The 15 cases reported in this paper represent only 3% of the total number of cases and therefore did not contribute significantly to the measles incidence during the outbreak. However, these cases most likely represent an underestimate of the real number of infections that occurred through hospital contacts and nosocomial transmission. It is likely that isolation measures and separate admission procedures were not always adopted in case of admission of a patient with signs and symptoms compatible with measles. In the first outbreak, nosocomial transmission may have been responsible for the spread of the infection from the Roma/Sinti to the Italian population. Also of concern is the fact that four healthcare professionals developed measles. As the incidence of measles declines, nosocomial transmission is likely to become an important source of infection and sustain the occurrence of outbreaks among non-immunised health staff and hospital contacts, representing a serious problem in the elimination of measles [26] . Strategies to minimize nosocomial spread of infection should become a priority for control and effectively implemented in the future.