At the beginning of the COVID-19 pandemic, people not traveling curbed the spread of other infectious diseases as well. As soon as travel restrictions began to be lifted, however, these diseases got on the move again as well.

A major outbreak of measles spread across several parts of Europe last year, leading to an explosive, nearly 45-fold increase in the number of cases from fewer than 1,000 in 2022 to more than 42,000 last year.

Measles is the most widespread in Russia and Central Asian countries, with Romania, the U.K., France and Austria experiencing major outbreaks as well.

"In Romania, where there are more than 2,000 cases, there were three deaths as of last year, including two children under one year old," said Kärt Sõber, director of the Department of Communicable Diseases Epidemiology at Estonia's Health Board. "Two more deaths were reported in Romania as of the start of this year."

In Estonia, four people were infected with measles last year, all of which were travel-acquired cases. This time, the further spread of the disease managed to be prevented. The country also saw a measles outbreak in 2019 that included 27 reported cases.

"Measles is a classic highly contagious disease," said Piret Rospu, a family doctor at Tabasalu Family Health Center. "It spreads through the air, and one infected person among unvaccinated people can infect an average of 18 people. There are children unprotected against measles in every country, and they all come in contact with one another at airports."

Measles is especially life-threatening in young children, but also at risk are unvaccinated elderly as well as immunocompromised people.

"Measles is a disease that could be completely eradicated worldwide," Sõber noted. "This hasn't succeeded yet, as these outbreaks continue in various countries, but it would essentially be possible through vaccination."

Herd immunity in Estonia compromised

Measles vaccine coverage in Estonia has been worsening by the year, and in the past five years has remained below the critical threshold, meaning that fewer than 95 percent of children are vaccinated against the disease.

"Today we've reached the point where first dose vaccine coverage is already below 90 and second dose [coverage] already below 80 percent, which means that the risk of transmission of such local outbreaks absolutely exists," Rospu emphasized.

Under Estonia's national immunization schedule, children are vaccinated against measles at age one, and receive a booster vaccine at age 13, at which point they are considered protected for life.

Those vaccinated against the disease during the last decade or so of the Soviet occupation, however, should nonetheless be careful.

"A measles vaccine produced in Russia was in use between 1980-1992, the quality of which was at times unstable," Sõber warned, recommending that those vaccinated within that time period should get an additional dose of measles vaccine to boost effectiveness.

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