Global measles cases in children under 5 up 40% since COVID-19

Measles cases among children younger than 5 years rose an estimated 40% worldwide after the COVID-19 pandemic, from 11.1 million in 2019 to 15.6 million in 2023, according to a Global Burden of Disease (GBD) analysis published in Nature Medicine.¹ The increase reverses a nearly 80% global decline in cases recorded between 1990 and 2019. Investigators linked it to pandemic-related disruptions in routine immunization, health systems, and funding.²

"Our study shows urgent action is needed to restore routine immunisation programs," said Benn Sartorius, associate professor at the University of Queensland Frazer Institute in Brisbane, Australia. He added that health systems must be able to sustain high coverage through global crises.²

GBD measles study design and under-5 case estimates

Researchers used GBD 2023 data to estimate measles cases, deaths, and vaccine coverage gaps in children younger than 5 years across 204 countries and territories from 1990 through 2023.¹ The work was funded by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.²

An estimated 23.7 million infants, or about 1 in 5, missed their first dose of measles-containing vaccine (MCV1) in 2023.² Sub-Saharan Africa, which had the highest measles mortality rate across the study period, accounted for half of those missed doses. South Asia accounted for 20%.²

Australasia was an outlier. The region posted one of the largest gains in second-dose (MCV2) coverage from 1990 to 2019, and by 2023 it had the highest coverage of any region, with an estimated 96% of children younger than 5 years receiving a second dose.²

Measles transmission risk and MCV coverage in young children

Measles spreads through the air. The World Health Organization (WHO) estimates a single case can produce up to 18 secondary infections where population immunity is low.² A previously published analysis estimated case fatality as high as 3% among infants younger than 1 year in low- and middle-income countries in 2019.²

Two doses of measles-containing vaccine remain the most effective prevention. Measles vaccination is estimated to have averted nearly 59 million deaths from 2000 to 2024.²

More recent WHO and UNICEF estimates suggest the recovery remains stalled. Global MCV1 coverage was 84% and MCV2 coverage was 77% in 2025, and 57 countries reported large or disruptive measles outbreaks that year.⁴

MMR vaccination coverage declines in US kindergartners

Sartorius noted that recent US outbreaks show measles can reemerge in high-income countries where immunity gaps develop. He also pointed to rising misinformation in some populations since the pandemic.² US kindergarten MMR coverage has slipped from about 95% to 92%.²

CDC data for the 2025-2026 school year put coverage at 92.4%. About 280,000 kindergartners lacked documentation of a completed 2-dose MMR series, and exemptions reached 4.2%.³ State-level MMR coverage ranged from 98.9% in West Virginia to 75.2% in Idaho.³

Interpreting the post-COVID-19 measles resurgence

The findings describe a temporal association. They do not establish that pandemic disruptions alone caused the rise in cases. Still, missed doses are concentrated in lower-resourced regions, and coverage is eroding in some high-income settings, which suggests immunity gaps are widening on more than 1 front. The investigators said the estimates could help health authorities find under-vaccinated populations and target catch-up vaccination.²

References

1. Global and regional burden of measles and vaccine coverage among children under 5 years, 1990-2023: a Global Burden of Disease Study. Nat Med. Published online October 21, 2026. doi:10.1038/s41591-026-04661-7

2. University of Queensland. Childhood measles vaccination rates fall worldwide post COVID-19. EurekAlert! October 21, 2026. Accessed October 21, 2026. https://www.eurekalert.org/news-releases/1148645

3. Kindergarten vaccine exemptions rose in 2025-2026: CDC. Axios. August 17, 2026. Accessed October 21, 2026. https://www.axios.com/2026/08/17/kindergarten-vaccine-rates-fall

4. World Health Organization, UNICEF. Global childhood immunization coverage inches forward despite conflict and hesitancy. July 15, 2026. Accessed October 21, 2026. https://www.unicef.org/turkiye/en/press-releases/global-childhood-immunization-coverage-inches-forward-despite-conflict-and-hesitancy