Progress and challenges in measles elimination activities in Italy, 2020–2024

Background

In Italy measles incidence declined in 2020–2022, mainly due to non-pharmaceutical interventions implemented during the COVID-19 pandemic. From 2023, a resurgence of cases was observed, in line with trends reported across Europe and major outbreaks reported in 2023–2024. This study aimed to assess activities implemented to achieve the measles elimination target during the 2020–2024 period in Italy.

Methods

Data routinely collected by the National Verification Committee (NVC) through the Annual Status Updates (ASUs) during the 2020–2024 period were analysed. The evaluation focused on population immunity levels, supplemental immunization activities (SIAs) and national surveillance performance indicators.

Results

First‑dose vaccination coverage at 24 months declined in 2020 (91.5%) and increased to 94.8% by 2024. Second‑dose coverage in 2024 remained below target among children aged 7 years (84.5%) and adolescents aged 16–18 years (90.9%-89.7%). From 2020–2024, the number of SIAs increased from 11 to 29, and expanded in geographic coverage (from 2 to 5, out of 21 Regions/Autonomous Provinces) and target groups, involving mainly children and adolescents. Among surveillance performance indicators, four of them failed to reach the WHO targets: origin of infection identified and viral detection for sporadic cases, both below the target of ≥ 80%, the former ranging from 11.1 % in 2021 to 65.9% in 2023 and the latter decreasing from 63% in 2023 to 56.9% in 2024. Finally, the rate of discarded cases, with the highest observed value of 0.08/100.000 in 2023 (target ≥2/100.000), and the representativeness of reporting of discarded case, showed persistent low values.

Conclusions

Declines in measles incidence alone are insufficient to achieve and maintain elimination if challenges persist in two-dose vaccination coverage, population immunity, SIA implementation, and surveillance system performance. Sustained and targeted public health efforts remain essential.

Key messages

• The resurgence of measles in Italy shows that temporary declines in incidence, without high vaccine coverages and strong surveillance systems, are insufficient to achieve elimination.

• Although SIAs increased and expanded across Regions and age groups, persistent immunity gaps continue to undermine measles elimination efforts and require targeted, sustained public health actions.