Measles: How to deal with the rising number of cases?

One of the World Health Organization 's priorities is the elimination of measles, the most communicable disease among those preventable by vaccination.

However, the latest data published by the European Centre for Disease Prevention and Control (ECDC) reflect continued transmission in the European Union, with a marked increase in reported cases since 2023, following a period of lower activity during the COVID-19 pandemic.

What can we do to stop it?

First, let's get to know the enemy better. Measles is a disease that causes skin lesions, transmitted by a virus whose only reservoir and source of infection are infected people.

It is transmitted from a sick individual to a susceptible individual through the air by dissemination of expelled droplets or by direct contact with nasal or pharyngeal secretions.

Its clinical diagnosis requires the presence of a maculopapular rash (a skin rash characterized by the simultaneous presence of flat spots and raised bumps), fever, and at least one of the following symptoms: cough, rhinorrhea, or conjunctivitis.

For vaccinated people who have contact with a case, the likelihood of becoming ill is very low. But if they do eventually contract the infection, symptoms may be milder or absent , so clinical suspicion should be heightened in these individuals.

This situation occurs more frequently in healthcare workers, although immunological memory after exposure shortens the infectious period, thereby reducing transmission capacity.

Measles-associated complications occur in approximately 30% of cases, especially in children under five years of age, adults, and people with immunosuppression. The most common complications are pneumonia, otitis media, and diarrhea, and, less frequently, encephalitis.

As we noted above, measles is gaining ground in Europe: between February 2024 and January 2025, more than 30,000 cases were diagnosed in the European Union, with Romania, Italy, Germany, Belgium, and Austria leading the statistics.

Spain has been on a measles elimination path since 2016 and has a Strategic Plan to achieve this goal. Although the incidence here remained at very low levels until the end of 2022, the number of imported cases then began to increase significantly, with a subsequent increase in secondary cases and outbreaks.

As of May 2025, more than 200 diagnoses have been confirmed in Spain. Most of them were imported cases related to international travel to Morocco and Romania, countries experiencing significant outbreaks due to poor vaccination coverage.

In the latest seroepidemiological study conducted in Spain (2017-2018), it was observed that the seroprevalence of measles antibodies (i.e., the level of antibodies that protect against the disease, whether due to previous exposure or due to adequate vaccination) was sufficient in almost all age groups. However, they fell to 88% in the Spanish population born between 1988 and 1997, and to 78% in the foreign population of these groups.

Vaccination is the most effective preventive measure against measles. Routine measles immunization began in 1978 and was replaced in 1981 by the MMR vaccine, which simultaneously protects against measles, mumps, and rubella. In Spain, coverage with two doses of the MMR vaccine among children is above 94%, very close to the 95% required to maintain elimination.

In order to maintain these high levels of coverage, the recommendations for MMR vaccination are:

Administer both doses of vaccine to the child population.

Review vaccination status and complete it with two doses for all people born after 1978 and with no history of having suffered from the disease.

Review and update the vaccination schedule upon first contact with the healthcare system for all people arriving from another country or autonomous community.

Review your vaccination status and complete it before traveling. When traveling to areas with a high incidence of COVID-19, you can consider getting your child vaccinated early.

Review and update vaccination status for healthcare workers. A third dose is not indicated for these professionals who have already received two doses, regardless of the time elapsed since the second.

People who suspect they have measles should take the following precautions:

Proceed with immediate and strict home isolation.

Use the surgical mask correctly.

Inform your primary care physician by phone.

Follow the instructions of healthcare professionals.

For their part, the latter must:

Consider diagnosing measles in patients who present with fever and rash.

Indicate the isolation of the case and use a surgical mask.

If the healthcare professional has been exposed to a case, they must follow the preventive measures indicated by the occupational risk prevention services.

Make an urgent telephone report to the epidemiological surveillance services if you suspect a case.

And finally, epidemiological surveillance services must:

Coordinate the study of suspected cases for confirmation and isolation.

Study the contacts by reviewing their vaccination status to complete it.

Investigate outbreaks.

Promote genotyping of cases.

The increase in outbreaks in several countries and the continued drop in imported cases in Spain suggest the need to improve vaccination coverage. Being immunized by having had measles or by having received both doses offers protection against this disease.

Furthermore, isolation measures and proper mask use are effective in preventing infection. Given the increasing spread of measles worldwide, those who are not properly immunized may contract the disease at some point in their lives and should protect themselves with vaccination.

Article published in The Conversation and written with the advice of the Spanish Society of Epidemiology .