Peer-reviewed article

Spatial and temporal trends of measles and measles vaccination status in Ethiopia, 2015-2024.

Yitbarek K, Sheel M, Woldie M, Mahimbo A, Alemu MA et al. · 28 Mar 2026

Abstract

Background Measles is a leading vaccine-preventable cause of child morbidity and mortality, with Ethiopia's recent resurgence driven by suboptimal vaccination coverage and repeated crises. This highlights the need to close immunity gaps in line with the WHO Immunisation Agenda 2030 (IA2030). We analysed national and subnational measles and vaccination patterns to provide timely evidence to guide progress. Methods We analysed 2015-2024 measles surveillance data from the Ethiopian Public Health Emergency Management system. Vaccination data was obtained from WHO/UNICEF estimates and subnational vaccination data from 2016 and 2019 Demographic and Health Surveys. We analysed demographic, temporal, and spatial patterns of measles and measles vaccination. An interrupted time-series analysis assessed changes in incidence following the introduction of the second routine measles dose (MCV2) in 2019. Results Between 2015 and 2024, Ethiopia reported 95,904 measles cases, with substantial variation and peaks in 2015, 2023, and 2024. Children under five accounted for about half cases, and incidence was highest in western, south-western, and southern regions, with shifting hotspots over time. National incidence declined until 2021, then rose sharply, reaching its peak in 2024. Most cases occurred in dry winter season. First-dose vaccination coverage increased from 56% in 2015 to 72% in 2024, while second-dose coverage rose from 35% at its 2019 introduction to 59% in 2024. Our analysis found no significant change in incidence following the introduction of MCV2. Conclusion Measles remains a major public health challenge in Ethiopia, with rising incidence in recent years and marked geographic disparities in disease burden and vaccination coverage. Despite improvements in routine immunisation, coverage remains below levels required for elimination, and the introduction of MCV2 has not yet produced a measurable impact. Strengthening routine vaccination, enhancing surveillance quality, and targeting underserved regions are essential to reduce measles transmission and move towards national and global elimination goals.