A recent measles outbreak across Europe and higher than usual reported cases in the United States have gotten people on edge. There have been 137 cases so far in 2018, compared to 120 in all of last year.

Measles is one of the most contagious viral diseases in existence. About 4 million cases were reported every year until a vaccine was introduced in 1963; after that there were about 500,000 cases a year. Overall, numbers have gone down as vaccination has become common or, in some countries, mandatory. Immunization has resulted in an 84% drop in deaths from the infection between 2000 and 2016 worldwide. In the United States the MMR vaccine against measles, mumps and rubella is required for children attending public schools.

While the benefits of immunizations are very well established, there is a growing movement in America and across the world against vaccinations. Numerous studies, including recent research published in the journal PLOS Medicine, have found a higher prevalence of infections in urban areas that allow for nonmedical exemptions — rules that permit parents not to vaccinate their kids based on their beliefs.

Another name for measles is rubeola or morbili. Symptoms include fever, dry cough, runny nose, red eyes and sore throat. A rash that includes flat blotches appear on the skin. There is no specific treatment. The mortality rate is 1 to 2 per 1,000 cases. The incubation period ranges from seven to 21 days.

To determine the countries where measles is currently a big public health problem, 24/7 Wall St. reviewed the number of confirmed measles cases between 2011 and August 2018 from the World Health Organization (WHO). Data in 2018 is being updated as more information becomes available. The countries on the list are ranked based on the percentage increase in diagnoses over the last two years. In order to qualify, the countries had to have at least 150 confirmed cases of measles so far in 2018. For the purposes of this list, measles cases are defined as laboratory confirmed, epidemiologically linked, and clinical cases as reported to the WHO. An outbreak is defined as three or more linked cases, according to the CDC.

Click here to see the 25 countries where measles is a serious problem.

25. United Kingdom
> Population: 60.6 million
> Cases in 2018: 856
> Cases in 2017: 282
> Cases in 2016: 571

The worst measles outbreak in the United Kingdom of Great Britain and Northern Ireland, as called by the WHO, was in 2012 and 2013 when each year had 1,900 confirmed cases. The second worst period was between 2007 and 2009 with over 1,000 diagnoses every year. The most affected people were young adults who were not vaccinated as children.

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24. Chad
> Population: 15 million
> Cases in 2018: 738
> Cases in 2017: 28
> Cases in 2016: 168

Local health authorities declared an epidemic in June. Chad is on track of reaching the highest number of cases since 2014, when 1,251 were confirmed. The second worst outbreak was in 2006 with 632 diagnoses. Excluding these exceptions, there have been on average of 137 confirmed measles cases.

23. Libya
> Population: 6.5 million
> Cases in 2018: 613
> Cases in 2017: 3
> Cases in 2016: 28

In 2005, Libya conducted a national campaign to vaccinate all people between nine months and 20 years old. Libya’s biggest measles outbreak in recent history occurred in 2009 when the country had 329 confirmed cases. For comparison, the year before that, there were only eight. Libya seemed to have everything under control by 2014, when the numbers started to steadily decline — until this year.

22. Benin
> Population: 11.4 million
> Cases in 2018: 498
> Cases in 2017: 192
> Cases in 2016: 98

This country in West Africa has dealt with worse measles outbreaks in the recent past. In 2013 and 2014, there were 757 and 761 measles cases, respectively, and almost 1,000 in 2009. In fact, only twice over the last decade did the number of cases fall under 100. After a 2009 WHO/UNICEF vaccination campaign that covered more than 72% of the population, the number of measles cases decreased by nearly two-thirds.

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21. Burkina Faso
> Population: 19.5 million
> Cases in 2018: 1,547
> Cases in 2017: 45
> Cases in 2016: 223

Burkina Faso is dealing with the worst measles outbreak since at least 2006. This is the first year in over a decade when the number of confirmed cases has exceeded 1,000. It fell by almost half between 2012 and 2013, from 803 to 422. The CDC has worked on improving the country’s public health system by introducing vaccines.

