After years of decline, measles is on the rise in Europe, according to a new report.
As of October, European health officials reported more than 26,000 measles cases this year and nine deaths. That's a threefold increase in cases from the same time period in 2007, said the World Health Organization.
France accounted for about 14,000 cases, mainly in children older than five and in young adults.
Other big outbreaks of the highly-contagious disease have been identified in Spain, Romania, Macedonia, and Uzbekistan.
So far, measles has killed nine people in Europe and hospitalized thousands of others. The report was published Thursday by the U.S. Centers for Disease Control and Prevention.
"We are seeing a surge of cases much larger than we've seen in the past five or six years," said Rebecca Martin, immunization program manager for WHO's Europe office in Copenhagen.
Measles cases had been dropping for years, but began to increase sharply in late 2009.
Martin said the epidemic was fuelled mainly by low vaccination rates and noted about half the cases were in people older than 15.
"Over the years, people who haven't been vaccinated are now giving the virus a big opportunity to spread," Martin said.
The report said overall vaccination rates in Europe were high, but still didn't meet the 95 per cent target needed to stop outbreaks. Of the people who got measles, about half weren't vaccinated and the vaccination histories of many of the others was unknown.
Measles re-emerges in Canada, U.S.
More cases in Europe have also meant spillover elsewhere. The U.S. has 205 cases this year — the most in a decade — and virtually all are linked to other regions, including 20 cases from Europe.
Because North America has so little measles, every imported case requires a thorough investigation and response costing tens of thousands of dollars, Martin said.
Health officials have said the re-emergence of measles in Canada has been traced back travelers who brought the disease back after visiting France.
The U.S. normally only has about 50 cases a year. In May, international health officials posted an alert urging travellers everywhere to get vaccinated before flying overseas.
Measles is highly contagious and up to 90 per cent of people exposed to an infected person get sick, experts say. The virus spreads easily through the air, and in closed rooms, infected droplets can linger for up to two hours after the sick person leaves.
It causes a fever, runny nose, cough and a rash all over the body. The disease kills about one to two children for every 1,000 it infects, and can also cause pregnant women to have a miscarriage or premature birth.
In 2008, there were about 164,000 measles deaths worldwide. More than 95 per cent of those deaths were in poor countries.
Health officials say controlling measles outbreaks in Europe is still being compromised because of ignorance of the disease's severity and skepticism about the vaccine.
The measles shot was tainted by now discredited research published by Andrew Wakefield in 1998 suggesting a possible link between autism and the vaccine for measles, mumps and rubella.
Parents abandoned the vaccine in droves and suspicion about its safety still lingers, even though repeated studies have shown no connection.
Unlike in the U.S., where most states require children to be vaccinated against measles before starting school, no such regulations exist in most of Europe.
Spain and Switzerland exclude unvaccinated children from school during measles outbreaks, but don't otherwise insist on vaccination.
In France and Britain, parents are advised to have their children immunized if they haven't received the measles shot, but there is no penalty for not doing so.
WHO's Martin said Europe's measles epidemic appeared to be on the decline. She said France and Switzerland were planning to offer the measles vaccine to older age groups in the future.
She warned people who skipped the shot that measles is not a mild disease.
"It's a dangerous decision not to get vaccinated," she said. "One death is too many when we have an effective vaccine."