# Measles in Romania, 2016–2025: who died, and who could have protected them

Two epidemics, from the reports of Romania's National Institute of Public Health

Two measles epidemics, 55,940 confirmed cases and 94 deaths. Of those whose age was published, 43 of 89 were babies under one. Romania's schedule gives the first vaccine dose at 12 months. Until then, their protection depends largely on the people around them. In 2024, 3,475 babies under one caught measles: a rate of 2,061.1 per 100,000, 15 times that of the whole population.

## How many of 25 children in each Romanian county had no measles vaccine at two

Every year the institute checks the records of children born in July and counts how many had their first dose of the measles, mumps and rubella vaccine (MMR, ROR in Romanian) by age two. Pick a county and a birth year. The class below holds 25 children born there that year.

## Why it is mostly babies who die

A baby cannot get the MMR vaccine before 12 months on Romania's routine schedule. During the epidemic, doctors could vaccinate from 9 months: between December 2023 and September 2024, 38,540 doses went to children aged 9–11 months. Below 9 months, Romania does not vaccinate. A baby's protection then depends mostly on the people nearby: brothers and sisters, parents, other children at the doctor's surgery or on the hospital ward.

For some of the deaths in 2023–2024 the institute recorded the child's contacts: “contact with his 3-year-old brother, unvaccinated against measles”, “a confirmed measles contact on the ward”.

In the first epidemic, 35 of the 64 deaths were babies under one (26 under 9 months) and 47 were children under two. 62 were unvaccinated; one, a 4-year-old, was vaccinated. In the second, of the 25 whose age was published, 8 were babies under one and 6 were between one and two. 5 were adults with severely weakened immunity (HIV/AIDS, myeloma, treatment that suppresses it). Two of them had been vaccinated; in such patients the vaccine may no longer protect. Their protection, too, depends a great deal on the people around them.

In every year of the two epidemics (2016–2020 and 2023–2025), the institute's annual reports give babies under one the highest measles rate of any age. In 2024: 3,475 babies with confirmed measles, 2,061.1 per 100,000, 15 times the rate of the whole population (133.78 per 100,000).

## Does the vaccine work? The epidemic's own data answer

If the vaccine did not protect, sick children would be vaccinated as often as children in general. The institute's data show otherwise. Of the children aged 1–4 who caught measles in 2023–2025 and whose history was known, only 7.5% had had a dose. The children aged 1–4 in the epidemic were born between 2019 and 2024. For those born in 2019–2022, the institute's surveys found between 59.8% vaccinated (at 12 months) and 88.2% (at two).

If the real share of vaccinated children aged 1–4 lay somewhere in that range, the screening method (which epidemiologists use when no dedicated study exists) gives 95–99% protection against the disease: 95% at the low end, 99% at the high end. It is not a measurement: the vaccination of sick and of healthy children comes from different sources, 615 sick children have an unknown history, and detection may differ between vaccinated and unvaccinated children. But the gap between 7.5% and 59.8–88.2% stays wide however those errors are taken.

## How many Romanian children have the measles vaccine at two

The WHO target for eliminating measles is at least 95% of the population with two doses. The national figure in the institute's surveys did not reach 95% in any year, even for the first dose. Of children born in July 2017, 92.2% had it at two. Of those born in July 2022, 84.4%.

For children born in July 2024 the institute counted differently: straight from the electronic vaccination register, not from doctors' records. It found 69.6%. The register misses vaccinations never entered in it, so the figure is not drawn on the same line as the earlier years. The institute's 2025 annual report gives, for the whole country, 65.5% for the first dose and 55.1% for the second.

## Did the less vaccinated counties have more measles?

A little, and not everywhere. For each county, the vaccination of children born in 2018, 2019 and 2020 was averaged and set beside its measles rate in the second epidemic up to 1 September 2024, the last date with county counts. The test was chosen before the calculation.

The ten counties with the lowest vaccination (75.8–84.3%) had 214 cases per 100,000 people. The other 32 had about 100. Above that level a county's average says almost nothing: Covasna and Giurgiu reported more than 95% and were among the worst hit. Across all 42 the correlation is weak (-0.28; -0.34 when weighted by population).

The likely reason: measles spreads between people who meet, on one street, in one village, at one school. A county average mixes places vaccinated almost completely with places where almost no one is. The public data go no lower than the county, so this page cannot show more.

Nor did being hit hard in the first epidemic shield a county in the second (correlation 0.16). And the map changed within the second epidemic: in 2025 the highest rates were in Satu Mare (252.5), Neamț (241), Sălaj (166.8) per 100,000, counties that up to 1 September 2024 had lower rates (Satu Mare 65.6, Neamt 140.9, Salaj 99.3).

