High Measles Complication Rates and Vaccine Breakthroughs Among Pediatric Cases in Iraq: A Cross-Sectional Study

<ns3:p>Background Measles constitutes a substantial public health concern in Iraq. Despite concerted efforts to achieve elimination in accordance with World Health Organization targets, comprehensive understanding of its epidemiological patterns and vaccine effectiveness remains critically important. Objectives This investigation aimed to: (1) assess the relationship between age and clinical manifestations among measles patients; (2) evaluate Iraq’s progress toward measles elimination objectives; and (3) identify immunization coverage gaps. Methods This cross-sectional study enrolled 200 laboratory-confirmed measles cases (serological or molecular confirmation) from Ramadi Teaching Hospital, Al-Anbar Province, Iraq, during January 2023 to March 2024. Vaccination status was verified through official refrigerator immunization cards. Statistical analyses employed chi-square tests and multivariable logistic regression to adjust for potential confounding variables. Results Among 200 confirmed measles cases, 32% were infants aged <12 months and 68% were children aged 1-9 years. Notably, 71% represented breakthrough infections among individuals who had received at least one vaccine dose. Severe complications included pneumonia (77%), diarrhea (73%), otitis media (45%), and encephalitis (23%). Unvaccinated children demonstrated 3.2-fold increased odds of developing pneumonia. Disease burden was disproportionately higher in rural populations (58%). Mean C-reactive protein concentration was 56.8 mg/dL. Conclusion Measles persists with substantial morbidity in Iraq. The breakthrough infection rate (71%) significantly exceeds World Health Organization Eastern Mediterranean Regional Office reports (45-50%), suggesting unique regional challenges. Achieving elimination necessitates urgent evaluation of vaccination programs, strengthening of routine immunization services, and enhancement of surveillance systems. Future investigations should assess post-vaccination seroconversion rates and conduct molecular genotyping studies.</ns3:p>