Measles and rubella rebound amid dropping vaccination rates

Measles and rubella, diseases once under control, are resurging as vaccination rates fall globally. In just over a year, nearly 3,000 measles cases and 18 preventable deaths were reported in Kenya

Measles and rubella are infectious diseases that spread through the air when an infected person coughs or sneezes.

Measles is more serious and is characterised by high fever, cough, red eyes, and a rash that starts on the face and spreads across the body. It can lead to severe complications such as pneumonia or even death, especially in young children.

Rubella, also known as German measles, is usually milder and causes a light fever, swollen glands, and a pink rash. However, rubella is very dangerous among pregnant women, as it can cause serious birth defects or miscarriage, as noted by the World Health Organization (WHO).

Before the introduction of the measles vaccine in 1963, measles was a leading cause of death worldwide, claiming approximately 2.6 million lives annually, primarily among children under five years old. Mortality rates were especially high in developing countries, where limited access to healthcare, malnutrition, and co-infections compounded the severity of the disease.

While measles is caused by a virus, most deaths result from complications arising from the infection. Pneumonia is the most common cause of fatality. The virus suppresses the immune system, leaving the lungs vulnerable to secondary bacterial infections — a condition particularly dangerous for malnourished children.

Encephalitis, an inflammation of the brain, occurs in about one in every thousand measles cases and could lead to seizures, permanent brain damage, or death. Severe diarrhoea and dehydration were also frequent complications, especially in areas with inadequate access to clean water and healthcare.

Malnutrition, notably vitamin A deficiency, significantly increases the risk of death from measles-related complications. Additionally, subacute sclerosing panencephalitis (SSPE), a rare but fatal degenerative brain disease, could develop years after the initial measles infection.

Recent research, published in Science, demonstrated that measles virus infection can erase previously acquired immune memory, effectively “resetting” the immune system. This immune amnesia leaves survivors more susceptible to other infectious diseases for months or even years after recovery, resulting in increased morbidity and mortality beyond the acute phase of measles itself.

In Africa, measles mortality rates ranged from 10 to 30 per cent among infected children, particularly in rural and impoverished communities, meaning that up to one in three children who contracted measles could succumb to the disease. In 2023, over 10.3 million people were infected with measles globally, marking a significant setback after decades of progress in controlling the disease.

Measles has resurged in many parts of the world, including high-income countries that had previously eliminated the disease. Several factors have contributed to this worrying trend.

One of the primary reasons, according to studies, is a decline in vaccination coverage. In various regions, including wealthier nations, vaccination rates have fallen below the level needed to maintain herd immunity. This drop can be largely attributed to vaccine hesitancy and the spread of misinformation.

UNICEF notes that in low- and middle-income countries, additional challenges such as logistical difficulties, ongoing conflicts, and weaknesses in healthcare systems have further limited access to vaccines.

Another key factor is the increase in global travel and urbanisation. The rise in international movement and densely populated urban areas has allowed measles to spread rapidly from regions experiencing outbreaks to places that were previously measles-free

The Covid-19 pandemic also played a significant role. Disruptions in healthcare services during the pandemic caused many people to miss routine vaccinations, creating immunity gaps within communities and increasing their vulnerability to measles outbreaks.

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Waning immunity in adults has contributed to the resurgence. Although the measles vaccine is highly effective, immunity can diminish over time in some individuals, especially those who received only one dose of the vaccine or were never naturally exposed to the virus. This decline in immunity raises the risk of outbreaks among older

Lancet highlights a concerning global decline in childhood vaccination rates since 2010, with measles immunization experiencing notable setbacks. The analysis, led by the University of Washington, utilized data from over 1,000 sources spanning 204 countries between 1980 and 2023. It reveals that, despite earlier progress, vaccination coverage for essential vaccines like measles, polio, and diphtheria has stalled or reversed in many regions

Between 2010 and 2019, measles vaccination rates declined in 100 of the 204 countries studied. Notably, 21 out of 36 high-income countries experienced a drop in coverage for at least one routine childhood vaccine.

According to WHO, global measles deaths fell by more than 70 per cent between 2000 and 2016. The Americas declared measles eliminated in 2016 thanks to strong and consistent immunisation efforts.

However, progress has reversed in recent years. A combination of vaccine misinformation, healthcare access issues, and disruptions caused by the Covid-19 pandemic led to millions of children missing their routine measles shots. As a result, measles cases have been rising again across the globe.

To prevent future outbreaks and move closer to eliminating measles once more, health experts stress the importance of maintaining at least 95% vaccination coverage with two doses of the measles vaccine. Without this, even a single infected person can trigger widespread transmission.

In response to a troubling global resurgence of measles, Health Cabinet Secretary Aden Duale has announced a nationwide immunization campaign in Kenya, scheduled to run from July 5 to July 14, 2025.

The campaign aims to protect children against two serious but preventable diseases: Measles-Rubella (MR) and typhoid. Children aged nine to 59 months will receive the MR vaccine, while those aged nine months up to 14 years will be given the Typhoid Conjugate Vaccine (TCV). Following the campaign, TCV will be incorporated into Kenya’s routine immunization schedule for administration at 9 months of age.

This initiative comes at a time when measles is resurging not only in Kenya but across the globe, including in countries that had previously eliminated the disease. Recent data show significant outbreaks in Europe, with Romania, Kazakhstan, Italy, and France among the worst affected. In East Asia and the Pacific, countries like Vietnam, Mongolia, Cambodia, and the Philippines have reported tens of thousands of cases.

The United States has also seen a dramatic increase, with over 1,000 cases confirmed in 2025 alone—its largest outbreak in decades. Similar patterns have been observed in India, Pakistan, Ethiopia, Nigeria, Yemen, and Indonesia. Health experts warn that the combination of declining vaccination rates, misinformation, and the aftermath of the Covid-19 pandemic has created dangerous immunity gaps, allowing the disease to return.

In Kenya, a measles outbreak has been confirmed in 18 counties, with 2,949 cases and 18 deaths reported between January 2024 and February 2025. The Ministry of Health (MoH) has attributed this surge, in part, to low uptake of the second dose of the MR vaccine, which is typically administered at 18 months. Many children remain unprotected and vulnerable to severe illness.

At the same time, Kenya is grappling with a rise in antimicrobial-resistant typhoid, particularly affecting children under 15. Those under the age of five face the highest risk of severe complications or death. The spread of typhoid has been exacerbated by climate change, rapid urbanization, and challenges in sanitation and clean water access. Despite these challenges, vaccination remains one of the most effective tools in stopping the spread of both diseases.

Emphasising the urgency of the campaign, CS Duale stated, "The Ministry of Health will roll out a nationwide immunisation campaign from July 5 to July 14, targeting typhoid and measles-rubella—two dangerous yet preventable diseases threatening the health and lives of our children."

MoH is urging all parents, caregivers, and community members to ensure every eligible child is vaccinated. Public support and participation are seen as crucial to the campaign’s success and to safeguarding Kenya’s children from these deadly but preventable illnesses.