In Italy, measles is a disease subject to mandatory notification, and according to the routine procedure, physicians must report suspected measles cases to their LHU within 48 hours of diagnosis. The local health authorities then report confirmed measles cases to the ASP monthly. At the beginning of the outbreaks this procedure was modified and physicians were asked to report suspected measles cases to both the local health authorities and ASP offices within 24 hours of diagnosis. Personnel of the LHUs performed epidemiological investigation of suspected cases including laboratory investigation and contact tracing.