Bangladesh has recently notified the World Health Organization (WHO) about the surge in measles cases on 4 April 2026. Out of the total 64 districts, the current measles outbreak indicates widespread transmission, affecting 58 (91%) districts across divisions1. A total of 19 161 suspected cases and 2973 laboratory-confirmed measles cases were reported between 15 March and 14 April 2026. Additionally, 30 confirmed measles-related deaths (1.1% case fatality ratio CFR) and 166 suspected measles-related deaths (CFR 0.9%), primarily among unvaccinated children under 2 years of age, were recorded during this period. A total of 12 318 hospital admissions and 9772 hospital discharges were also recorded. The majority (79%) of cases were children under the age of 5, of which 66% were children below 2 years and 33% were infants below 9 months. This is a matter of critical concern in view of the larger impact on pediatric. Driven by constant domestic transmission, Bangladesh has witnessed a significant rise in measles cases since January 2026, with the most affected regions being Dhaka (8263 cases), Rajshahi (3747 cases), Chattogram (2514 cases), and Khulna (1568 cases). The cases are chiefly found in densely populated informal human settlements, including industrial and slum clusters. As per available data, the national-level risk is high due to continuing transmission across multiple divisions, the large number of vulnerable children, evident immunity gaps, and the instances of measles-related suspected deaths. Measles is highly contagious that affects humans of all age groups and remains a leading cause of death among the young. It may cause serious illness in malnourished children below 5 years, especially those with vitamin A deficiency and the immunocompromised. The measles virus is transmitted through airborne droplets and contact with infected individuals. Initial symptoms include high fever, runny nose, bloodshot eyes, cough, and tiny white spots inside the mouth, which usually appear 10–14 days after infection (with a range of 7–23 days). Usually appearing 10–14 days after exposure, the rash spreads from the head to the trunk and then to the lower extremities. The infected individual is contagious from 4 days before to 4 days after the rash appears. Measles is usually a mild to moderately severe ailment. The disease is self-limiting, and there is no specific antiviral therapy. Although most infected individuals recover within 2–3 weeks, measles can become complicated. The severities include secondary ear infections, loss of hearing, diarrhea, pneumonia, and blindness. Severe measles complications also include encephalitis (inflammation of brain cells), damage to brain cells, and, eventually, death. Safe measles vaccination effectively provides protection to the vulnerable population. The WHO recommends the administration of a double dose of Measles-Containing Vaccine (MCV) as part of the routine immunization schedule. WHO also recommends conducting supplementary immunization activities or mass immunization campaigns as an effective strategy to vaccinate children who might have missed routine immunization. This approach rapidly improves herd immunity and reduces susceptibility within a community. A nationwide measles-rubella (MR) vaccination campaign was approved in Bangladesh on 30 March 2026 as an outbreak response measure. Following this, an MR vaccination campaign for children in the 6–59-month age group was initiated on the 5th of April. A vitamin A campaign was initiated in the country for all suspected and confirmed cases of measles on 15 March 2025 as an essential part of the model case management and treatment. Enhanced hospital preparedness, strengthened routine immunization to prevent further spread, ascertained availability of vitamin A, strengthened isolation wards, improved case detection and reporting, and reinforcement of infection prevention and control measures are recommended during an outbreak. Surveillance and epidemiological analyses were strengthened, and rapid response teams were activated at the district level. On-site trainings at health facilities are being conducted to improve case detection, and weekly reports on the situation are being prepared to facilitate evidence-based decision-making. During this Bangladeshi outbreak, measles was found sub-optimally among non-immunized children. They were either unvaccinated or had received only a single measles vaccine dose. Some children were also reportedly infected before attaining the vaccination eligibility age of 9 months. This clearly indicates substantial immunity gaps. Bangladesh had substantially progressed towards measles elimination before this outbreak, and the confirmed measles incidents were quite low. The country has prided itself on a strong childhood vaccination program year after year2. A recent decline in MR vaccine coverage in children between 2024 and 2025, as the vaccine went out of stock, increased their susceptibility and could have contributed to the outbreak. Gaps in routine immunization and the absence of regular nationwide supplementary MR campaigns since 2020 could also be liable. As mentioned, the majority of the cases were among the unvaccinated and under-vaccinated infants during the present outbreak, who were too young to be vaccinated. This raised concerns about uninterrupted transmission and severe disease outcomes1. Linked to the unstable political scenario, this outbreak was entirely preventable, and action to curb its recurrence must be ensured2. With constant