Importation-Driven Measles Resurgence and the Fragility of Elimination, Japan, 2024–2026

As measles elimination unravels across the Americas, Europe, and the Western Pacific, Japan is experiencing a resurgence of measles; the World Health Organization had verified elimination of measles in Japan in 2015. By epidemiologic week 20 of 2026, a total of 498 cases had been reported, exceeding every full-year total since 2020. Median case-patient age has fallen to 26 years, shifting the burden from a generation who received single-dose measles vaccinations to younger cohorts caught between successive vaccination-policy transitions. Among case-patients with a documented 2-dose vaccination history, more than half experienced modified measles, an attenuated, easily missed illness that delays diagnosis and isolation. As mass gatherings concentrate global travel, Japan has become a sentinel for the fragility of measles elimination, including in countries that consider elimination status secure. Surveillance shows importation-driven resurgence; the shift in genotype profile from D8 to B3 predominance back to D8 enabled tracking of source countries.