locally acquired (not imported) and 25 054 (87.0%) 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 28 791 cases with known age, 12 816 (44.5%) were in children under five years; 7 880 (27.4%) cases were aged 15 years or older. The highest notification rates were observed among infants under one year of age (928.4 cases per million) and children aged 1-4 years (542.6 cases per million) (Table 2).
Table 2. Notification rate of measles cases (per million population) by age group, EU/EEA, 1 March 2024 to 28 February 2025
Figure 5. Number of measles cases by time (year and week) and by age group, EU/EEA, reported between 1 March 2024 and 28 February 2025
A total of 2 713 cases (9.2%) had an unknown vaccination status (Figure 6). The proportion of cases with unknown vaccination status was highest in adults above 30 years of age (1046 of 2 713 cases; 29.6%). Of 26 669 cases (100.0% of all cases) with a known age and vaccination status, 22 992 (86.2%) were unvaccinated, 2 378 (8.9%) were vaccinated with one dose of a measles-containing vaccine, 1 213 (4.5%) were vaccinated with two or more doses, and 50 (0.2%) were vaccinated with an unknown number of doses.
Among 9 346 cases reported in the ages 1–4 years (the target age group of the first, and in certain countries second, dose[7]), 7 972 (85.3%) were unvaccinated, 912 (9.8%) were vaccinated with one dose of a measles-containing vaccine, 39 (0.4%) were vaccinated with two or more doses and 422 (4.5%) were vaccinated with an unknown number of doses.
Figure 6. Number of measles cases by age group and vaccination status, EU/EEA, 1 March 2024 to 28 February 2025
Figure 7. Proportion of measles cases by vaccination status and age, by country, EU/EEA, 1 March 2024 to 28 February 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 February 2025
Of 29 countries who routinely report rubella data to ECDC, 28 countries reported rubella data for February 2025.
Overall, case numbers decreased compared with the previous month, however this is subject to change in the event of a future retrospective update.. A total of 10 cases were reported by three countries (Germany, Poland and Sweden) and 25 countries reported zero cases.
Rubella cases from 1 March 2024 to 28 February 2025
From 1 March 2024 to 28 February 2025, 30 EU/EEA Member States reported a total of 49 cases of rubella, 20 (1.0%) of which were laboratory confirmed (Table 4). During this 12-month period, 22 countries (Croatia, Czechia, Denmark, Estonia, Greece, Spain, Ireland, Cyprus, Latvia, 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 Germany (24), Poland (16), Sweden (four) and Italy (two), accounting for 49.0, 32.7, 8.2 and 4.1 percent of all cases, respectively (Table 4). Notification rates above the EU/EEA average of 0.1 cases per million population were reported by Poland (0.4), Sweden (0.4), Germany (0.3), Lithuania (0.3) and Bulgaria (0.2).
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 March 2024 to 28 February 2025
Figure 10. Rubella notification rate (per million population) by country, EU/EEA, 1 March 2024 to 28 February 2025