mass protests, Bangladesh has faced repeated political crises in the last couple of years. Being led by an interim government from August 2024 till February 2026, routine vaccination activity was disrupted. The mass MR vaccination campaign, which should take place every fourth year, could not be conducted during this period (the last campaign was held in 2020)2. Furthermore, several administrative positions in the health sector across the hierarchy in the country remained vacant. Agitations and strikes by healthcare workers in various posts led to the expanded immunization program being halted. The lack of administrative preparedness, shortage of funds, and delayed fund allocation led to vaccine stock depletion, which made the situation more complex to handle2. Bangladesh shares its land borders extensively with India and Myanmar, and measles is endemic across South-East Asia. The cross-border measles transmission risk, mostly among unvaccinated or inadequately vaccinated travelers, was considerable due to cross-border population movement. The unvaccinated (zero-dose) children population was considerably high in Myanmar. Ongoing conflict and the humanitarian crisis in the country have limited surveillance and response capabilities. Bangladeshi cities like Jashore and Chapainawabganj, with high case occurrences, share busy land crossings with India, thus increasing the risk of disease transmission across the border. In spite of the high vaccination coverage, India has reported a rise in case counts over the past 6 months. Strengthening integrated epidemiological surveillance is important to timely detect suspected cases in public and private healthcare settings. Additionally, strengthening epidemiological surveillance in high-traffic border regions is critical to detect and respond to suspected measles cases promptly. Uninterrupted national-, regional-, and local-level coordination needs to be ensured. As the outbreak continues, establishing adequate hospital case management is essential to counter the nosocomial transmission risk. Vaccinating the exposed population, such as healthcare workers, people in transportation and tourism, and international travelers is recommended. WHO has recommended maintaining at least 95% sustained homogeneous MCV vaccination coverage with the first and second doses in all municipalities in Bangladesh. Immunizing migrants and residents in high-traffic border areas may be established to ensure herd immunity. Maintaining MR and/or MMR vaccine and syringe stock during outbreaks is suggested to control case imports. Vulnerable contacts in all settings may be administered post-exposure prophylaxis, including MCV or normal human immunoglobulin doses. Seamless routine immunization systems for displaced, indigenous, and other susceptible populations are critical to achieving and sustaining high herd immunity levels against vaccine-preventable diseases like measles. A global rise in measles incidents was strongly associated with reduced vaccination coverage. The recent surge in measles cases is not only restricted to Bangladesh; other countries have also reported a high number of cases between 2020 and 2025 in comparison to the occurrences during the same period in other calendar years. Other low- and medium-income countries in conflict and mass displacement, like Sudan, are currently battling measles3. Countries like Angola, Cameroon, Uganda, Yemen, India, Japan, Pakistan, Canada, Mexico, the USA, Bolivia, Paraguay, and Belize recently reported a significant rise in the reported cases as compared to the occurrences in earlier years (https://id-info.jihs.go.jp/en/surveillance/idwr/featured/2026/10/index.html; https://www.cdc.gov/global-measles-vaccination/data-research/global-measles-outbreaks/index.html). Measles cases were also reported among visitors to the USA. It is worth noting that measles cases and measles-related deaths were estimated to have globally decreased between 2000 and 2024. This was attributed to the steady, rigorous, and consistent increase in double-dose measles vaccination. The global first-dose coverage increased from 71% in 2000 to 84% in 2024, and the second dose increased from 17% in 2000 to 76% in 20243. However, data indicated that the two-dose measles immunization coverage remained below 95% threshold. Disrupted routine immunization was also reported during the COVID-19 pandemic4. When people returned to normal social interactions, high measles incidents were globally witnessed during 2024 and 2025, attributable to decreased vaccine coverage. A recent demographic study in Bangladesh reported that almost a third of the measles-infected children were below 9 months, necessitating strengthened routine child immunization alongside adolescent immunization5. Measles cannot be effectively prevented solely through sanitization measures such as hand hygiene and the use of face masks, as the virus is airborne. In this context, routine vaccination of children is very essential. International mass-gathering events like the Asiad (Japan), FIFA World Cup (USA, Canada, Mexico), Hajj (Saudi Arabia), and Arbaeen Pilgrimage (Iraq) are scheduled this year. Such events could potentially increase the risk of transmission of infectious diseases due to the large crowds and heavily floating populations6. Therefore, governments and health officials may need to devise appropriate healthcare policies before the commencement of these events.
Mohapatra et al. (Wed,) studied this question.
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