Measles outbreak risk in Afghanistan: provincial immunity gaps and epidemic potential following immunisation system disruption.
Vaccine·
- DOI
- 10.1016/j.vaccine.2026.129078
- PMID
- 42641255
- PMCID
- —
- OpenAlex
- —
- Study type
- Journal article
- Publisher
- Publisher unavailable
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings suggest that routine one-dose MCV delivery alone is insufficient to reach the measles population-immunity threshold under the model's central assumptions, and that sustained two-dose routine immunisation, high-reach SIAs, and restored immunisation-system capacity may be required.
Structured evidence summary
Research question
The study examined provincial heterogeneity in measles-containing vaccine (MCV1) coverage across Afghanistan and quantified how coverage-derived immunity gaps translate into transmission potential and supplementary immunisation activity (SIA) needs following routine immunisation disruption.
Study design
A secondary analysis of household survey data from the 2022-23 Afghanistan Multiple Indicator Cluster Survey (MICS), combined with deterministic SEIR modelling, stochastic tau-leaping simulations, and an observational comparison against WHO week-14 surveillance data.
Population and setting
Children aged 12-23 months across the 34 provinces of Afghanistan (unweighted n = 6177; weighted n = 6383), with results framed at the national and provincial levels.
Main findings
Provincial MCV1 coverage ranged from 8.6% to 88.7%, with every province showing R_cov above 1 (range 2.63-13.80; U5-weighted aggregate 7.95). A theoretical MCV1 coverage of 100.36% would be required to reach the immunity threshold, versus 96.22% for a complete two-dose series. An upper-bound 3.5-year accumulation of ~3.02 million unprotected children was estimated. Province-summed SIA needs were 4.06 million children under preferential targeting and 7.53 million under random targeting, and single-importation establishment probabilities ranged from 65.9% to 93.9% across nine illustrative provinces.
Public-health relevance
The findings suggest that routine one-dose MCV delivery alone is insufficient to reach the measles population-immunity threshold under the model's central assumptions, and that sustained two-dose routine immunisation, high-reach SIAs, and restored immunisation-system capacity may be required.
Important limitations
The authors note that the surveillance comparison is retrospective and demonstrates geographic concordance rather than external validation of the model. This summary is limited to the supplied single-article abstract and metadata, and decision-grade interpretation requires review of the original paper.
GIDS interpretation
Within GIDS, the article is discoverable as a modelling and survey-based study on measles vaccination coverage and transmission dynamics in Afghanistan, providing contextual background on subnational immunity gaps; it should not be interpreted as confirming any active surveillance signal.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 12 auditable classifier relationships to diseases, places, topics, and study design.