Measles is targeted for elimination since 2001, with a significant reduction in cases recorded worldwide, but outbreaks occur periodically due to immunization gaps. This study analyzes the evolution of vaccination coverage rates (VCRs) in Romania, a EU country with large measles epidemics during the last two decades, including an ongoing outbreak in 2023. Vaccination against measles has been part of the National Immunization Program since 1979, initially as a single dose, and from 1994 onwards it has had two doses. The initially high national VCRs of >97% gradually declined from 2010 onward and remained constantly under 90%, with further decreases during the COVID-19 pandemic. The lowest VCRs for both vaccine doses in the last decade were recorded in 2022 and were 83.4% for the first dose and 71.4% for the second dose, with significant differences among Romania’s 42 counties. Several factors contributed to this decline, including failure to attend the general practitioners’ offices, increased number of children lost to follow-up due to population movements, missed vaccination opportunities due to temporary medical contraindications, a surge in vaccine hesitancy/refusal, a decreasing number of general practitioners and discontinuities in vaccine supply. The persisting suboptimal VCRs in Romania threaten the progress toward measles elimination.

Since January 2011 Romania has been experiencing a measles outbreak with 2,072 cases notified in 29 of the 42 Romanian districts. Most cases occurred in the north-western part of the country among unvaccinated children with the highest number of cases (893 cases) registered in children aged one to four years. This report underlines once more the need for additional measures targeting susceptible populations to achieve high vaccination coverage with two doses of measles-mumps-rubella vaccine.

We report an outbreak of measles that has been ongoing in the district of Neamt, Romania, since 22 August 2010. As of 21 September, 17 of 21 suspected cases have been laboratory-confirmed and there was one measles-related fatality.

Background/Objectives: Measles is a highly contagious viral disease that continues to have a profound effect on morbidity in Romania. Identifying temporal and spatial trends in how the disease spreads among the country’s counties and regions, both in the same disease generation as well as one generation apart (2-week case lag), aided by forecasting tools, could provide valuable insights into tailoring public health interventions. Methods: A big data analysis has been performed on notified measles cases from January 2020 to December 2024 using Python v3.13 grouping cases based on location (using the Nomenclature of territorial units for statistics) and time of the onset of the disease. Results: Feedback loops among both counties and macroregions have been identified (for example Centru-Brașov and București-Ilfov with a correlation factor of 0.77) while monthly forecasting for 2025 and 2026, explored using both the SARIMA and the Holt-Winters models (MAE 1616.74 and 1281.99, respectively), shows the measles might continue to be a burden, with the Holt–Winters models exhibiting slightly more reliable monthly forecast data nationwide, helping to define a solid basis for future predictions and decisions. Conclusions: The spatial feedback loops, both interregional or within the same region, coupled with the trend of lowering vaccination rates, contribute to the persistent emergence of new measles cases which might continue throughout 2025 and 2026 based on the forecasting, distinct from previous outbreaks which followed a specific cadence.

Background/Objectives: Romania remains endemic for measles due to suboptimal vaccine coverage rates. During the last three epidemics, the highest incidence of measles was recorded in children younger than 1 year, who should have been partially protected by maternal antibodies. A nationwide cross-sectional seroprevalence study was conducted on persons of fertile age, to evaluate potential immunity gaps in the population. Methods: Between June and October 2020, 959 serum samples were collected from individuals aged 25–44 years (46.5% females) from all the geographic regions in Romania. Measles IgG antibodies were assessed using an enzyme-linked immune assay (DIA.PRO-Diagnostic Bioprobes Srl, Italy). Statistical analysis was performed in IBM SPSS Statistics 27.0, using Fisher’s exact and chi-squared tests to test for associations between seropositivity and demographic factors, with p < 0.05 considered statistically significant. Results: The overall measles seroprevalence was 77%, without gender- or geographic region-related differences. Both the seropositivity rate and the measles antibodies titers increased with age, with the highest difference between the oldest and the youngest age group (p = 0.057), suggesting persistent immunity after natural infection in older individuals or anamnestic responses in vaccinated persons, caused by repeated exposures to the circulating virus. An additional confirmatory pilot study on 444 pregnant women confirmed the low level of measles seroprevalence (68.4%), with a significant upward trend in older ages (75% in those aged >40 years old vs. 65% in those aged 25–29 years, p = 0.018 and mean reactivity of measles antibodies 3.05 ± 1.75 in those aged >40 years vs. 2.28 ± 1.39 in those aged 25–29 years, p = 0.037). Conclusions: This study signals critical immunity gaps in the population that contribute to the accumulation of susceptible individuals and recurrent measles outbreaks. The absence of measles antibodies in women of childbearing age increases the newborn’s susceptibility to infection, with potentially severe complications.

Background and Objectives: Measles is a highly contagious but vaccine-preventable disease with significant morbidity in the European region, including Romania, especially in the post-COVID-19 era with low vaccination rates which no longer provide herd immunity. The current study aims to show how vaccination reduces the disease burden. Methods: A study using 29,148 cases with measles-compatible features in Romania from the 2020–2024 period was performed, analyzing symptoms, complications, and hospitalization rates comparatively between vaccinated and non-vaccinated groups. Results: Our findings show substantial hospitalization rates reduction among vaccinated cases with an over 12% decrease—depending on the number of MMR doses—as well as reduced severity of clinical features, but no significant effect on disease duration. Conclusions: MMR vaccination provides protection beyond primary disease prevention, as it reduces the disease burden among measles cases by reducing disease-related hospitalizations and improving clinical outcomes.