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By Philippa Roxby, BBC News
There was an "alarming" nearly 45-fold increase in measles cases in Europe last year, the World Health Organisation (WHO) says.
Health chiefs are warning cases are still rising and "urgent measures" are needed to prevent further spread.
Some 42,200 people were infected in 2023, compared to 941 during the whole of 2022.
The WHO believes this is a result of fewer children being vaccinated against the disease during the Covid-19 pandemic.
In the UK, health officials said last week that an outbreak of highly contagious measles in the West Midlands could spread rapidly to other towns and cities with low vaccination rates.
More than 3.4 million children under the age of 16 are unprotected and at risk of becoming ill from the disease, according to NHS England.
Millions of parents and carers are being contacted and urged to make an appointment to ensure their children are fully vaccinated against measles. The measles, mumps and rubella (MMR) vaccine is given in two doses - the first around the age of one and the second when a child is about three years and four months old.
The vaccine is very effective at protecting against measles, but only 85 percent of children starting primary school in the UK have had both jabs.
Speaking about the situation in Europe, Dr Hans Kluge, regional director at the WHO, said: "We have seen, in the region, not only a 30-fold increase in measles cases, but also nearly 21,000 hospitalisations and five measles-related deaths. This is concerning.
"Vaccination is the only way to protect children from this potentially dangerous disease."
Measles can be a serious illness at any age. It often starts with a high fever and a rash, which normally clears up within 10 days - but complications can include pneumonia, meningitis, blindness and seizures.
Babies who are too young to have been given their first dose of vaccine, pregnant women and those who have weakened immune systems are most at risk. During pregnancy, measles can lead to stillbirth, miscarriage and a baby being born with a low birth weight.
All countries in the European region are being asked to detect and respond to measles outbreaks quickly, alongside giving vaccines to more people.
The WHO said measles had affected all age groups last year - young and old alike.
Overall, two in five cases were in children aged 1-4, and one in five cases were in adults aged 20 and above.
Between January and October 2023, 20,918 people across Europe were admitted to hospital with measles. In two countries, five measles-related deaths were also reported.
Pandemic effect
Vaccination rates for the first dose of the MMR vaccine, which protects against measles, slipped from 96 percent in 2019 to 93 percent in 2022 across Europe. Uptake of the second dose fell from 92 percent to 91 percent over the same period.
That seemingly small drop in vaccination take-up means more than 1.8 million children in Europe missed a measles vaccination during those two years.
"The Covid-19 pandemic significantly impacted immunisation system performance in this period, resulting in an accumulation of un-[vaccinated] and under-vaccinated children," the WHO reported.
With international travel booming once again, and social-distancing measures removed, the risk of measles spreading across borders and within communities is much greater - especially within under-vaccinated populations, it said.
Even countries that have achieved measles elimination status are at risk of large outbreaks, the WHO warned.
It says that 95 percent of children need to be vaccinated with two doses against measles in all communities to prevent the spread of the highly-contagious disease.
This story was originally published by the BBC.