The document summarizes measles and rubella surveillance data from the WHO European Region from March 2020 to February 2021. It finds that the majority of measles cases were reported by 10 countries, with Uzbekistan reporting the most at 1723 cases. For rubella, the majority of cases were reported by 5 countries, with Poland reporting the most at 53 cases. Overall measles cases decreased from over 100,000 in 2018 to around 12,000 in 2020, while rubella cases decreased from over 800 in 2018 to around 200 in 2020. Both measles and rubella disproportionately affected younger age groups and those who were unvaccinated or incompletely vaccinated.

1. Vaccine-preventable Diseases and Immunization programme
Division of country health programmes
Data as of 01 April 2021
Measles and rubella monthly update—
WHO European Region
www.euro.who.int

2. Measles
Updates including 2021
2

3. 3
Measles cases—WHO European Region,
March 2020–February 2021
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city
or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2021. All rights reserved.
Top 10 countries
Country Cases
Uzbekistan 1723
Kazakhstan 1075
Russian Federation 643
Romania 383
Kyrgyzstan 347
Turkey 259
France 78
Bulgaria 71
Tajikistan 67
Ukraine 64
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021
(1 country*)
* Montenegro submitted the last report for December 2019

4. 4
Measles incidence per million population—
WHO European Region, March 2020–February 2021
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city
or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2021. All rights reserved.
Top 10 countries
Country Incidence
Kazakhstan 57.25
Kyrgyzstan 53.19
Uzbekistan 51.48
Romania 19.91
Bulgaria 10.22
Tajikistan 7.02
Russian Federation 4.41
Republic of Moldova 3.47
Turkey 3.07
Georgia 2.76
Population source: United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021
(1 country*)
* Montenegro submitted the last report for December 2019

5. 64
67
71
78
259
347
383
643
1075
1723
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Ukraine
Tajikistan
Bulgaria
France
Turkey
Kyrgyzstan
Romania
Russian Federation
Kazakhstan
Uzbekistan
Number of cases
5
Ten countries with the highest numbers of measles cases—
WHO European Region, March 2020–February 2021
Out of 4 868 measles cases reported for March 2020 to February
2021, 4 710 (97%) cases were reported by these 10 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

6. 6
Measles cases by month—WHO European Region,
2019–February 2021
Criteria for date of case inclusion may differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
2019
(n=104442)
2020
(n=12198)
2021
(n=15)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible

7. 7
Measles genotypes by week of sample collection—
WHO European Region, week 9, 2018 to week 8, 2021
0
20
40
60
80
100
120
140
160
180
200
9
10
11
12
13
14
15
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51
52
1
2
3
4
5
6
7
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9
10
11
12
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15
16
17
18
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20
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34
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43
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45
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51
52
1
2
3
4
5
6
7
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16
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18
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20
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22
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34
35
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39
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41
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43
44
45
46
47
48
49
50
51
52
53
1
2
3
4
5
6
7
8
2018 2019 2020 2021
Number
of
sequences
reported
Week of sample collection
H1 D4 D9 B3 D8 C2
2018 2019 2020
Data source: WHO measles nucleotide surveillance online database (MeaNS) data as of 01 April 2021
2021

8. Measles
Latest update for 2020
8

9. 9
Measles cases—WHO European Region, 2020
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city
or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2021. All rights reserved.
Top 10 countries
Country Cases
Uzbekistan 4053
Kazakhstan 3269
Russian Federation 1100
Romania 976
Kyrgyzstan7 708
Turkey7 611
Bulgaria 245
France 240
Ukraine 211
Tajikistan 168
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021
(1 country*)
* Montenegro submitted the last report for December 2019

10. 10
Measles incidence per million population—
WHO European Region, 2020
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city
or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2021. All rights reserved.
Top 10 countries
Country Incidence
Kazakhstan 176.21
Uzbekistan 122.89
Kyrgyzstan 110.35
Romania 50.40
Bulgaria 35.00
Tajikistan 18.02
Russian Federation 7.54
Turkey 7.32
Belgium 5.20
Georgia 5.00
Population source: United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021
(1 country*)
* Montenegro submitted the last report for December 2019

