Measles and Rubella Surge in Africa: Children Bear the Brunt of a Preventable Crisis

Introduction: An Alarming Public Health Reversal

New surveillance data from the World Health Organization (WHO) Regional Office for Africa reveals a deeply concerning trend: a significant resurgence of measles and circulating rubella across the continent, with young children paying the heaviest price. This report covers the period from January through September 2025 and paints a picture of a region where hard-won gains in childhood immunization are under severe threat. The data indicates that measles, a highly contagious and potentially deadly vaccine-preventable disease, is not only re-emerging but doing so at a scale that qualifies as “large and disruptive outbreaks” in multiple nations. Concurrently, rubella—which can cause devastating congenital defects if contracted by pregnant women—remains endemic in several areas. This comprehensive analysis breaks down the numbers, identifies the root causes, examines regional disparities, and outlines the critical steps needed to protect Africa’s most vulnerable populations from these entirely preventable diseases.

Key Points: The 2025 Outbreak in Summary

• Scale of Measles: 81,315 suspected measles cases reported across Africa (Jan-Sep 2025); 34,222 (42.1%) lab-confirmed, yielding an incidence rate of 26.9 per million people.
• Childhood Burden: Children under 5 years old account for 63% of all confirmed measles cases; those aged 5-9 represent an additional 23%.
• Geographic Concentration: West Africa is the epicenter, reporting 47% of all confirmed cases. Eight countries (Angola, Nigeria, Ethiopia, DRC, Niger, Cameroon, Uganda, Togo) account for 77% of the continental total.
• Rubella Circulation: 2,349 lab-confirmed rubella cases (incidence: 1.9 per million), highlighting ongoing transmission.
• Critical Outbreak Thresholds: Sixteen countries have exceeded the WHO-defined threshold for “large and disruptive outbreaks” (>20 cases per million).
• Vaccination Response: Major catch-up campaigns are planned or underway in Chad, Congo, CAR, DRC, Nigeria, Togo, Ethiopia, Guinea, and Niger.
• Systemic Weaknesses: Significant gaps in laboratory specimen collection and timely data sharing are hampering outbreak detection and response in nations like Angola, Madagascar, South Sudan, and Nigeria.
• A Glimmer of Success: Four island nations (Cape Verde, Mauritius, São Tomé and Príncipe, Seychelles) reported zero cases, demonstrating that elimination is achievable with robust systems.

Background: Understanding Measles and Rubella

Measles (Rubeola): A Highly Contagious Threat

Measles is caused by a virus in the paramyxovirus family. It spreads through direct contact and airborne transmission when infected individuals cough or sneeze. It is one of the most contagious human diseases, with an R0 (basic reproduction number) of 12-18, meaning one person can infect 12-18 others in a susceptible population. Symptoms begin with fever, cough, runny nose, and red eyes, followed by a characteristic rash. Complications are severe and disproportionately affect young children and malnourished individuals, including pneumonia (the most common fatal complication), encephalitis (brain swelling), and severe diarrhea. There is no antiviral treatment; prevention relies entirely on safe, effective, and inexpensive vaccination. The Measles-containing vaccine (MCV) is typically administered in two doses.

Rubella (German Measles): The Silent Danger to Unborn Children

Rubella is caused by a different togavirus. It is less contagious than measles (R0 of 5-7) but poses a unique and catastrophic risk: Congenital Rubella Syndrome (CRS). If a woman is infected with rubella during early pregnancy, the virus can cross the placenta and cause miscarriage, stillbirth, or severe birth defects in the infant, including heart abnormalities, cataracts, deafness, and intellectual disability. For children and adults, rubella is often a mild illness with a rash and low-grade fever, which contributes to its under-recognition. The rubella vaccine is almost always combined with measles, mumps, and sometimes varicella (chickenpox) vaccines (MMR or MMRV). Eliminating rubella requires very high population immunity (>95%) to protect pregnant women and future generations.

The Immunization Gap: A Precarious Balance

Both diseases are vaccine-preventable. Herd immunity against measles requires approximately 95% vaccination coverage with two doses to interrupt transmission. The current outbreaks across Africa signal a critical erosion of this herd immunity. The primary drivers are multifaceted: disruptions to routine immunization services due to conflicts, population displacement, and strained health systems; growing vaccine hesitancy fueled by misinformation; and the profound impact of the COVID-19 pandemic, which caused millions of children to miss their routine vaccinations globally, creating an immunity gap that diseases like measles are now exploiting.

Analysis: Deconstructing the 2025 Outbreak Data

Geographic Spread and Hotspot Identification

The data unequivocally points to West Africa as the current epicenter of the measles crisis, accounting for nearly half of all confirmed cases. This aligns with persistent challenges in the region, including high population density, mobility, and healthcare access issues. The concentration of cases in just eight countries underscores that outbreaks are not random but cluster where immunization systems are weakest. The designation of “large and disruptive outbreaks” in 16 countries—spanning West, Central, and East Africa—indicates a continental-scale emergency, not isolated incidents. The success of the four island nations (Cape Verde, Mauritius, São Tomé and Príncipe, Seychelles) is a powerful proof-of-concept. Their ability to maintain zero reported cases likely stems from more manageable geography, stronger primary healthcare integration, and consistent vaccination program funding, offering a model for others.

The Disproportionate Burden on Young Children

The age distribution data is stark and tragically predictable. With 63% of cases in children under five and 86% in those under ten, the data confirms that measles remains a disease of the unvaccinated infant and toddler. This is a direct consequence of gaps in routine immunization. The first dose of measles vaccine is typically given at 9-12 months. If coverage for this first dose is low, a large cohort of infants enters the most vulnerable age group without protection. The significant proportion in the 5-9 age bracket suggests that either the second dose (usually at 15-18 months) is being missed, or there has been a multi-year accumulation of unvaccinated children due to systemic failures. These children are paying the price for collapsed or inconsistent health services.

