Changing Measles Epidemiology in Ghana, 2018-2023: Exploring Impact of COVID-19-Related Disruptions on Vaccination Coverage and Incidence.
7 affiliations
- 1Department of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- 2African Field Epidemiology Network, Accra, Ghana.
- 3Department of Epidemiology and Biostatistics, Fred. Binka School of Public Health, University of Health and Allied Science, Ho, Ghana.
- 4Expanded Program on Immunization, Public Health Division, Ghana Health Service, Accra, Ghana.
- 5UNICEF Country Office, 4-8 Rangoon Close, Cantonment, Accra, Ghana.
- 6World Health Organization Ghana Country Office, 12 Agbaamo Street, Accra, Ghana.
- 7Disease Surveillance Department, Public Health Division, Ghana Health Service, Accra, Ghana.
Abstract
Background: Measles remains a public health threat in Ghana due to persistent immunity gaps and suboptimal vaccination coverage. The COVID-19 pandemic disrupted routine immunization and may have altered measles transmission. This study assessed measles burden, vaccination status of confirmed cases, and spatiotemporal trends in Ghana, and examined the pandemic's impact on measles control. Methods: We analyzed measles cases reported in Ghana from 2018 to 2023, including age, sex, vaccination status, and region, alongside national measles-rubella (MR) vaccination coverage. Cumulative incidence was calculated as confirmed cases per million population. Interrupted time series analysis assessed pandemic-related disruptions in vaccination coverage and case reporting. Multivariable logistic regression identified factors associated with infection and vaccination status. Results: Ghana reported 1688 confirmed measles cases, a cumulative incidence of 51.9 per million, with a case fatality rate of 0.1%. Incidence rose from 1.1 per 1,000,000 in 2018 to 28.3 per 1,000,000 in 2023, with wide geographic variation. The odds of measles infection were higher among those aged 5-14 years (aOR = 1.41; 95% CI: 1.19-1.68, p < 0.001) and 15-44 years (aOR = 1.74; 95% CI: 1.37-2.22, p < 0.001) than among infants under one year. Compared with no vaccination, one dose was associated with lower odds of measles infection (aOR = 0.41; 95% CI: 0.34-0.48, p < 0.001), as was two doses (aOR = 0.38; 95% CI: 0.33-0.44, p < 0.001). MR1 coverage fell from 91.7% to 86.2%, and MR2 coverage stayed below the 95% herd immunity threshold throughout, with both showing an inverse relationship with incidence. The COVID-19 pandemic caused an immediate 64% decline in confirmed cases (IRR 0.36, 95%CI 0.17-0.75, p = 0.007). MR2 coverage dropped 3.66 percentage points at pandemic onset while MR1 rose slightly; neither change was significant. Conclusions: Measles burden in Ghana rose substantially between 2018 and 2023, with geographic variation and an inverse relationship between MR coverage and incidence. Suboptimal two-dose coverage and pandemic disruptions sustained transmission despite vaccination's protective effect. Strengthening routine immunization and surveillance during emergencies is critical to detect outbreaks early and achieve measles elimination.
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BibTeX
@article{baidenlaryea2026changing,
title = {{Changing Measles Epidemiology in Ghana, 2018-2023: Exploring Impact of COVID-19-Related Disruptions on Vaccination Coverage and Incidence.}},
author = {Eunice Baiden-Laryea and Mercy Opare Addo and Joseph Asamoah Frimpong and Samuel Adolf Bosoka and Bernard Nkrumah and Rita Asante Kusi and Emmanuel Tettey Sally and Paul Henry Dsane-Aidoo and Abdul Gafaru Mohammed and Patrick Avevor and Horlali Gudjinu and Dennis Odai Laryea},
journal = {Tropical medicine and infectious disease},
year = {2026},
month = oct,
doi = {10.3390/tropicalmed11100295},
url = {https://europepmc.org/article/MED/42931479},
note = {CC BY},
}
RIS
TY - JOUR
TI - Changing Measles Epidemiology in Ghana, 2018-2023: Exploring Impact of COVID-19-Related Disruptions on Vaccination Coverage and Incidence.
AU - Eunice Baiden-Laryea
AU - Mercy Opare Addo
AU - Joseph Asamoah Frimpong
AU - Samuel Adolf Bosoka
AU - Bernard Nkrumah
AU - Rita Asante Kusi
AU - Emmanuel Tettey Sally
AU - Paul Henry Dsane-Aidoo
AU - Abdul Gafaru Mohammed
AU - Patrick Avevor
AU - Horlali Gudjinu
AU - Dennis Odai Laryea
PY - 2026
DA - 2026/10/16
JO - Tropical medicine and infectious disease
DO - 10.3390/tropicalmed11100295
UR - https://europepmc.org/article/MED/42931479
AB - Background: Measles remains a public health threat in Ghana due to persistent immunity gaps and suboptimal vaccination coverage. The COVID-19 pandemic disrupted routine immunization and may have altered measles transmission. This study assessed measles burden, vaccination status of confirmed cases, and spatiotemporal trends in Ghana, and examined the pandemic's impact on measles control. Methods: We analyzed measles cases reported in Ghana from 2018 to 2023, including age, sex, vaccination status, and region, alongside national measles-rubella (MR) vaccination coverage. Cumulative incidence was calculated as confirmed cases per million population. Interrupted time series analysis assessed pandemic-related disruptions in vaccination coverage and case reporting. Multivariable logistic regression identified factors associated with infection and vaccination status. Results: Ghana reported 1688 confirmed measles cases, a cumulative incidence of 51.9 per million, with a case fatality rate of 0.1%. Incidence rose from 1.1 per 1,000,000 in 2018 to 28.3 per 1,000,000 in 2023, with wide geographic variation. The odds of measles infection were higher among those aged 5-14 years (aOR = 1.41; 95% CI: 1.19-1.68, p < 0.001) and 15-44 years (aOR = 1.74; 95% CI: 1.37-2.22, p < 0.001) than among infants under one year. Compared with no vaccination, one dose was associated with lower odds of measles infection (aOR = 0.41; 95% CI: 0.34-0.48, p < 0.001), as was two doses (aOR = 0.38; 95% CI: 0.33-0.44, p < 0.001). MR1 coverage fell from 91.7% to 86.2%, and MR2 coverage stayed below the 95% herd immunity threshold throughout, with both showing an inverse relationship with incidence. The COVID-19 pandemic caused an immediate 64% decline in confirmed cases (IRR 0.36, 95%CI 0.17-0.75, p = 0.007). MR2 coverage dropped 3.66 percentage points at pandemic onset while MR1 rose slightly; neither change was significant. Conclusions: Measles burden in Ghana rose substantially between 2018 and 2023, with geographic variation and an inverse relationship between MR coverage and incidence. Suboptimal two-dose coverage and pandemic disruptions sustained transmission despite vaccination's protective effect. Strengthening routine immunization and surveillance during emergencies is critical to detect outbreaks early and achieve measles elimination.
SN - 2414-6366
ER -