20. Spain
> Population: 46.3 million
> Cases in 2018: 206
> Cases in 2017: 149
> Cases in 2016: 38

Confirmed cases of measles jumped from 38 to 201 between 2016 and 2018. The spike certainly is worrisome, but Spain has faced much worse. The disease spread to more than 3,500 people in 2011, most of whom lived in clustered communities — nearly 40% of them had to be hospitalized. The highest number of cases was seen among people five to 14 years old. The following year in 2012, there were 1,210 confirmed cases.

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19. Belarus
> Population: 9.5 million
> Cases in 2018: 216
> Cases in 2017: 1
> Cases in 2016: 29

The last time Belarus had so many confirmed cases of measles was in 2006 — when there was a total of 153. Since then, however, the average reported number of cases has been 16. The recent spike is significant enough to prompt the Canadian government to add Belarus to a travel warning list, which recommends that visitors to certain countries get vaccinated.

18. Mali
> Population: 19.5 million
> Cases in 2018: 643
> Cases in 2017: 21
> Cases in 2016: 109

Mali faced epidemic levels in 2009-2010 when it had over 3,700 confirmed measles cases. Back then, nomadic groups presented a huge challenge for the vaccination of hundreds of thousands of children, according to humanitarian organization Médecins Sans Frontières.

17. Algeria
> Population: 42.3 million
> Cases in 2018: 288
> Cases in 2017: 231
> Cases in 2016: 49

The number of measles diagnoses in Algeria so far this year have already exceeded the total of 231 in 2017, which up to that point was the worst measles outbreak on record in the country.

Some local media have reported that the actual number this year may be between 600 and 2,300.

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16. Saudi Arabia
> Population: 33.2 million
> Cases in 2018: 840
> Cases in 2017: 429
> Cases in 2016: 106

Saudi Arabia is experiencing its third worst outbreak in recent times. In 2006 and 2007 there were 813 and 3,550 confirmed measles diagnoses, respectively. An analysis of collected passive and active surveillance data from the Saudi Health Ministry shows a high incidence of the viral infection among unvaccinated populations.

15. Uganda
> Population: 38.8 million
> Cases in 2018: 2,075
> Cases in 2017: 892
> Cases in 2016: 252

Unless the number of measles incidents is heavily unreported, Uganda hasn’t previously faced a measles outbreak of such proportions. The only year that comes fairly close is 2006, the first for which data is known, when there were 1,035 confirmed cases.

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14. Russian Federation
> Population: 144.0 million
> Cases in 2018: 3,313
> Cases in 2017: 898
> Cases in 2016: 179

With data available only through August, Russia is already undergoing one of the worst years for measles on record. Previously, the worst period on record was 2014, with cases peaking at 3,236.

Measles vaccinations were highly recommended for travelers to the 2018 World Cup in Russia.

13. Côte d’Ivoire
> Population: 24.3 million
> Cases in 2018: 763
> Cases in 2017: 164
> Cases in 2016: 54

The Ivory Coast as of August already broke the record set in 2011 when there were 619 measles diagnoses. With the exceptions of that year and 2010, the most number of cases the country has had is 164. Interestingly, paying health workers and volunteers via cell phones has helped increase vaccination rates in the country, according to UNICEF.

12. Iraq
> Population: 39.9 million
> Cases in 2018: 450
> Cases in 2017: 21
> Cases in 2016: 27

While the increase in measles diganoses since 2016 in Iraq is certainly concerning, the country is still a long away from its worst recorded measles outbreak. A decade ago, there were 5,095 confirmed cases. In 2009, there were 8,763 confirmed cases — by far the highest in recent history.

The last nationwide campaign to immunize children against the viral infection took place in December 2016.

