{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:36:58Z","timestamp":1780472218514,"version":"3.54.1"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Measles and rubella remain major public health concerns in the Eastern Mediterranean Region (EMR), despite regional elimination goals. In 2023, the region experienced an increase in measles outbreaks. This study assessed outbreak detection and response challenges in either case definition or data analysis, in addition to gaps in laboratory and genotyping data integration to improve preparedness and response. Method: A retrospective epidemiological study was conducted using official World Health Organization (WHO) data on measles and rubella (MR) in EMR countries, from 1 January to 31 December 2023. Routine MR surveillance line list, genotyping data and supplemental immunization activity (SIA) reported by countries were used. Results: In 2023, 1206 suspected measles outbreaks were reported in 13 countries; 942 (78%) were confirmed. Rubella accounted for 158 confirmed outbreaks. Children under 5 years old comprised 76% of cases, with 62% zero dose. Timely detection was achieved in only 46% of outbreaks, with wide national variation. Genotype B3 predominated, but missing genotyping data limited verification. Six immunization campaigns occurred; however, outbreaks persisted due to high zero dose, limited targeting, and delayed responses. Conclusions: Persistent immunity gaps, under detection, inconsistent genotyping, and delayed response hindered MR control in EMR. Strengthening surveillance, integrating epidemiological and molecular data, expanding targeted supplementary immunization activities, and ensuring timely response are essential tasks. Standardized outbreak definitions, capacity building, and regular subnational analyses remain critical to regional elimination goals.<\/jats:p>","DOI":"10.3390\/vaccines14030272","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T09:44:41Z","timestamp":1773999881000},"page":"272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Status of Measles and Rubella Outbreak Detection, Early Alerts, and Response in Eastern Mediterranean Region (EMR), 2023"],"prefix":"10.3390","volume":"14","author":[{"given":"Eman","family":"Elmahdy","sequence":"first","affiliation":[{"name":"World Health Organization, Eastern Mediterranean Region Office, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eltayeb","family":"Elfakki","sequence":"additional","affiliation":[{"name":"World Health Organization, Eastern Mediterranean Region Office, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amany","family":"Ghoniem","sequence":"additional","affiliation":[{"name":"World Health Organization, Eastern Mediterranean Region Office, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7066-9004","authenticated-orcid":false,"given":"Basma M.","family":"Saleh","sequence":"additional","affiliation":[{"name":"School of Science and Engineering, The American University in Cairo, Cairo 11511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Mahony","sequence":"additional","affiliation":[{"name":"Independent Epidemiology Consultant, Jakarta 12190, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7855-2963","authenticated-orcid":false,"given":"Quamrul","family":"Hasan","sequence":"additional","affiliation":[{"name":"World Health Organization, Eastern Mediterranean Region Office, Cairo 11371, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","unstructured":"WHO (2025, August 22). Measles. WHO, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/measles."},{"key":"ref_2","unstructured":"WHO (2025, October 09). WHO Immunization Data Portal\u2014Detail Page, Available online: https:\/\/immunizationdata.who.int\/global\/wiise-detail-page."},{"key":"ref_3","unstructured":"WHO (2025, August 22). Rubella. WHO, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/rubella."},{"key":"ref_4","unstructured":"WHO EMRO (2025, October 10). Countries. Available online: https:\/\/www.emro.who.int\/countries.html."},{"key":"ref_5","unstructured":"World Health Organization, Regional Office for the Eastern Mediterranean (2021). Guide to the Documentation and Verification of Measles and Rubella Elimination in the WHO Eastern Mediterranean Region, World Health Organization, Regional Office for the Eastern Mediterranean. 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Policy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101758","DOI":"10.1016\/j.cegh.2024.101758","article-title":"Evaluation of Measles-Rubella Control and Prevention Program Implementation: System and Community Review","volume":"29","author":"Gusrina","year":"2024","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2884","DOI":"10.1016\/j.vaccine.2022.02.057","article-title":"Nepal measles outbreak response immunization during COVID-A risk-based intervention strategy","volume":"40","author":"Bose","year":"2022","journal-title":"Vaccine"},{"key":"ref_14","unstructured":"(2025, August 22). PAHO Issues Epidemiological Alert for Measles Cases in the Americas\u2014PAHO\/WHO|Pan American Health Organization. Available online: https:\/\/www.paho.org\/en\/news\/31-10-2024-paho-issues-epidemiological-alert-measles-cases-americas."},{"key":"ref_15","unstructured":"CDC (2025, August 22). Measles (Rubeola). 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IFRC, Available online: https:\/\/www.ifrc.org\/article\/stopping-measles-outbreak-its-tracks-sierra-leone."},{"key":"ref_19","unstructured":"apofeed (2025, August 22). Reactive Measles Vaccination Campaign in Ethiopia Reaches over 1.7 Million Children. African Business, Available online: https:\/\/african.business\/2024\/11\/apo-newsfeed\/reactive-measles-vaccination-campaign-in-ethiopia-reaches-over-1-7-million-children."},{"key":"ref_20","unstructured":"MSF (2025, August 22). DRC: MSF Emergency Team Responds to Measles Outbreak in Equateur Province. MSF, Available online: https:\/\/www.msf.org.za\/news-and-resources\/latest-news\/drc-msf-emergency-team-responds-measles-outbreak-equateur-province."},{"key":"ref_21","unstructured":"European Centre for Disease Prevention and Control (2025, August 22). Measles, Annual Epidemiological Report for 2023, Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/measles-annual-epidemiological-report-2023."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/3\/272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T10:03:54Z","timestamp":1774001034000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/3\/272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["vaccines14030272"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14030272","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}