After a period of very low detection of measles in the WHO European Region in 2021, cases have been increasing since early 2022. Persistent immunity gaps and missed doses of vaccines due to the COVID-19 pandemic have left many people, among them an increased number of children, susceptible to this potentially fatal disease.
To prevent a resurgence of measles and other serious vaccine-preventable diseases, WHO calls for urgent action in all countries to identify all those, especially children, who have missed vaccine doses, and to devise targeted strategies relevant to local settings to enable them to catch up.
Following large outbreaks of measles in 2018 and 2019 with nearly 200 000 reported cases, the number of reported measles cases in the Region fell in 2020 to just over 12 000. For 2021, only 159 measles cases were reported in 22 countries; however, this increased in 2022, with 904 cases reported to date in 27 countries.
All countries of the Region have faced challenges in maintaining immunization coverage at pre-pandemic levels through routine service delivery of measles-containing vaccines and other vaccines in their national immunization schedules.
Vaccination coverage also differs widely both between and within countries. Some have been able to conduct catch-up activities between COVID-19 pandemic waves and maintain desirable levels of coverage. In others, routine immunization has been interrupted or postponed for a considerable period among significant portions of the national population.
Supplemental immunization activities that were planned in a few countries in the Region before the pandemic have also been affected. As Ukraine responds to urgent health needs linked to the war and Türkiye to the recent earthquakes, these countries face possible impacts on the provision of routine vaccination services, thereby increasing the risk of infectious disease outbreaks.
“Everyone deserves the incredible protection vaccines provide,” says Dr Nino Berdzuli, Director of the Division of Country Health Programmes at WHO/Europe. “But, as we have seen all too clearly during this COVID-19 pandemic, often those who need protection most are less likely to receive it. Leaving no one behind requires an urgent, dual-track approach: we must strengthen our immunization systems to address challenges to routine immunization while also striving to reach the most vulnerable with COVID-19 vaccines.”
Action needed to prevent large outbreaks
Sustaining at least 95% routine coverage with 2 doses of a measles-containing vaccine will interrupt transmission of the virus and prevent the return of large outbreaks. It is also critical to increase awareness among both health-care professionals and the public about the risks of the disease.
In addition, WHO urges countries to ensure that measles surveillance is strong enough to detect and investigate suspected cases without delay. Indeed, to prevent further transmission, countries need to be ready to respond swiftly and effectively in the event of measles outbreaks.
The measles vaccine has been in use since the 1960s. It is safe, effective and inexpensive. WHO recommends immunization for all susceptible children and adults for whom measles vaccination is not contraindicated. Reaching all children with 2 doses of measles vaccine, either alone or in a measles-rubella (MR), measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) combination, should be the standard for all national immunization programmes.
Measles is a vaccine-preventable disease targeted for elimination in most WHO regions, including the European Region. Transmission of the highly contagious respiratory virus that causes the disease declined across the world due to COVID-19 response measures, including physical distancing, mask use and international travel restrictions.
However, the disease has not disappeared, and the risk of large outbreaks has only increased. In 2021, a record high of nearly 40 million children missed a measles vaccine dose: 25 million children missed their first dose and an additional 14.7 million children missed their second dose.
This decline is a significant setback in global progress towards achieving and maintaining measles elimination and leaves millions of children susceptible to infection. In many countries around the world, as soon as pandemic response measures were relaxed, surveillance systems started detecting increasing numbers of measles cases and outbreaks.