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11. Lebanon
> Population: 4.6 million
> Cases in 2018: 875
> Cases in 2017: 126
> Cases in 2016: 44

The last time Lebanon experienced such high numbers of confirmed cases was in 2013. This is consistent with a warning by the WHO, which states that even though safe and free vaccines are available, the virus remains endemic in Lebanon and outbreaks are expected every four to five years. The other times when there were more than 300 diagnoses was in 2006 and 2007 with 845 and 388 cases, respectively.

10. Philippines
> Population: 107.0 million
> Cases in 2018: 11,670
> Cases in 2017: 1,606
> Cases in 2016: 647

For a country with a population of over 100 million people, a few thousand measles cases a year may not seem a big problem. But when that number jumps to almost 54,000, as it did in 2014, there is reason to be concerned. This year, the number is again above 10,000. The CDC is warning people traveling to the country to get vaccinated.

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9. Czech Republic
> Population: 10.6 million
> Cases in 2018: 164
> Cases in 2017: 147
> Cases in 2016: 7

The most reported measles cases this Central European country has had to deal with was 223 in 2014. The following two years that number dropped to eight and seven, which is relatively typical for the Czech Republic. The most confirmed cases this year are in the capital, Prague, according to local reports.

8. Israel
> Population: 8.9 million
> Cases in 2018: 339
> Cases in 2017: 16
> Cases in 2016: 10

This is the worst measles outbreak in Israel since 2008 when 891 cases were confirmed. Local media reports that in September alone, 2,130 were reported, but experts say the actual number is probably 10 times higher. The most cases have been in Jerusalem.

7. France
> Population: 65.1 million
> Cases in 2018: 2,686
> Cases in 2017: 519
> Cases in 2016: 79

While France is still far from reaching the record set in 2011 when there were 15,214 confirmed measles cases, it is on track to match the second worse tally — 5,019 in 2010. In 2017, the French government made vaccination against measles mandatory, effective January 2018.

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6. Yemen
> Population: 30.8 million
> Cases in 2018: 7,285
> Cases in 2017: 2,101
> Cases in 2016: 143

Yemen has been in a civil war since 2015. There is a shortage of doctors, which has led to a decrease in the quality of healthcare and the quantity of medical supplies. One result is a lower immunization rate. The humanitarian crisis has also resulted in severe overcrowding, which turns into a breeding ground for infectious diseases, according to UNICEF.

5. Turkey
> Population: 81.9 million
> Cases in 2018: 509
> Cases in 2017: 69
> Cases in 2016: 9

The number of cases has increased dramatically this year, but it’s still far from the peak of 7,415 in 2013. Nevertheless, UNICEF warns that the virus continues to be a health problem, especially among infants and pre-school children, due to low vaccination rates.

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4. Georgia
> Population: 3.7 million
> Cases in 2018: 1,129
> Cases in 2017: 96
> Cases in 2016: 14

Georgia has had between eight and 64 confirmed cases a year between 2006 and 2012. Then an outbreak occurred with at least 7,868 people infected in 2013 and 3,190 the following year.

3. Ukraine
> Population: 42.6 million
> Cases in 2018: 29,464
> Cases in 2017: 4,782
> Cases in 2016: 90

The crisis has reached epidemic levels here. Ukraine is the hardest-hit European country with 29,464 confirmed cases so far in 2018. The second worst outbreak occurred in 2012 with 12,744 diagnoses. The CDC is advising people traveling to Ukraine to get the MMR vaccine.

2. Serbia
> Population: 7.0 million
> Cases in 2018: 5,019
> Cases in 2017: 702
> Cases in 2016: 14

Serbia has not seen a measles outbreak like this before. According to WHO records that go back to 2006, the previous worst year was 2017 with 702 confirmed cases. This is another country on the “get vaccinated if you’re going there” list, as per the CDC.

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1. Venezuela
> Population: 29.2 million
> Cases in 2018: 4,605
> Cases in 2017: 727
> Cases in 2016: 6

The measles outbreak in Venezuela has reached epidemic levels. The Pan American Health Organization has been urging people throughout South America to get vaccinated. Brazil blames Venezuela for its own spike in measles due to people fleeing the political and economic crisis there.

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