Despite the World Health Organization (WHO)’s ambitious goal of eliminating measles from the European Region by 2015, several countries in Europe have been experiencing recent outbreaks of measles, as reported by the European Center for Diseases Prevention and Control (ECDC), including Greece, Ireland (Dublin), Romania and Slovakia.

ECDC’s report for August 2018 presents the data for the past year (1 July 2017 to 30 June 2018), with measles cases being reported in almost al EU/EEA member states (all except for Malta), with a total case count of 13,234 in the region. The countries contributing the highest numbers of cases during this period were, in descending order, Italy, Greece, France and Romania (https://www.ecdc.europa.eu/sites/portal/ files/documents/Monthly-Measles-Rubella-monitoring-report-August-2018.pdf).

Romania has recently been facing one of the largest measles outbreaks in the post-vaccination era, which started in early 2016 and presented continued transmission for more than two years, with measles cases being reported in all seasons, with an increasing trend. According to the latest report of the National Center for Surveillance and Control of Transmissible Diseases, for 31 August 2018, the total case count in Romania for the current outbreak is 15,109, with a high mortality index, and a total number of 59 deaths to date (http://cnscbt.ro/index.php/informari-saptamanale/rujeola-1/982-situatia-rujeolei-in-romania-la-data-de-31-08-2018/file).

This is largely due to a recent drop in the two-dose vaccination coverage during the past years, which after 2008 fell well below the target of 95%, below 90% after 2012, and reaching 75% in 2017, as reported by the WHO (http://apps.who.int/immunization _monitoring/globalsummary/timeseries/tswucoveragemcv2.html). Notably, this low coverage rate was reported in the midst of the current outbreak, despite active measures to ensure catch-up vaccination where needed, and to add a supplementary dose of measles-containing vaccine at the age of 9 months, to protect young children from developing measles prior to the 1 year landmark set for starting measles vaccination in Romania.