Measles cases in Europe tripled between 2017 and 2018, reaching their highest recorded level in the last decade, according to new data from the World Health Organization (WHO) published this month. There were 72 deaths from measles in 2018, up from just 42 the year before.

More than 90 percent of the cases were concentrated in just ten countries, including France, Italy, and Greece, according to BBC News.

Ukraine saw the highest number of cases by far with 53,218, over ten times the amount of Serbia, which had the next highest number of cases at over 5,000. Ukraine’s measles rate was also ten times its rate in 2017, with 1,209 cases per one million people.

This increase fueled Europe’s overall increase, with 25,863 cases in 2017, up to over 82,000 last year.

During its conflict with neighboring Russia, rates of measles, mumps, and rubella vaccination fell to 31 percent in Ukraine, among the lowest rates worldwide. By the end of 2017, child vaccination rates had bounced back, reaching about 90 percent. WHO officials say this rate will need to be maintained to prevent further outbreaks.

“The picture for 2018 makes it clear that the current pace of progress in raising immunization rates will be insufficient to stop measles circulation,” said WHO regional director for Europe Dr. Zsuzsanna Jakab. “While data indicate exceptionally high immunization coverage at regional level, they also reflect a record number affected and killed by the disease. This means that gaps at local level still offer an open door to the virus.”

The news comes as other parts of the world continue to face increasingly frequent outbreaks, including a new outbreak in the Philippines that has caused 26 deaths with 1,813 cases as of January 26th – a 74 percent increase from the year before. Vaccination rates have been falling after concern over problems with an unrelated dengue vaccine, called Dengvaxia. With 2.4 million unvaccinated children there, doctors are concerned about how far the outbreak could spread.

Researchers say vaccination rates of about 95 percent are necessary to prevent outbreaks, and rates are falling in much of the world, thanks in part to misinformation and concern over side effects. This decline is extending to parts of the world where measles had all but disappeared, including Europe and the US – and resurgence of measles cases is following close behind.

According to the WHO, worldwide cases increased 30 percent between 2016 and 2017.

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