J Pediatr Infect Dis 2023; 18(05): 256-260
DOI: 10.1055/s-0043-1770988
Original Article

Frequency and Reasons for Vaccination Failure against Measles among Pediatric Cases at a Tertiary Care Hospital of Karachi

Ammarah Jamal
1   Department of Pediatrics, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
1   Department of Pediatrics, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
Faiza Hayee
2   Department of Pediatrics, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
Yousuf Yahya
1   Department of Pediatrics, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan
› Author Affiliations


Objective A nationwide measles–rubella (MR) vaccination campaign was executed in Pakistan in November 2021. Despite that, there was a persistence of new measles cases. Thus, we designed this study to determine the measles vaccination status in patients with measles and to determine the reasons of missed vaccination during the campaign.

Methods We reviewed medical records of measles patients >1 month to 12 years of age, presenting to the pediatric emergency of a tertiary care hospital of Karachi, Pakistan, during January to June 2022. We recorded patients' demographics and vaccination status. Measles patients who were hospitalized were reviewed to see if the child has or has not received vaccination during the MR campaign and what were the reasons for missed vaccination.

Results A total of 1,058 children presented with measles out of which 52.9% were male. The mean age of the patients was 2.2 years. Excluding 24.3% of the patients because of age <9 months, 800 (75.6%) patients were eligible for measles vaccine. Out of these, 80% received the vaccine (94.6% had one dose and only 5.3% had two doses). Among the 98 admitted patients, 68 (69.3%) were eligible for vaccination during the MR campaign, out of which 88.2% did not get the vaccine. Common reasons of missed vaccination were: lack of knowledge of the campaign (36.6%), impossibility to find vaccination facility (23.3%), and lack of trust in vaccines (15%).

Conclusion Most of the hospitalized measles patients had missed the vaccine during the MR campaign, mostly because of lack of knowledge of the campaign. This calls for devising strategies to improve coverage of vaccination services.

Ethical Considerations

The study was approved by the Institutional Review Board of the Dow University of Health Sciences.

Authors' Contribution

A.J. conceived the idea, drafted the manuscript, reviewed the article critically, and gave final approval. S.N. interpreted the data, drafted the article, and gave final approval. F.H. analyzed the data, drafted the article, and gave final approval. Y.Y. contributed to acquisition of data, reviewed the article, and gave final approval. All authors agree to be accountable for the article.

Publication History

Received: 25 January 2023

Accepted: 31 May 2023

Article published online:
24 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Hussain H, Akram DS, Chandir S, Khan AJ, Memon A, Halsey NA. Immune response to 1 and 2 dose regimens of measles vaccine in Pakistani children. Hum Vaccin Immunother 2013; 9 (12) 2529-2532
  • 2 Centers for Disease Control and Prevention. Vaccines and Preventable Diseases [Internet]. USA: CDC; updated January 26, 2021 [accessed June 28, 2022]. Available at: https://www.cdc.gov/vaccines/vpd/measles/index.html#content
  • 3 World Health Organization. Measles [Internet]. WHO; December 5, 2019 [accessed June 28, 2022]. Available at: https://www.who.int/news-room/fact-sheets/detail/measles
  • 4 Kuehn BM. International measles vaccination campaign to reach millions. JAMA 2020; 323 (11) 1033
  • 5 Sarma H, Budden A, Luies SK. et al. Implementation of the World's largest measles-rubella mass vaccination campaign in Bangladesh: a process evaluation. BMC Public Health 2019; 19 (01) 925
  • 6 Eposi HC, Randolph NA, Benjamin KM. Measles outbreak investigation in a highly vaccinated community in the Centre region of Cameroon. J Public Health Africa 2021; 12 (01) 1775
  • 7 Response to Measles Outbreaks in Measles Mortality Reduction Settings. Geneva: World Health Organization; 2009
  • 8 Jamal A, SYahya Y, Karim MT. Do we need to give measles vaccine to children earlier than the currently recommended age?. J Ayub Med Coll Abbottabad 2018; 30 (01) 111-114
  • 9 Jamal A, Yahya Y, Ashfaq AM, Baloch Z. Impact of measles vaccination on the acquisition and frequency of measles infection in Province of Sindh. Annals ASH KM&DC 2017; 22: 237-242
  • 10 Green MS, Schwartz N, Peer V. Gender differences in measles incidence rates in a multi-year, pooled analysis, based on national data from seven high income countries. BMC Infect Dis 2022; 22 (01) 358
  • 11 Currier II RW, Hardy Jr GE, Conrad JL. Measles in previously vaccinated children. Evaluation of an outbreak. Am J Dis Child 1972; 124 (06) 854-857
  • 12 United Nations International Children Emergency Fund. Pakistan to immunize more than 90 million children against measles and rubella [Internet]. UNICEF; November 12, 2021 [accessed December 16, 2022]. Available at: https://www.unicef.org/pakistan/press-releases/pakistan-immunize-more-90-million-children-against-measles-and-rubella
  • 13 Priyadharshini JA, Jasmine A. Coverage survey of measles-rubella mass vaccination campaign in a rural area in Tamil Nadu. J Family Med Prim Care 2019; 8 (06) 1884-1888
  • 14 Majdzadeh R, Moradi A, Zeraati H, Sepanlou SG, Zamani G, Zonobi V. Evaluation of the measles-rubella mass vaccination campaign in the population covered by Tehran University of Medical Sciences. East Mediterr Health J 2008; 14 (04) 810-817
  • 15 Morice A, Carvajal X, León M. et al. Accelerated rubella control and congenital rubella syndrome prevention strengthen measles eradication: the Costa Rican experience. J Infect Dis 2003; 187 (Suppl. 01) S158-S163
  • 16 Bozkurt AI, Bostanci M, Cevahir N. et al. Evaluation of a mass measles vaccination campaign among school children aged 7-14 years old in Denizli, Turkey. Indian J Pediatr 2010; 77 (08) 879-883
  • 17 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage?. Cureus 2021; 13 (11) e19751
  • 18 Muhammad SZ, Shaikh N, Asad D, Fatima N. Challenges to mass immunization against COVID-19 in Pakistan: a lower-middle income vaccine-hesitant country. J Glob Health 2022; •••: 12
  • 19 Uddin MJ, Adhikary G, Ali MW. et al. Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh. BMC Infect Dis 2016; 16 (01) 411
  • 20 Krishnendhu VK, George LS. Drivers and barriers for measles rubella vaccination campaign: a qualitative study. J Family Med Prim Care 2019; 8 (03) 881-885
  • 21 Agarwal AK, Sengar A, Gupta P, Mahore R. ‘MR vaccine campaign in India’–get ahead success. South Asian Res J Med Sci 2019; 1 (02) 51-55
  • 22 Patel M, Lee AD, Clemmons NS. et al. National update on measles cases and outbreaks - United States, January 1-October 1, 2019. MMWR Morb Mortal Wkly Rep 2019; 68 (40) 893-896