Measles, Mumps and Rubella (MMR) vaccination is recommended in Italy. A country-wide study of the 1996 birth cohort revealed that coverage with MMR vaccine in the autonomous Province of Bolzano is the third lowest in Italy (after Campania and Calabria). The aim of the study was to evaluate the situation regarding measles in order to plan and implement necessary strategies. To assess MMR vaccine coverage, routine vaccination data were evaluated for quality and validity, and subsequently MMR coverage rates were calculated by birth cohort (1996-99) and commune. In addition, a descriptive epidemiologic analysis of all reported measles cases was performed. Hospital discharge records were used to estimate the complications and costs of hospital admitted measles cases. MMR vaccine coverage rates vary between rural (40%) and urban (80%) areas. Furthermore, communes with more than 50% Italian speaking inhabitants have higher MMR vaccine coverage than communes mainly populated by German speaking persons. In 1997 and 1999, epidemics with 1,889 and 992 cases, respectively, were reported. Five- to nine-year-old children were the most affected age group. Most cases were reported from communes with vaccine coverage rates below 40%. Six percent of measles cases, reported between January 1996 and October 2001 were admitted to hospital. The mean period of admission for measles cases was 4.6 days (range 1 to 84 days), the mean estimated costs 1,987.18 Euro per patient. The total amount of direct costs was estimated to be 386,437.72 Euros. Due to low vaccine coverage rates, especially in rural areas, and the ongoing circulation of the measles virus in the population, it is likely that an extensive measles epidemic will occur in the near future, resulting in evitable suffering of patients and extensive costs for the public health system. Only an effective immunization campaign will be able to prevent a future epidemic.