## The two epidemics, week by week

The first epidemic started in 2016 in the west (Caraș-Severin, Arad, Timiș) and died out during the pandemic, in 2020: 20,204 confirmed cases, 64 deaths. The second began in 2023 in Brașov and Mureș and reached every county: 35,736 cases and 30 deaths by the end of 2025. 2024 alone had 25,505 cases, about seven times as many as 2023.

Almost all the sick were unvaccinated: 81.7% of cases in the second epidemic had no dose.

## What this means for one child

Romania's national schedule gives the MMR vaccine at 12 months and at 5 years, free, at the family doctor. A child who missed a dose can catch up; the family doctor decides how. If you are not sure which vaccines a child has had, the doctor can see the record and the electronic register.

For a child's exact dates, a personal calendar (in Romanian) is on Vaccinurile copilului și ale familiei.

## How the cases were counted

- Cases come from the institute's reports: 207 weekly reports (December 2016 to September 2024), 16 monthly ones (September 2024 to December 2025) and the annual reports for 2024 and 2025. They are confirmed cases: by laboratory, by link to a confirmed case or, rarely, clinically only.
- First epidemic by county: the cumulative table of 10 November 2017, plus the new cases reported each week by county up to July 2020. That places 19,681 of 20,204 cases; 523 fall in weeks with no published report and appear only in the national total.
- Second epidemic by county: the last county table is of 1 September 2024, with 23,972 cases (67% of the total). Later reports give the national total only.
- County populations are the ones the institute used: cases divided by the rate it published on 1 September 2024.
- Vaccination: the institute's surveys of children born in July, assessed at 24 months (cohorts 2015–2022), out of the children doctors found (93–95% of live births). Children “born or gone abroad” count as unvaccinated. For the 2024 cohort, the electronic register. The class of 25 rounds: 25 × (1 − share vaccinated).
- Deaths: the institute's list of the 64 deaths of 2016–2019 (age, vaccination) and the reports' description of each death in 2023–2025. One is printed “aged 2 de ani” for an adult and was left without an age. The page uses no names and no stories from the press.
- Vaccine protection: the screening method (Orenstein and colleagues, 1985) on children aged 1–4 in 2023–2025, with the population share vaccinated taken between the lowest and highest national survey values; a sensitivity calculation, not a measurement.

## Questions

### Why do mostly babies die of measles?

Because they cannot yet be vaccinated (the first dose is at 12 months, from 9 months during an epidemic), and in the institute's list of deaths for 2016–2019 most causes given are pneumonia and respiratory failure. In the first epidemic, 35 of the 64 deaths were babies under one.

### How many measles cases and deaths has Romania had?

In the first epidemic, from 2016 to July 2020, 20,204 confirmed cases and 64 deaths. In the second, from 2023 to 31 December 2025, 35,736 cases and 30 deaths.

### What is the measles vaccination rate in each Romanian county?

The page shows, for each county, the share of children born in July 2015–2022 who had a first MMR dose at two, from the institute's surveys, plus the register figure for children born in 2024.

### How well does the MMR vaccine protect?

A rough calculation on Romania's epidemic data (the screening method, children aged 1–4) gives between 95% and 99%, if the share vaccinated lay between the values the institute's surveys found. It is not a direct measurement.

### Why do vaccinated people get measles too?

Because no protection is complete, and because in a large epidemic even a small share of very many exposed people is many cases. Two of the vaccinated adults who died had serious conditions that weaken immunity; in such patients the vaccine may no longer protect.

## Sources

Every number comes from documents of Romania's National Institute of Public Health (its National Centre for Communicable Disease Surveillance and Control), public on insp.gov.ro, downloaded on 1 November 2026. The page does not republish their documents, maps or charts.

- “Situația rujeolei în România” (measles situation in Romania), weekly reports 2016–2024 and monthly 2024–2025: weekly, monthly.
- “Situația deceselor datorate rujeolei, România 2016–2019” (measles deaths), in the same archive.
- “Analiza rezultatelor estimării acoperirii vaccinale la vârsta de 24 de luni” (coverage at 24 months), cohorts 2015–2022 and 2024: vaccination coverage.
- “Analiza bolilor transmisibile aflate în supraveghere” (annual surveillance reports) for 2024 and 2025: annual reports.
- National vaccination schedule: Ministry of Health order 964/2022, annex 1, on legislatie.just.ro.
- Screening method: Orenstein W.A. et al., “Field evaluation of vaccine efficacy”, Bulletin of the World Health Organization 63(6), 1985.
- Related work: Donadel M. et al., BMC Infectious Diseases 21:279 (2021), child deaths 2016–2018; Stanescu A. et al., Vaccines 12(1):107 (2024), the counties hit hardest in 2023.