Rubella: The Co-Circulating Threat

While the rubella case count (2,349) is much lower than measles, its presence is highly significant. Rubella’s lower incidence often masks its transmission until it finds a susceptible pregnant woman, leading to CRS cases that may only be detected months later. The fact that it is being detected in surveillance systems means the virus is circulating in communities, posing a latent threat to maternal and newborn health. The simultaneous circulation of measles and rubella strongly argues for the use of combined measles-rubella (MR) vaccines in campaigns, maximizing the public health impact of each vaccination touchpoint.

Systemic Failures: Surveillance and Laboratory Gaps

The WHO report candidly highlights operational weaknesses that blind health authorities to the true scale of outbreaks. Low specimen collection rates in key countries (Angola 31%, Madagascar 53%, South Sudan & Nigeria 51%) mean many suspected cases are not lab-confirmed, leading to under-reporting and delayed response. Data sharing gaps—with countries like Eritrea, Rwanda, South Africa, and South Sudan failing to submit complete datasets—prevent a real-time, continent-wide operational picture. The specific issue in Ethiopia, where lab databases lacked specimen receipt dates, cripples the calculation of key performance indicators like turnaround time, which is vital for assessing lab efficiency. These gaps create a dangerous information vacuum, allowing outbreaks to grow larger before they are detected and responded to. They point to under-resourced laboratory networks, poor data management systems, and a lack of standardized reporting protocols.

Practical Advice: Protecting Children and Strengthening Systems

For Parents and Caregivers

• Vaccinate without delay: Ensure your child receives both doses of the measles-containing vaccine (MCV1 and MCV2) on the national schedule. If you are unsure of your child’s status or your own, consult your local health clinic immediately. The vaccine is safe, free in public health systems, and highly effective.
• Recognize symptoms: Be alert for high fever, cough, runny nose, red eyes, and a rash that starts on the face and spreads downward. Seek medical care immediately if you suspect measles.
• During an outbreak: Follow public health advisories. Mass vaccination campaigns are the most effective tool. Participate in them when they are announced in your community. For infants too young for vaccination (under 9 months), minimize exposure to large gatherings and ensure other household members are vaccinated to create a “cocoon” of protection.
• For women of childbearing age: Verify your rubella immunity status. If you are not immune, get vaccinated at least one month before planning a pregnancy. The MMR vaccine is contraindicated during pregnancy.

For National Health Authorities and Policymakers

• Conduct urgent, high-quality Supplementary Immunization Activities (SIAs): The planned campaigns in late 2025 for Chad, Congo, CAR, DRC, Nigeria, and Togo must be meticulously planned, funded, and executed to reach every child under five, especially in hard-to-reach and conflict-affected areas. Use SIAs to also introduce the rubella vaccine if not already in the routine schedule.
• Strengthen Routine Immunization: SIAs are a firefighting measure. The long-term solution is a resilient routine immunization system. Invest in cold chain equipment, healthcare worker training, and reliable supply chains to ensure consistent vaccine availability at every primary health center.
• Invest in Surveillance: Allocate specific resources to improve laboratory specimen transport and testing capacity. Implement mandatory, electronic, case-based surveillance reporting with standardized indicators to eliminate data gaps and delays. Conduct regular data quality audits.
• Enhance Community Engagement: Combat vaccine hesitancy with proactive, culturally sensitive communication involving trusted community and religious leaders. Use local media to address myths and explain the safety and importance of vaccination.
• Foster Regional Collaboration: Cross-border coordination is essential, as populations move. Countries must share outbreak data and synchronize vaccination campaigns in border regions to prevent re-importation.

FAQ: Common Questions on the Africa Measles-Rubella Surge

Is measles making a comeback in Africa?

Yes, this is a clear resurgence. After significant progress towards elimination, measles has returned with force in many African countries due to accumulated immunity gaps from missed vaccinations, largely exacerbated by the COVID-19 pandemic and ongoing system weaknesses. It is not a “new” strain but the same preventable virus finding susceptible populations.

Why are children the most affected?

Children are the most affected because measles vaccination is scheduled in early childhood. When routine immunization services falter, large numbers of infants and young children remain unprotected, creating a pool of susceptible hosts. The disease then spreads most efficiently among this age group.

Are the measles and rubella vaccines safe?

Absolutely. The measles and rubella vaccines (often combined as MMR) have an excellent safety record spanning decades. They are among the most studied and safest medical interventions. Mild side effects like fever or rash can occur, but severe adverse reactions are extremely rare. The benefit of preventing measles death, blindness, and encephalitis, and rubella’s congenital defects, vastly outweighs any minimal risk.

What is the difference between measles and rubella?

While both cause a rash and fever, measles is generally a more severe illness with higher fever and risk of dangerous complications like pneumonia and encephalitis. Rubella is often milder in children but is a major threat to fetuses if a pregnant woman is infected, causing Congenital Rubella Syndrome (CRS). Both are prevented by vaccination.

Can adults get measles or rubella?

Yes, any unvaccinated person of any age can contract measles or rubella. Adults who missed vaccination as children, healthcare workers, and international travelers are at risk. Adults born after 1957 who are unsure of their vaccination status should consider getting the MMR vaccine.

What does “elimination” mean, and is it possible in Africa?

Elimination means reducing the incidence of a disease to zero in a defined geographical area through deliberate efforts, requiring sustained high vaccination coverage and excellent surveillance. The case of the four African island nations with zero cases proves it is possible. For the mainland, elimination remains a challenging but achievable goal with committed investment, political will, and community trust.

Conclusion: A Crossroads for Child