Missed Routine Vaccination Leading to Measles Outbreak: A Single Center Study from King Abdullah Teaching Hospital, Mansehra, Pakistan
DOI:
https://doi.org/10.36283/ziun-pjmd15-1/015Keywords:
Children, conjunctivitis, cough, measles, VaccinationAbstract
Background: In Pakistan, measles is experiencing a particularly dangerous resurgence, with cases rising steadily since 2021. This study was performed to assess the frequency of missed routine measles vaccination among children with measles during the recent outbreak reported at King Abdullah Teaching Hospital, Mansehra, Pakistan.
Methods: This analytical, cross-sectional study was conducted at King Abdullah Teaching Hospital, Mansehra, Pakistan, from January to June 2024, using non-probability consecutive sampling. Inclusion criteria were children aged 6 months to 10 years, with clinical features of measles, and accompanied by cough, coryza, or conjunctivitis. Vaccination status was classified as updated for children who received all age-appropriate measles vaccine doses, unvaccinated for those with no dose, and incomplete for those who received only the first dose or did not complete the full schedule. Analyses were performed in SPSS v26, with significance set at p<0.05, using appropriate comparative statistical tests.
Results: A total of 261 children were included, with a median age of 13.0 (8.0–24.0) months, while 150 (57.5%) were male. Measles-containing vaccine (MCV) status was updated in 70 (26.8%), unvaccinated in 135 (51.7%), and incomplete in 56 (21.5%) children. Urban residence was highest among updated cases (60.0%), while 77.0% unvaccinated children lived in rural areas (p<0.001). Hospital-acquired measles was observed only among unvaccinated children (8.1%). Facility unavailability (30.9%), and parental negligence (30.4%) were leading reasons for missed vaccination.
Conclusion: A high frequency of missed routine measles vaccination was observed among hospitalized children in Mansehra and demonstrated significant differences in clinical and demographic features by vaccination status.
References
1. Wang R, Jing W, Liu M, Liu J. Trends of the Global, Regional, and National Incidence of Measles, Vaccine Coverage, and Risk Factors in 204 Countries From 1990 to 2019. Front Med (Lausanne). 2022 Jan;8:798031. doi: 10.3389/fmed.2021.798031
2. Gastañaduy PA, Goodson JL, Panagiotakopoulos L, Rota PA, Orenstein WA, Patel M. Measles in the 21st Century: Progress Toward Achieving and Sustaining Elimination. J Infect Dis. 2021 Sep;224(12 Suppl 2):S420-S428. doi: 10.1093/infdis/jiaa793
3. WHO. Measles cases surge worldwide, infecting 10.3 million people in 2023. Available from: https://www.who.int/news/item/14-11-2024-measles-cases-surge-worldwide--infecting-10.3-million-people-in-2023
4. WHO. Global measles threat continues to grow as another year passes with millions of children unvaccinated. Available from: https://www.who.int/news/item/16-11-2023-global-measles-threat-continues-to-grow-as-another-year-passes-with-millions-of-children-unvaccinated
5. Rana MS, Usman M, Alam MM, Ikram A, Salman M, Umair M. The world's largest measles-Rubella vaccination campaign in Pakistan: Time to invest in routine immunization. Hum Vaccin Immunother. 2022 Jul;18(5):2080444. doi: 10.1080/21645515.2022.2080444
6. CDC. Progress Toward Measles Elimination—Pakistan, 2000–2018. MMWR 2019. ;68(22);505–510. Available from: https://www.cdc.gov/mmwr/volumes/68/wr/mm6822a4.htm
7. Pasadyn F, Mamo N, Caplan A. Battling measles: Shifting strategies to meet emerging challenges and inequities. Ethics Med Public Health. 2025 Jan;33(1): 101047. doi: 10.1016/j.jemep.2025.101047
8. Halane S, Ahmed A, Ahmed MM, Hersi MD, Sani J. Assessing Prevalence and Regional Disparities in Zero-Dose Immunization Among Children Aged 12-23 Months in Somalia. J Epidemiol Glob Health. 2025 Apr;15(1):59. doi: 10.1007/s44197-025-00395-w
