Intended for healthcare professionals


Measles cases in Europe tripled from 2017 to 2018

BMJ 2019; 364 doi: (Published 07 February 2019) Cite this as: BMJ 2019;364:l634
  1. Jacqui Thornton
  1. London, UK

More than 80 000 people in 47 of 53 European countries contracted measles in 2018, with 72 deaths, the World Health Organization has said.1 In countries reporting hospitalisation data 61% of patients with measles were admitted to hospital.2

The total number of people infected with the virus in 2018 was the highest this decade,1 three times the total reported in 2017 (23 927 cases) and 15 times the record low recorded in 2016 (5273 cases).3

Despite more children in the WHO European region being vaccinated against the disease than ever before, progress on vaccination is uneven between and within countries. This leaves clusters of susceptible people unprotected, particularly in middle income countries, WHO said.

Ukraine had an incidence rate of 1209 per 1 million population and 53 218 cases; Serbia had a rate of 579 and 5076 cases; Georgia had a rate of 563 and 2203 cases; and Albania a rate of 499 and 1466 cases.4

WHO urged affected countries to target their interventions to places and groups where immunisation gaps persist.

The European region 2018 data found 82 596 people contracted measles. In countries reporting hospitalisation data, nearly two thirds (61%) of cases were hospitalised.

In 2017 the European region achieved its highest estimated coverage for the second dose of measles vaccination, with a rate of 90%. And more children in the region received the full two dose series on time in 2017 than in any year since WHO started collecting data in 2000.

Coverage with the first dose of the vaccine also increased slightly to 95%, the highest level since 2013. However, progress in the region, based on achievements at the national level, can mask gaps at subnational levels, which are often not recognised until outbreaks occur.

Zsuzsanna Jakab, WHO regional director for Europe, said, “The picture for 2018 makes it clear that the current pace of progress will be insufficient to stop measles circulation.

“While data indicate exceptionally high immunisation coverage at regional level, they also reflect a record number affected and killed by the disease. This means that gaps at local level still offer an open door to the virus.

“We must do more and do it better to protect each and every person from diseases that can be easily avoided.”

The European Vaccine Action Plan 2015-2020 (EVAP)5 lays out a strategy endorsed by all 53 member states to eliminate measles and rubella. At least 95% of every population needs to be immune, through two doses of vaccination or prior exposure to the virus, to ensure community protection for everyone—including babies too young to be vaccinated and others who cannot be immunized due to existing diseases and medical conditions.

“In adopting EVAP, all countries in the European region agreed that elimination of measles and rubella is possible, and is also a cost effective way to protect people of all ages from avoidable suffering and death,” said Nedret Emiroglu, director of the Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe.

Most of the countries struggling with suboptimal immunisation coverage against measles in Europe are middle-income countries. WHO said its regional office is working with them to implement a coordinated strategy to tackle targeted programme areas.


  • Clarification: On 12 February 2019 we amended the first two paragraphs to clarify the data and sources.