Background/Objectives: A resurgence of measles has been observed in Europe and worldwide since 2023. The aim of this article is to describe characteristics of cases reported to the Italian national measles surveillance system and discuss reasons for the outbreak and its public health relevance. Methods: We analyzed measles cases reported to the Italian national measles surveillance system with a symptom onset from August 2023 to January 2025. Results: Overall, 1164 cases were reported, of which 1065 (91.5%) were laboratory confirmed. The median age was 30 years, but the highest incidence was in children under one year of age. Transmission occurred mainly in families and nosocomial settings. Multiple importations occurred during 2023, which initially led to localized outbreaks with limited spread but was subsequently followed by increasing local transmission in 2024. Conclusions: These findings suggest lingering immunity gaps in children and adults in Italy, highlighting the potential severity of measles and the ease with which measles crosses country borders. Besides improving routine immunization coverage, targeted vaccination opportunities should be provided to susceptible population groups. Communication activities are also needed to increase awareness about disease severity, especially among young adults. In view of the upcoming travel season, travel clinics should encourage persons without evidence of measles immunity to be vaccinated before any international travel.

Background/Objectives: Since 2023, a significant increase in measles cases has been reported worldwide, and Italy has been among the most affected European countries. In this context, the integration of laboratory and epidemiological data enables timely case classification and helps distinguish between imported and indigenous cases, supporting disease control. However, most studies address only selected aspects of surveillance. Therefore, this study aimed to provide an integrated analysis of virological and epidemiological surveillance activities conducted between November 2023 and December 2025 by the Regional Reference Laboratory in the Emilia-Romagna Region (ERR). Methods: A total of 806 clinical samples (269 urine, 267 oral fluids—saliva or oropharyngeal swabs—and 270 sera) from 291 suspected measles cases were tested by molecular and/or serological methods, and MV genotyping was performed. Samples from discarded cases were also analysed for parvovirus B19 (B19V), human herpesvirus 6 (HHV-6), enterovirus (EV), and varicella zoster virus (VZV), chikungunya virus (CHIKV) and dengue virus (DENV). Results: Of 291 suspected cases, 176 (60.5%) were confirmed. Median age was 33 years, with 46% in the 15–39 year group. Vaccination status was available for 165: 90.3% were unvaccinated, 5.4% had one dose, and 4.2% had two doses. Notably, over half of confirmed cases occurred in areas with vaccine-hesitant communities. MV strain characterisation was performed in 99.4% of MV-RNA positive cases, with 84.3% genotype D8 and 15.6% genotype B3; 83% of strains were of indigenous origin, suggesting an ongoing endemic circulation. Clinical data showed complications in 19.3%, mainly pneumonia and diarrhoea. Additionally, differential diagnosis enabled the identification of the etiological agent in 37.5% of measles/rubella discarded cases, and 37.6% (29/77) tested positive for B19V. Conclusions: The study results highlight that effective measles surveillance must be supported by integrating timely virological diagnosis, molecular and epidemiological investigations, and differential diagnosis, to achieve the WHO goals of eliminating measles transmission.