In early September 2018, cases of measles began to appear in Antananarivo, Madagascar. Capitol health authorities challenged by the district's poverty and Madagascar's relatively-low vaccination rate were unable to contain the highly-contagious disease, and what followed became the largest measles outbreak yet in Madagascar's history. With more than 115,000 people infected and more than 1,200 dying, the outbreak has become Madagascar's most serious outbreak of measles in the 21st century.