. A major, prolonged measles outbreak occurred in Israel during 2018-19, despite vaccination coverage rates of 97% and 96% for the first and second doses, respectively, of measles containing vaccine (MCV).
. To study the causes and patterns of the outbreak through analysis of the epidemiological data, review the control measures taken, and identify lessons learned and efforts needed to prevent recurrences.
. All reported cases of measles in Israel from 1 March 2018 through 30 September 2019 were analysed using the epidemiological, clinical, laboratory, and demographic data that are systematically reported to the Division of Epidemiology of the Ministry of Health.
. A total of 4,311 measles cases were reported. 75% of case patients were children and 25% were adults. Pockets of undervaccination and delayed vaccination were identified: 72.6% of measles patients whose vaccination histories were known had not received any doses of MCV. Case importation was also a key factor, with a majority being adults coming from European countries and over half from Ukraine, a major locus of measles cases during the recent measles resurgence in Europe. Control measures were implemented at the local, district, and national levels.
. Similarities were noted between the 2018-19 outbreak and the prior one in 2007-08, principally pockets of undervaccination in the Jewish ultra-orthodox community, and case importation. Efforts to improve timeliness and coverage in pockets of undervaccination, and compliance with travel immunization guidelines, will be continued.

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