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The Lazio region is one of the Italian regions where sustained measles transmission continues to occur. We investigated measles cases reported by the emergency department (ED) of the largest pediatric hospital in Italy, located in Lazio.We reviewed clinical records of all measles cases from 0 to 18 years of age evaluated in the ED in 2008–2013. We compared demographic and clinical characteristics of patients admitted to the inpatient setting with those of patients discharged home to assess possible determinants of hospital admission.Of 248 patients with measles evaluated in the ED, 113 (45.6%) were admitted as inpatients. The number of measles cases peaked in 2011 (N = 122; 49.2%), when epidemics were reported in Lazio. Median age was 2.7 years (range: 21 days to 17.9 years), and 31 patients (13%) had an underlying chronic illness. The strongest independent predictor of hospitalization was having an underlying chronic illness [adjusted odd ratio (OR): 9.87; 95% confidence interval: 3.13–31.13]. Other factors independently and significantly associated with higher risk of hospitalization were taking medications at the time of ED visit, being younger than 1 year of age and having altered liver enzyme values. Eighty-five percent of children >15 months of age who were hospitalized were not vaccinated. One hundred six hospitalized children (94%) had at least 1 measles complication; 1 child required intensive care for respiratory insufficiency.Hospitalizations of children with measles continue to occur in European areas where elimination has not been achieved. Children with chronic diseases represent a vulnerable population that is at higher risk of hospitalization.