What question did this study set out to answer?

This study aims to analyze measles incidence trends, vaccination coverage, and the demographic and geographic distribution of cases in Saudi Arabia from 2015 to 2024.

May 20, 2026Open Access

Measles in the Post-COVID Era: Incidence Trends, Vaccination Coverage, Demographic and Subnational Distribution in Saudi Arabia, 2015–2024

Key Points

This study aims to analyze measles incidence trends, vaccination coverage, and the demographic and geographic distribution of cases in Saudi Arabia from 2015 to 2024.
Annual incidence and vaccination data sourced from WHO and Saudi Ministry of Health (2015–2024).
Data stratified by month, region, age, and nationality.
Descriptive analyses included rates per 1,000,000 population and percentage changes.
Pre-COVID-19 incidence was 19.7/1,000,000, below EMR and global averages.
COVID-19 caused a decline to 1.1/1,000,000 in 2020, a 96.6% suppression, exceeding global (−82.2%) and EMR (−61.2%) declines.
Incidence rebounded to 67.8/1,000,000 in 2023, with children under 15 accounting for 71.6–90.6% of cases.

Abstract

Background/Objectives: The COVID-19 pandemic disrupted routine immunisation globally. Saudi Arabia presents a unique epidemiological context for measles, combining high vaccination coverage with mass pilgrimages and a large expatriate workforce. This study examined measles incidence trends, vaccination coverage, and demographic and geographic burden distribution in Saudi Arabia (2015–2024), with comparative analysis against GCC countries, the Eastern Mediterranean Region (EMR), and global data. Methods: Annual incidence and vaccination coverage data were obtained from the WHO Global Health Observatory and WHO/UNICEF WUENIC; monthly, regional, age- and nationality-stratified data from the Saudi Ministry of Health Annual Statistical Book (2015–2024). Incidence was expressed per 1,000,000 population across three epochs: pre-COVID-19 (2015–2019), pandemic disruption (2020–2021), and post-COVID-19 rebound (2022–2024). Descriptive analyses included period means, percentage changes, rate ratios, and rate differences. Results: Pre-COVID-19 incidence (mean 19.7/1,000,000) remained below EMR and global averages. The pandemic produced near-complete suppression (−96.6% to 1.1/1,000,000 in 2020), exceeding global (−82.2%) and EMR (−61.2%) declines. A marked rebound occurred in 2023 (67.8/1,000,000), surpassing the pre-pandemic peak despite MCV1/MCV2 coverage above 96%. Non-Saudi nationals bore disproportionate burden in 2021 (20.7 vs. 1.1/1,000,000) and 2023 (70.4 vs. 64.8/1,000,000). Children under 15 accounted for 71.6–90.6% of annual cases, with the 5–<15-year group’s contribution rising from 12.7% (pre-COVID mean) to 27.7% in 2024. Geographic burden shifted annually with no consistently dominant region. Conclusions: Saudi Arabia’s post-pandemic rebound despite high national coverage implicates sub-population susceptibility gaps among non-national residents and school-age children, alongside importation risks from mass pilgrimage. Targeted strategies addressing demographic and geographic heterogeneity are essential to meet WHO 2030 elimination targets.

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