Avian Flu Diary: ECDC: Measles - Annual Epidemiological Report for 2024

#18,455

According to WHO estimates - globally there were 10.3 million cases of measles in 2023, with 107,500 related deaths - mostly in children younger than 5 years of age.

They cited ` Inadequate immunization coverage' as driving the surge in cases, noting that only 83% of children had received their first dose of measles vaccine, while just 74% received the recommended second dose.

A year ago, the ECDC reported:

In 2023, 2 361 cases of measles were reported by 30 EU/EEA Member States. The overall notification rate was 5.2 cases per 1 000 000 population, which was significantly higher than the notification rate observed the last three years (2022:0.3, 2021:0.1, and 2020:4.3). Despite the rise, the 2023 rate remains lower than the pre-pandemic

Today the ECDC has released their surveillance report for 2024, and it shows a 10-fold increase in measles cases (and 23 deaths).

In 2024, a total of 35 212 measles cases were reported across the EU/EEA, marking a notable increase (ten-fold), from the 3 973 cases reported in 2023; in addition, cases reported followed a seasonal pattern, after a period (2021-23) in which the typical pattern was not evident. Measles activity had already begun to increase in 2023 after a period of unusually low activity during 2020–2022, coinciding with the COVID-19 pandemic.

While you'll want to download and read the full 13-page report ( Measles - Annual Epidemiological Report for 2024 - EN - [PDF-1.15 MB]), I reproduced the Key Points and conclusion. I'll have a bit more after the break.

Key facts

• In 2024, a total of 35 212 measles cases were reported across the EU/EEA, marking a notable increase (ten-fold), from the 3 973 cases reported in 2023; in addition, cases reported followed a seasonal pattern, after a period (2021-23) in which the typical pattern was not evident. Measles activity had already begun to increase in 2023 after a period of unusually low activity during 2020–2022, coinciding with the COVID-19 pandemic.

• The overall notification rate in 2024 was 77.4 cases per 1 000 000 population, which was substantially higher compared to 9.1 in 2023, and notably exceeding pre-pandemic levels observed in 2019 (27.2 cases per 1 000 000). Romania reported the highest notification rate at 1 610.7 cases per 1 000 000 population, accounting for approximately 87% (30 692) of all EU/EEA cases, followed by Austria (59.5), Belgium (44.9) and Ireland (39.6) per 1,000,000 population.

• In 2024, measles cases were reported among all age groups, and infants under one year of age were the most affected group, with a notification rate of 1 175.4 cases per 1 000 000 population, followed by children aged 1–4 years (688.7 cases per 1 000 000). Individuals above the age of 14 years represented 26% of the overall reported cases; some countries reported the majority of cases (range:28-53%) in individuals above 30 years of age. A total of 14 of the 23 measles deaths reported in 2024 (22 of which from Romania), were observed in children below five years of age.

• Of the cases with known vaccination status in 2024, 87% (27 692) were unvaccinated, and a total of 90% of children between the ages of one and four years were unvaccinated. Children in this age group are those who are targeted for the first dose of measles vaccination in EU/EEA countries, and sometimes the second dose.

• The observed vaccine coverage estimates indicate that in many countries, routine childhood vaccination against measles remains below the recommended level to achieve and sustain measles elimination, with average weighted vaccination coverage for the first dose of measles containing vaccine (MCV1) in the EU/EEA declining slightly in 2024 (93.9%) compared to 2023 (94.2%). Only four countries in the EU/EEA reached the ≥95% threshold for the second dose of measles-containing vaccine in 2024. In two countries there was a positive upward trend of 3% or above (range up to 7%) when comparing the estimates from 2020 to 2023 for the first dose, as well as an upward trend in four countries for the second dose. A downward trend of 3% or more was observed in eight countries, for both the first and the second dose.

• Accelerated efforts are needed to increase vaccination coverage and uptake of both routine childhood immunisation and catch-up campaigns in adolescents and adults who have missed vaccination in the past. To this end, the deployment of upgraded digitalised immunisation information systems to identify and reach the unvaccinated is critical and should form an integral part of national efforts to improve the performance and management of the overall national immunisation programmes. Continuous high quality surveillance and prompt outbreak investigations are also key tools to closely monitor measles

Conclusion

In 2024, the EU/EEA region recorded the highest number of measles cases observed in the past two decades, significantly exceeding pre-pandemic levels. This sharp increase underscores persistent immunity gaps and vulnerabilities within the population, exacerbated by suboptimal measles vaccination coverage. Although the impact of the COVID-19 pandemic on immunisation programmes varied by country — with some experiencing declines and others maintaining or slightly improving coverage — most EU/EEA countries have yet to achieve or sustain the ≥95% vaccination coverage target with two doses of measles-containing vaccine.

Enhanced epidemiological surveillance, prompt outbreak investigation, and control measures remain critical for interrupting transmission and achieving regional elimination targets. Urgent action to address existing immunity gaps through targeted catch-up vaccination campaigns, particularly among populations disproportionately impacted by pandemic disruptions are essential. Strengthened public health communication and accelerated efforts to enhance vaccine acceptance remain crucial for restoring high immunisation coverage and preventing future measles outbreaks in the EU/EEA.

In 2019, just prior to the COVID lockdown, the United States reported the most measles cases (1274) in 25 years, raising concerns that this scourge - considered eliminated in the U.S. since 2000 - was making a comeback.

While measles cases plummeted during the pandemic, last year the U.S. reported a modest 285 cases (and zero deaths). But already in 2025 we've seen nearly 900 cases and 3 deaths.

Between waning vaccination uptake and rampant misinformation on the internet, measles (and other childhood diseases) are making a comeback. The chart below (source: CDC) shows the remarkable effectiveness of the vaccination campaign which was started in 1963.

Too many parents today think of measles as a relatively benign childhood illness, but it can actually produce significant morbidity and mortality with respiratory, ocular, and neurological complications - sometimes resulting in death.

While I've touched briefly on the topic of of acquired immune amnesia, from measles infection (see here, here, and here), two weeks ago Dr. Ian M. MacKay - author of the Virology Down Under Blog - produced an in-depth explainer on both measles, and this adverse immunological impact from MeV infection.