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Peer-reviewedCC BY 4.0PLOS One

Spatio-temporal dynamics, transmission hotspots, and vaccination gaps driving measles persistence in Nigeria, 2006–2025

  • Sylvia Ezenwa-Ahanene1,2
  • Polycarp Dauda Madaki2,3
  • Ruth Manzo Sabo4
  • Oghenetega ThankGod Oweh2,5
  • Kalat Haruna Tauna6
  • Zubairu Zubairu Dalhatu2,6
  • Mustapha Sikirat Abiola2,7
  • Ifeoma Christiana Nwadiuto8
  • Muzzammil Gadanya1,2
  • Abubakar Yahya Imam2,9
9 affiliations
  1. 1Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
  2. 2Corona Management Systems, Kado, Abuja, Nigeria
  3. 3Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
  4. 4African Centre for Disease Control and Prevention, Addis Ababa, Ethiopia
  5. 5Department of Medical Biochemistry, College of Medicine, Kaduna State University, Kaduna, Nigeria
  6. 6Department of Public Health, Faculty of Basic and Applied Biological Sciences, Ahmadu Bello University, Zaria, Nigeria
  7. 7Kwara State Ministry of Health, Ilorin, Nigeria
  8. 8Department of Community Medicine, Rivers State University, Rivers, Nigeria
  9. 9National Primary Healthcare Development Agency, Abuja, Nigeria
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Abstract

Background: Measles remains a major public health concern in Nigeria, contributing disproportionately to the global burden. Persistence of the disease is driven by sub-optimal vaccination coverage and heterogeneous transmission patterns, but the specific spatio-temporal dynamics and the quantitative impact of vaccination gaps at the sub-national level are not fully characterized. Objective: This study aimed to provide a comprehensive analysis of measles transmission in Nigeria from 2006 to 2025, with the specific objectives to identify spatial hotspots, quantify their temporal persistence, and evaluate the association between MCV1/MCV2 coverage and measles case ratio. Methods: We conducted a national retrospective ecological study, integrating 19 years of surveillance data (2006–2025) and geospatial information, with a focused 4-year analysis of vaccination records (2021–2024). Analytical methods included time-series decomposition, spatial autocorrelation (Local Moran’s I and Getis-Ord Gi*), and linear mixed-effects modeling to quantify vaccination effects while accounting for state-level heterogeneity. Results: Analysis of 253,595 measles cases revealed a highly clustered geographic distribution, with 86.4% of the national burden concentrated in northern Nigeria. We identified 38 persistent hotspot Local Government Areas that accounted for 23.2% of all cases. Vaccination coverage was low and disparate, with national averages of 73.8% for MCV1 and 38.4% for MCV2. Mixed-effects modeling confirmed a significant negative association between MCV1 coverage and the measles case ratio, while MCV2 coverage did not show a statistically significant independent effect. Conclusion: Measles transmission in Nigeria is driven by entrenched hotspots in the north and critical vaccination gaps threatening disease resurgence in the south. Achieving elimination requires a tailored strategy: intensive supplemental immunization activities and RI strengthening aimed at reducing endemic transmission in the northern hotspots, coupled with focused efforts to close routine immunization gaps in specific southern states.

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Cite

BibTeXRIS
BibTeX
@article{ezenwaahanene2026spatiotemporal,
  title = {{Spatio-temporal dynamics, transmission hotspots, and vaccination gaps driving measles persistence in Nigeria, 2006–2025}},
  author = {Sylvia Ezenwa-Ahanene and Polycarp Dauda Madaki and Ruth Manzo Sabo and Oghenetega ThankGod Oweh and Kalat Haruna Tauna and Zubairu Zubairu Dalhatu and Mustapha Sikirat Abiola and Ifeoma Christiana Nwadiuto and Muzzammil Gadanya and Abubakar Yahya Imam},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0359837},
  url = {https://doi.org/10.1371/journal.pone.0359837},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Spatio-temporal dynamics, transmission hotspots, and vaccination gaps driving measles persistence in Nigeria, 2006–2025
AU  - Sylvia Ezenwa-Ahanene
AU  - Polycarp Dauda Madaki
AU  - Ruth Manzo Sabo
AU  - Oghenetega ThankGod Oweh
AU  - Kalat Haruna Tauna
AU  - Zubairu Zubairu Dalhatu
AU  - Mustapha Sikirat Abiola
AU  - Ifeoma Christiana Nwadiuto
AU  - Muzzammil Gadanya
AU  - Abubakar Yahya Imam
PY  - 2026
DA  - 2026/10/27
JO  - PLOS One
DO  - 10.1371/journal.pone.0359837
UR  - https://doi.org/10.1371/journal.pone.0359837
AB  - Background: Measles remains a major public health concern in Nigeria, contributing disproportionately to the global burden. Persistence of the disease is driven by sub-optimal vaccination coverage and heterogeneous transmission patterns, but the specific spatio-temporal dynamics and the quantitative impact of vaccination gaps at the sub-national level are not fully characterized. Objective: This study aimed to provide a comprehensive analysis of measles transmission in Nigeria from 2006 to 2025, with the specific objectives to identify spatial hotspots, quantify their temporal persistence, and evaluate the association between MCV1/MCV2 coverage and measles case ratio. Methods: We conducted a national retrospective ecological study, integrating 19 years of surveillance data (2006–2025) and geospatial information, with a focused 4-year analysis of vaccination records (2021–2024). Analytical methods included time-series decomposition, spatial autocorrelation (Local Moran’s I and Getis-Ord Gi*), and linear mixed-effects modeling to quantify vaccination effects while accounting for state-level heterogeneity. Results: Analysis of 253,595 measles cases revealed a highly clustered geographic distribution, with 86.4% of the national burden concentrated in northern Nigeria. We identified 38 persistent hotspot Local Government Areas that accounted for 23.2% of all cases. Vaccination coverage was low and disparate, with national averages of 73.8% for MCV1 and 38.4% for MCV2. Mixed-effects modeling confirmed a significant negative association between MCV1 coverage and the measles case ratio, while MCV2 coverage did not show a statistically significant independent effect. Conclusion: Measles transmission in Nigeria is driven by entrenched hotspots in the north and critical vaccination gaps threatening disease resurgence in the south. Achieving elimination requires a tailored strategy: intensive supplemental immunization activities and RI strengthening aimed at reducing endemic transmission in the northern hotspots, coupled with focused efforts to close routine immunization gaps in specific southern states.
SN  - 1932-6203
ER  -