Resurgent Measles in Pakistan: A 5-Year Analysis of Vaccination Gaps, Surveillance Challenges, and Urban-Rural Disparities in Khyber Pakhtunkhwa: A 5-Year Analysis of Vaccination Gaps, Surveillance Challenges, and Urban-Rural

Abdul Nasir; Wasia Ullah; Muhammad Izaz; Zia Ul Islam

doi:10.54393/pbmj.v8i8.1238

Authors

Abdul Nasir Department of Health, Dir Upper Khyber Pakhtunkhwa, Pakistan
Wasia Ullah Department of Zoology, Abdul Wali Khan University, Mardan, Pakistan
Muhammad Izaz World Health Organization, Khyber Pakhtunkhwa, Pakistan
Zia Ul Islam Department of Health, Dir Upper Khyber Pakhtunkhwa, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v8i8.1238

Keywords:

Measles Surveillance, Zero-Dose Children, Vaccination Coverage, Disease Elimination, Health Systems Strengthening

Abstract

Measles remains a substantial public health concern in low and middle-income countries. Objectives: This study aimed to provide a comprehensive analysis of measles surveillance data from Khyber Pakhtunkhwa (KP) province in Pakistan from 2020 to 2024, examining epidemiological trends, vaccination coverage, and the effectiveness of the surveillance system. Methods: This retrospective descriptive study conducted a thorough surveillance analysis using several data sources, including weekly vaccine-preventable disease (VPD) reports, zero reports, and standardized case investigation forms provided to the EPI monitoring information system (EPI-MIS). For statistical analysis, Stata 17.0 and R 4.2.1 software programs were used. Results: 82% of cases comprised unvaccinated children (zero-dose) aged 6-59 months, suggesting severe gaps in regular vaccination. Laboratory testing verified 5,550 (39%) measles cases, whereas 6,398 (44%) were rejected, with a non-measles/non-rubella discard rate of 19.4/100,000, indicating a better differential diagnosis. The surveillance system achieved high performance indicators, with 97% district reporting completeness and 87% timeliness. However, case investigation adequacy decreased to 65% in 2024 (p<0.001), especially in low-compliance districts like North Waziristan and Peshawar. Urban centers administered fewer booster doses (Peshawar: 0) than rural areas (Charsadda: 21,155 doses; p<0.001). While specimen collection matched WHO standards (88%), South Waziristan's low rates indicated regional diagnostic shortcomings. Conclusions: The study concluded the critical need for tailored vaccination programs in high-risk areas, improved real-time surveillance, and health system improvement in KP to achieve measles control.

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