A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Of 1,289 measles case-patients during April 2025–March 2026 in Jerusalem, Israel, 11 children died, a measles-specific mortality rate of 1.1 deaths/100,000 population. The measles-specific mortality rate among children <5 years of age was 7.7 deaths/100,000 population but 80.1 deaths/100,000 population in 6 neighborhoods populated by ultraorthodox Jews, a 47% measles-attributed death fraction.
In the United States, 2–3 deaths occur for every 1,000 reported measles cases ( https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-7-measles.html ), a case-fatality rate (CFR) of 0.2%–0.3%. Overall, measles CFR is 0.3%–5.3% in low- and middle-income countries ( 1 ). The measles-specific mortality rate (MSMR) ranges from 0.04 deaths/100,000 population in Europe to 2.2 deaths/100,000 population in Africa ( 2 ). Immunosuppressed persons, malnourished persons, and children <5 years of age are at higher risk for death from measles ( 3 ).
The previous outbreak in Israel occurred during 2018–2019, during which 4,290 cases were reported ( 4 ). Of those cases, a total of 1,415 (33.0%) were in persons living in the city of Jerusalem ( 5 , 6 ), and 2 fatalities were reported (CFR 0.14%; MSMR 0.2 deaths/100,000 Jerusalem population). Jerusalem is the largest city in Israel, having a population of ≈1 million in 2025 (10.2% of the population of Israel), comprising ≈600,000 (62%) Jewish and ≈400,000 (38%) Arab persons ( 7 ). Of the Jewish population, ≈50.0% (≈300,000) were ultraorthodox religious Jews.
Coverage with the first measles, mumps, and rubella (MMR) and measles, mumps, rubella, and varicella (MMRV) vaccines among children 1–6 years of age in Jerusalem has decreased from 94.7% in 2019 to 78.3% in 2024 and is the lowest in Israel ( https://datadashboard.health.gov.il/portal/dashboard/serviceQuality ). Substantial geographic and ethnocultural differences exist across the city; coverage in April 2025 ranged from 99.4% among East Jerusalem Arab children to ≈55.0% in 6 designated neighborhoods (the 6 neighborhoods) in central Jerusalem, which has a population of ≈67,500, mostly ultraorthodox Jews.
We describe measles disease and death in Jerusalem during April 2025–March 2026. We also identify contributing factors to the unexpectedly elevated mortality rate.
We determined measles diagnosis by using reverse transcription PCR of pharyngeal or urine specimens or by a combination of clinical symptoms and epidemiologic linkage to another measles case ( https://www.gov.il/BlobFolder/policy/epi-92335924/he/files_regulation_epidemiology_epi-92335924.pdf ). We sequenced samples by using Sanger or next-generation sequencing at the Ministry of Health’s Central Virology Laboratory. We conducted epidemiologic investigations on all cases to identify the source of exposure and define close contacts.
We calculated acute-phase measles mortality rates for all cases reported to surveillance teams during the 2025–2026 outbreak, expressing results as CFR and by MSMR because not all incident cases were reported. We calculated CFR by dividing measles-related deaths by all reported measles cases in a designated area, and calculated MSM…