9. United Nations. Media Update: United Nations Pakistan, 24 April 2025. Available from: https://pakistan.un.org/en/293242-media-update-united-nations-pakistan-24-april-2025
10. National Institute of Health, Islamabad, Pakistan. Seasonal Awareness and Alert Letter. Available from: https://www.nih.org.pk/wp-content/uploads/2022/12/SAAL-55-Issue-updated-final.pdf
11. Vaccher S, Laman M, Danchin M, Angrisano F, Morgan C. Missed Measles Immunisations Places Individuals and Communities at Risk: The Equity Argument for Including Measles in Under-Immunised Definitions. Vaccines (Basel). 2025 Jan;13(2):108. doi: 10.3390/vaccines13020108
12. Delgado C. Measles: Millions of children missed routine vaccination last year, WHO and CDC warn. BMJ. 2024 Nov;387:q2541. doi: 10.1136/bmj.q2541
13. Gupta PC, Satapathy P, Gupta A, Sah R, Padhi BK. The fallout of the COVID-19 pandemic: missed measles shots? - correspondence. Ann Med Surg (Lond). 2023 Feb;85(3):561-563. doi: 10.1097/MS9.0000000000000255
14. Jani JV, De Schacht C, Jani IV, Bjune G. Risk factors for incomplete vaccination and missed opportunity for immunization in rural Mozambique. BMC Public Health. 2008 May;8:161. doi: 10.1186/1471-2458-8-161
15. Cuadros DF, Branscum AJ, Mukandavire Z, Miller FD, MacKinnon N. Dynamics of the COVID-19 epidemic in urban and rural areas in the United States. Ann Epidemiol. 2021 Jul;59:16-20. doi: 10.1016/j.annepidem.2021.04.007
16. Mohamud AM, Abdi MA, Abdullahi AM, Abdi AM, Osman MM, Mohamed MA, et al. Prevalence and factors contributing to missed opportunities for vaccination in Mogadishu, Somalia. IJID Reg. 2024 Dec;14:100507. doi: 10.1016/j.ijregi.2024.100507
17. Salleh H, Avoi R, Karim HA. Community-based intervention to improve measles vaccination completion in marginalised community settlements in Kota Kinabalu, Sabah: a cluster randomised control trial. BMC Infect Dis. 2025 Apr;25(1):514. doi: 10.1186/s12879-025-10902-w
18. Parums DV. A Review of the Resurgence of Measles, a Vaccine-Preventable Disease, as Current Concerns Contrast with Past Hopes for Measles Elimination. Med Sci Monit. 2024 Mar;30:e944436. doi: 10.12659/MSM.944436
19. Fappani C, Gori M, Canuti M, Terraneo M, Colzani D, Tanzi E, et al. Breakthrough Infections: A Challenge towards Measles Elimination? Microorganisms. 2022 Aug;10(8):1567. doi: 10.3390/microorganisms10081567
20. Verma B, Tripathy V, Vashi M, Jain S. Implications and Learnings of Measles Outbreak Through a Clinician’s Lens; Mumbai, India 2022–2023. Eur J Clin Med. 2024;5(6):8–12. doi: 10.24018/clinicmed.2024.5.6.361
21. Winter AK, Wesolowski AP, Mensah KJ, Ramamonjiharisoa MB, Randriamanantena AH, Razafindratsimandresy R, et al. Revealing Measles Outbreak Risk With a Nested Immunoglobulin G Serosurvey in Madagascar. Am J Epidemiol. 2018 Jun;187(10):2219-2226. doi: 10.1093/aje/kwy114
22. Do LAH, Mulholland K. Measles 2025. N Engl J Med. 2025 Dec;393(24):2447-2458. doi: 10.1056/NEJMra2504516
23. Michael F, Mirambo MM, Misinzo G, Minzi O, Beyanga M, Mujuni D, et al. Trends of measles in Tanzania: A 5-year review of case-based surveillance data, 2018-2022. Int J Infect Dis. 2024 Feb;139:176-182. doi: 10.1016/j.ijid.2023.12.007
24. Ilyas M, Afzal S, Ahmad J, Alghamdi S, Khurram M. The Resurgence of Measles Infection and its Associated Complications in Early Childhood at a Tertiary Care Hospital in Peshawar, Pakistan. Pol J Microbiol. 2020 Feb;69(2):1-8. doi: 10.33073/pjm-2020-020
25. Xia S, Gullickson CC, Metcalf CJE, Grenfell BT, Mina MJ. Assessing the Effects of Measles Virus Infections on Childhood Infectious Disease Mortality in Brazil. J Infect Dis. 2022 Dec;227(1):133-140. doi: 10.1093/infdis/jiac233
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