Turning the Tide on Measles: EOC-Led Response and School-Based Vaccination in Narathiwat Province’s Outbreak, 2024–2025

This study aimed to describe the epidemiological characteristics of the 2024–2025 measles outbreak in Narathiwat Province, identify factors associated with severe illness, and evaluate the effectiveness of outbreak control measures. A suspected case was defined as fever with maculopapular rash plus cough, coryza, conjunctivitis, or Koplik’s spots. Confirmed cases had laboratory evidence of infection, detected either by measles-specific immunoglobulin M antibodies using enzyme-linked immunosorbent assay or viral RNA via reverse transcription polymerase chain reaction. Epidemiologically linked cases met clinical criteria without laboratory confirmation but had documented exposure to a confirmed case. Between February 2024 and January 2025, 2,710 cases were reported: 47.0% suspected, 13.4% epidemiologically linked, and 39.6% confirmed. Most cases occurred in children aged 9 months to 4 years, and 9.3% of confirmed cases were severe. Risk factors included female gender (adjusted odds ratio (OR) 1.81, 95% confidence interval (CI) 1.18–2.79), age under 9 months (adjusted OR 7.84, 95% CI 1.77–34.70), and diarrhea (AOR 2.29, 95% CI 1.47–3.60). Following Emergency Operations Center activation, school-based surveillance, ring vaccination, vitamin A supplementation, and a phased vaccination campaign were implemented. School-based clusters declined from 19 to 1 within 42 days post-intervention. Ring vaccination coverage reached 65% and reduced secondary infections from 2.0% to 1.3% (p-value <0.01). The vitamin A uptake rate rose rapidly, reaching 100% by October 2024. The measles vaccine coverage increased from 47.9% to 65.0% among children aged under 12 years. These results highlight the outbreak burden in low-coverage areas and support integrated interventions.