11. 11
Ten countries with the highest numbers of measles cases—
WHO European Region, 2020
168
211
240
245
611
708
976
1100
3269
4053
0 500 1000 1500 2000 2500 3000 3500 4000 4500
Tajikistan
Ukraine
France
Bulgaria
Turkey
Kyrgyzstan
Romania
Russian Federation
Kazakhstan
Uzbekistan
Number of cases
Out of 12 198 measles cases reported for 2020, 11 581 (95%) cases were
reported by these 10 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

12. 12
Measles cases by month—WHO European Region,
2018–2020
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2018
(n=88693)
2019
(n=104442)
2020
(n=12198)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
Criteria for date of case inclusion may differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

13. 13
Measles cases and incidence by age group* and vaccination
status—WHO European Region, 2020
*Age was unknown for 34 cases.
Population source: United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2019 Revision.
390
71
17 12 9 9 3
0
50
100
150
200
250
300
350
400
450
0
500
1000
1500
2000
2500
3000
3500
4000
4500
<1
(n=4210)
1–4
(n=3201)
5–9
(n=1010)
10–14
(n=650)
15–19
(n=463)
20–29
(n=1061)
30+
(n=1569)
Incidence
per
million
population
Number
of
cases
Age group (years)
0 dose 1 dose 2+ doses Unknown Incidence
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

14. 30604
33254
26788
32857
18869
28413
5273
25872
88693
104442
12198
93 94 95 95 94 94 93
95 95 96
80
82 83
89 89 89 88
90 91 91
0
20
40
60
80
100
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
0
20000
40000
60000
80000
100000
120000
%
Coverage
Year
Number
of
cases
Measles cases MCV1 coverage MCV2 coverage
14
Measles cases, MCV1 and MCV2 coverage by year—
WHO European Region, 2010–2020
Data source: 1) Measles cases – monthly aggregated and case-based data reported by Member States to WHO/Europe or via ECDC/TESSy as of 01 April 2021.
2) MCV1 and MCV2 coverage - WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) as of 15 July 2020.
MCV1: first dose of measles-containing vaccine
MCV2: second dose of measles-containing vaccine

15. Rubella
Updates including 2021
15

16. 16
Five countries with the highest numbers of rubella cases—
WHO European Region, March 2020–February 2021
2
9
14
18
53
0 10 20 30 40 50 60
Italy
Turkey
Germany
Ukraine
Poland
Number of cases
Out of 102 rubella cases reported for March 2020 to February 2021,
96 (94%) cases were reported by these 5 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

17. 17
Rubella cases by month—WHO European Region,
2019–February 2021
0
20
40
60
80
100
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
2019
(n=630)
2020
(n=188)
2021
(n=15)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
Criteria for date of case inclusion may differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

18. Rubella
Latest update for 2020
18

19. 19
Five countries with the highest numbers of rubella cases—
WHO European Region, 2020
15
16
17
27
96
0 20 40 60 80 100 120
Turkey
Italy
Germany
Ukraine
Poland
Number of cases
Out of 188 rubella cases reported for 2020, 171 (91%) cases
were reported by these 5 countries.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

20. 20
Rubella cases by month—WHO European Region,
2018–2020
0
20
40
60
80
100
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
2018
(n=839)
2019
(n=630)
2020
(n=188)
Number
of
cases
Month
Lab confirmed Epi linked Clinically compatible
Criteria for date of case inclusion may differ in accordance with Member States’ surveillance systems.
Data source: Monthly aggregated and case-based data reported by Member States to WHO/Europe directly or via ECDC/TESSy data as of 01 April 2021

21. 21
Links to measles and rubella information
• WHO EpiData
www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/surveillance-and-data/who-epidata
• Country slides for measles and rubella
www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/
• WHO EpiBrief
www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/surveillance-and-data/who-epibrief