The total number of cases reported in 2024 means that the infection rate has been 77.4 cases per million inhabitants, a significantly higher figure than the 9.1 cases per million inhabitants in 2023 and even surpassing pre-pandemic data, with a rate of 27.2 cases in 2019. The ECDC has warned that measles activity began to increase in 2023 after a period of unusually low activity during 2020-2022, coinciding with the Covid-19 pandemic.
Reported cases have followed a seasonal pattern, after not observing the typical pattern between 2021 and 2023. The highest number of reported cases occurred between February and July, with a particularly sharp increase, while in the second half of the year, cases gradually decreased.
By countries, it is worth noting that all EU/EEA members reported cases during the past year, except for Latvia and Liechtenstein. Romania recorded the highest infection rate, with 1,610.7 cases per million inhabitants and a total of 30,692 cases, representing around 87 percent of all detected cases. Austria, with a rate of 59.5 cases per million inhabitants, Belgium (44.9), and Ireland (39.6) complete the list of countries with the highest number of cases per inhabitants.
In addition, the disease has occurred in all age groups, especially among infants under one year, where a rate of 1,175.4 cases per million inhabitants was observed, and in children aged one to four years, with a rate of 688.7 cases per million. Those over 14 years old accounted for 26 percent of all reported cases, while in certain countries, most infections occurred in adults over 30 years old, as was the case in France, where this age group accounted for 28.4 percent of cases, Poland (34.4%), Spain (38.5%), and Italy (52.4%).
### 79% REQUIRED HOSPITALIZATION
Seventy-nine percent of reported cases last year required hospitalization, in line with the 80 percent in 2023, but significantly higher than the 33 percent in 2022 and 55 percent in 2019. The majority of hospitalized individuals, around 85 percent, were not vaccinated. Regarding measles-related complications, these also affected unvaccinated individuals more, with pneumonia, otitis media, and encephalitis being the most common.
Additionally, 23 measles-related deaths have been reported, with 22 in Romania, a significant increase compared to the three deaths reported in 2023. Of the total deaths, 14 were reported in children under five years old.
Although most measles cases reported in 2024 originated from local transmission within EU/EEA countries, among cases with known importation status, 18 percent were imported and 7 percent were import-related, totaling 764 cases, a significant increase compared to 2023 (6.4%).
The majority of imported infections were acquired in other European countries, whether within the EU/EEA (26%) or outside the EU/EEA (39%), followed by Asia (22%) and Africa (4%). Imports from Austria, Germany, Spain, France, Italy, and Romania together accounted for 65 percent of these cases.
Taking this into consideration, the ECDC has urged countries to collaborate and exchange timely information to prevent further cross-border transmission and outbreaks within the EU/EEA region. They have also called for medical checks before any travel, even within the EU/EEA, and for healthcare professionals to verify and update measles vaccination in such cases.
### 87% WERE UNVACCINATED
Regarding whether reported patients were vaccinated against the infection or not, the report indicates that 87 percent (27,692 individuals) were not vaccinated. It is worth noting that 90 percent of children between one and four years old who were infected were also unvaccinated; the age group for which receiving the first dose of the vaccine is recommended in EU/EEA countries, and sometimes the second dose.
In this regard, the ECDC report points out that vaccine coverage in children remains below the recommended level to achieve and maintain measles elimination. The average weighted vaccine coverage for the first dose of the measles vaccine in the EU/EEA slightly decreased in 2024 (93.9%) compared to 2023 (94.2%). Only four EU/EEA countries reached the recommended vaccination percentage, that is, 95 percent.
The study notes that only two EU/EEA countries saw an increase of three percent or more in estimates of the first measles vaccination dose between 2020 and 2023, as well as an increase in four countries for the second dose. In contrast, there has been a decrease in vaccination rates, both for the first and second doses, in a total of eight countries.
The ECDC has called for intensified efforts to increase vaccination coverage and participation in systematic childhood immunization as well as booster vaccination campaigns in adolescents and adults who have not been vaccinated before. They have recommended the implementation of enhanced and digitized immunization information systems to identify and reach unvaccinated individuals, as well as continuous surveillance and rapid outbreak investigation.
Measles is an acute and highly contagious viral disease caused by a single-stranded ribonucleic acid (RNA) virus of the ‘Morbillivirus’ genus and ‘Paramyxoviridae’ family. It is characterized by symptoms such as high fever, cough, runny nose, eye inflammation, and a distinctive red rash that spreads throughout the body. Complications can be severe and include pneumonia, hearing loss, encephalitis, and death. It is estimated that 90 percent of unvaccinated individuals exposed to an infected person will contract the disease.
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