Measles surveillance data in Blantyre, Malawi were reviewed for 1996–8 to describe the epidemiology of infection and to estimate vaccine efficacy (VE) by the screening method. A total of 674 measles cases were reported to the Blantyre District Health Office during this period. Age distribution showed that 108 (16.1%) of the cases were aged less than 1 year. The median age was 5 years. Eighty percent of the cases between 1 and 19 years had been previously vaccinated. VE was 68.6% (95% CI, 52.7–79.2) for children 12–23 months of age and 67.3% (95% CI, 48.3–79.3) for infants 9–11 months of age. Reasons for this low vaccine efficacy are discussed. Previous vaccination history was negatively associated with the risk for developing cough during measles infection (odds ratio (OR), 0.30; 95% CI, 0.09–0.91), diarrhoea (OR, 0.64; CI, 0.44–0.95) and pneumonia (OR, 0.40; CI, 0.25–0.62). Logistic regression analysis showed that pneumonia in adults was negatively associated with vaccination history. The passive surveillance system for measles in Malawi was useful to describe the epidemiology of measles.