Measles – a clear and continuing threat

It’s World Immunisation Week (24 - 30 April) and we’re celebrating another year of one of humanity’s greatest achievements. Over the last 50 years, essential vaccines have saved at least 154 million lives globally. That’s six lives every minute, every day, for five decades.

In this blog, Dr Cheryl Gibbons, Lead Healthcare Scientist in Vaccination and Immunisation at Public Health Scotland (PHS), discusses measles, a disease that might be forgotten but isn’t gone for good. Cheryl explores how measles is being held at bay in Scotland by an effective vaccine that has saved more than 60 million lives worldwide.

For many people in Scotland today, measles may feel like an infection of the past or something confined to other parts of the world. Thankfully, most people in Scotland won’t ever encounter measles, and this principally reflects the success of the childhood immunisation programme.

Since the introduction of the measles vaccine in 1968, and the subsequent introduction of the MMR (measles, mumps and rubella) vaccine in 1988, cases of measles have declined considerably. Thanks to these vaccines, generations have been protected from the serious, and sometimes life-altering complications that the measles virus can cause. Around 10–20% of people who develop measles will suffer from complications that can include pneumonia, seizures, encephalitis (inflammation of the brain), and permanent hearing or vision loss. We need high vaccination coverage to protect us from a disease that is still a global threat and has the potential to cause significant outbreaks in Scotland.

Measles remains a global threat

In 2023, measles caused an estimated 107,500 deaths worldwide, with the vast majority occurring among unvaccinated or under-vaccinated children younger than five.

In 2024, 127,350 measles cases and 38 deaths were reported in the European Region, double the number of cases reported for 2023 and the highest number since 1997.

In the past month alone, Texas has reported more than 700 new cases.

As of 23 April, there have been 25 laboratory-confirmed measles cases in Scotland in 2025. There were 24 laboratory-confirmed measles cases in Scotland in 2024 and one in 2023.

Measles is highly infectious. The virus spreads through the air and is passed on by tiny droplets released when an infected person coughs or sneezes. It can remain in the air or on surfaces for up to two hours. Among all diseases that spread this way, measles is one of the most infectious and, in a completely unvaccinated population, a single person with measles can infect 15 to 20 others.

In addition, before developing the characteristic rash, an individual is infectious for four days, meaning that they may have attended work or education-settings, boarded a plane or bus, or taken part in a large gathering, and have unknowingly spread the virus to other susceptible individuals.

A highly effective vaccine

These occurrences are all preventable as measles is a vaccine-preventable disease, and the vaccine offers strong protection.

In Scotland, vaccination is free, and children are offered two doses. Having two doses of the MMR vaccine is the best way to protect you and your family from measles. Anyone who has missed a dose can catch up at any age.

Scotland has maintained high vaccine uptake rates, but we can’t be complacent. There has been a gradual decline in the number of children being vaccinated and a worrying inequality gap between those living in the most and least deprived areas. The World Health Organization (WHO) recommends that at least 95% of the population should be fully vaccinated to prevent outbreaks. Owing to the highly infectious nature, a single case of measles introduced to an under-vaccinated pocket of the community can quickly lead to a sizable outbreak.

Strategies to prevent the spread of measles

In response to the resurgence of measles in the UK and Europe since the pandemic, PHS continues to work with health boards to closely monitor and respond to any cases that arise in Scotland to protect the public.

We also work with a range of partners to raise awareness, encourage vaccine uptake, and protect every person from measles. Childhood immunisation is still the best way to achieve this, but we also offer the MMR vaccine to anyone who missed out on it earlier in life. This is particularly important for people who are travelling outside Scotland.

“Measles vaccine has saved more lives than any other vaccine in the past 50 years. To save even more lives and stop this deadly virus from harming the most vulnerable, we must invest in immunisation for every person, no matter where they live.”

— Dr Tedros Adhanom Ghebreyesus, Director-General, WHO

We know what works, we have the tools, and we’ve done it before. The challenge now is to reverse the decline in uptake and to close the gap.