Post-Measles Complications and Mortality in Children under Five Years in Low- and Middle-Income Countries: A Narrative Review
- 1ICMR-National Institute of Virology, Pune, Maharashtra 411021, India
- 2ICMR- National Institute of Translational Virology and AIDS Research, Pune, Maharashtra 411026, India
- 3Armed Forces Medical College, Pune, Maharashtra 411040, India
Abstract
Background: Global measles vaccination programs have achieved significant reductions in measles-related mortality, with World Health Organization (WHO)-led initiatives expanding vaccine coverage to over 85% of children worldwide. Despite this progress, measles elimination remains elusive, undermined by anti-vaccine sentiment, armed conflicts, migration, refugee crises, and post-COVID-19 disruptions. No WHO region has achieved or sustained measles elimination status since the COVID-19 pandemic, and elimination remains challenging in resource-limited and conflict-affected contexts. A critical yet underappreciated consequence of this ongoing burden is the rise of post-measles complications (PMCs). Vaccine-preventable diseases and malnutrition constitute two critical global health priorities; PMCs represent an important intersection of these agendas that warrant greater attention within the global health framework.
Objectives: To review and synthesize current epidemiological evidence on PMCs, examine their pathogenesis, and understand the need for integrated post-measles care strategies in vulnerable populations.
Methods: This narrative review included all papers that published primary data on any of the PMCs in the last 55 years, identified through PubMed and Google Scholar.
Findings: Epidemiological data show that 30–40% of measles cases in low- and middle-income countries (LMICs) develop complications, including pneumonia, diarrhea, otitis media, and, less commonly, encephalitis and ocular disease. PMCs are frequently misattributed to independent illnesses because they often emerge after a delay following the acute infection. Compounding this, measles-induced immune amnesia renders affected individuals vulnerable to secondary infections for up to 2–3 years post-infection. In LMICs and conflict-affected settings, this prolonged immunological vulnerability intersects with pre-existing risk factors such as malnutrition, micronutrient deficiencies, and poor healthcare access, which amplify the consequences substantially.
Conclusions: As measles cases resurge globally, the associated burden of PMCs is expected to increase correspondingly. Where PMCs represent a pressing, underaddressed concern, integrated post-measles care strategies are urgently needed from a global health perspective, especially in resource-limited and conflict-affected settings.
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BibTeX
@article{jadhav2026postmeasles,
title = {{Post-Measles Complications and Mortality in Children under Five Years in Low- and Middle-Income Countries: A Narrative Review}},
author = {Abhijeet V. Jadhav and Sankalp Ghadei and Sanket Sonawane and Pushkar Patil and Prashant Birajdar and Avinash Deoshatwar and Kunal Pise and Amol Nath and Shailesh Pawar and Naveen Kumar},
journal = {Annals of global health},
year = {2026},
month = oct,
doi = {10.5334/aogh.5307},
url = {https://europepmc.org/article/PMC/PMC13722016},
note = {CC BY},
}
RIS
TY - JOUR
TI - Post-Measles Complications and Mortality in Children under Five Years in Low- and Middle-Income Countries: A Narrative Review
AU - Abhijeet V. Jadhav
AU - Sankalp Ghadei
AU - Sanket Sonawane
AU - Pushkar Patil
AU - Prashant Birajdar
AU - Avinash Deoshatwar
AU - Kunal Pise
AU - Amol Nath
AU - Shailesh Pawar
AU - Naveen Kumar
PY - 2026
DA - 2026/10/26
JO - Annals of global health
DO - 10.5334/aogh.5307
UR - https://europepmc.org/article/PMC/PMC13722016
AB - Background: Global measles vaccination programs have achieved significant reductions in measles-related mortality, with World Health Organization (WHO)-led initiatives expanding vaccine coverage to over 85% of children worldwide. Despite this progress, measles elimination remains elusive, undermined by anti-vaccine sentiment, armed conflicts, migration, refugee crises, and post-COVID-19 disruptions. No WHO region has achieved or sustained measles elimination status since the COVID-19 pandemic, and elimination remains challenging in resource-limited and conflict-affected contexts. A critical yet underappreciated consequence of this ongoing burden is the rise of post-measles complications (PMCs). Vaccine-preventable diseases and malnutrition constitute two critical global health priorities; PMCs represent an important intersection of these agendas that warrant greater attention within the global health framework. Objectives: To review and synthesize current epidemiological evidence on PMCs, examine their pathogenesis, and understand the need for integrated post-measles care strategies in vulnerable populations. Methods: This narrative review included all papers that published primary data on any of the PMCs in the last 55 years, identified through PubMed and Google Scholar. Findings: Epidemiological data show that 30–40% of measles cases in low- and middle-income countries (LMICs) develop complications, including pneumonia, diarrhea, otitis media, and, less commonly, encephalitis and ocular disease. PMCs are frequently misattributed to independent illnesses because they often emerge after a delay following the acute infection. Compounding this, measles-induced immune amnesia renders affected individuals vulnerable to secondary infections for up to 2–3 years post-infection. In LMICs and conflict-affected settings, this prolonged immunological vulnerability intersects with pre-existing risk factors such as malnutrition, micronutrient deficiencies, and poor healthcare access, which amplify the consequences substantially. Conclusions: As measles cases resurge globally, the associated burden of PMCs is expected to increase correspondingly. Where PMCs represent a pressing, underaddressed concern, integrated post-measles care strategies are urgently needed from a global health perspective, especially in resource-limited and conflict-affected settings.
SN - 2214-9996
ER -