Prevalence of Measles in Vaccinated and Unvaccinated Children: a Cross Sectional Study

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Despite the availability of effective vaccines, measles outbreaks remain common, exacerbated by gaps in vaccination coverage and other socioeconomic factors. Objectives: This study aimed to determine the prevalence of measles and its association with vaccination status among children aged 4 months to 15 years presenting at Saidu Group of Teaching Hospital, Swat. Methodology: A cross-sectional study was conducted on 400 children diagnosed with measles. Data were collected using a structured questionnaire and analyzed with SPSS-27. Children were categorized into vaccinated and unvaccinated groups, and associations with demographic and clinical variables were assessed. Results: Among the 400 children, the prevalence of measles was 50.2%. The highest prevalence was observed in the 5–10 years age group (56.6%). A significant association was found between vaccination status and measles prevalence, with 43.34% of vaccinated and 67.4% of unvaccinated children affected (p = 0.04). Females had a significantly higher prevalence (58.65%) than males (p = 0.006). Complications occurred in 57.2% of cases, with pneumonia (37.4%) and diarrhea (27.8%) being the most frequent. Conclusion: The study highlights the effectiveness of measles vaccination in reducing disease incidence. However, cases among vaccinated children point to issues such as secondary vaccine failure and cold chain management. Enhanced immunization programs, improved healthcare access, and strategies to address vaccine hesitancy are critical to achieving measles elimination in Pakistan. Measles immunization non vaccination children Figures Figure 1 Figure 2 INTRODUCTION Measles is a major public health problem, and that is caused by a very contagious, measles virus that is a periodic menace in low- income and developing countries like Pakistan, occurring even though an effective vaccine exists. Measles is a contagious viral disease that may cause serious complications like pneumonia, encephalitis and death, especially in children under five years of age. Measles still causes significant morbidity and mortality worldwide[ 1 ]. By 2023, WHO estimates that measles affected nearly 10.3 million people across the globe, calculated to be a 20% hike from 2022, according to new facts by the World Health Organization (WHO) and the CDC [ 2 ]. Immunization is considered the most vital vitality in preventive medicine and now it is really a crying need. Through immunization, cost of treatment for diseases can be minimized, in turn poverty alleviation and socio-economic development of the country [ 3 ].WHO started immunization against measles in 1974 around the globe. This was first initiated in Pakistan in 1978 with the specific goal of eradicating measles along with other diseases like tetanus, diphtheria, tuberculosis, pertussis, and even polio, which can be prevented through vaccination [ 5 ]. In Pakistan, the Expanded Programme on Immunization provides measles vaccination in two doses, with one dose administered at the 9th month and the other at 15 months[ 6 ]. However, low coverage has resulted in outbreaks affecting mostly unvaccinated children. The causes of these outbreaks include low immunization coverage, vaccine hesitancy, and limited access to health services. Despite a worldwide goal of measles elimination, Pakistan still does not provide immunity against measles because of lapses in coverage, vaccine hesitancy, and socio-economic barriers. The WHO recommends that at least 95% of the population should be vaccinated to create herd immunity to prevent outbreaks; vaccination coverage in Pakistan is below this target, particularly in rural areas (WHO, 2021). Highly efficacious vaccination against measles neglects the public health of Pakistan. Numerous studies have marked the challenges of achieving and maintaining high vaccination coverage in the country. High prevalence rates obviously affect health outcomes between immunized and unimmunized children, with a higher risk for unvaccinated children to develop measles and suffer severe complications from it compared to their vaccinated counterparts. An analysis of a 2022-23 study, with 606 children from Nowshera in Pakistan, found out that positive measles cases among vaccinated children had a percent of 43.36, whereas unvaccinated children had that of 62.92% [ 7 ]. In addition, a meta-analysis indicated that the risk of measles in vaccinated children was reduced by seventy percent than that of unvaccinated children[ 4 ].An additional study conducted on cases of measles in 2020 from the province of Sindh confirmed that 59.1 percent of measles case confirmations were unvaccinated, while 29.6 percent had the first dose, and 10.3 percent took two doses [ 5 ]. A study done inside Karachi showed that only 30.94% of new cases of measles were said to have been vaccinated against measles[ 6 ]. Clinical outcomes also differ; unvaccinated children experience more severe complications, with 81.8% of complicated cases occurring in this study[ 7 ]. Estimations from Faisalabad and Jhang have determined that in a population of 1053 surveyed children, a highly significant number of measles cases reported are among unvaccinated individuals [ 8 ]. Measles outbreaks in a country like Pakistan depend on vaccination coverage, public awareness of the disease, and socio-economic factors. According to studies, low vaccination coverage among children aged between 1 to 2 years is the highest risk factor for susceptibility toward infection among unvaccinated individuals, which is also higher with infection in the way of outbreak occurrence [ 9 , 10 ]. Various global studies have raised concern regarding these issues to health systems for preventing and controlling future epidemics. Factors associated with measles outbreaks in different parts of the world have been described in several studies. In a multicountry study vaccinating children had a 15–30% reduction in ARI, and a 12–22% decrease in diarrhea across countries, such as India and Pakistan [ 11 ]. In rural Senegal, a study showed that vaccine efficacy was 90%, protecting even those with low antibody levels considerably [ 12 ]. Another study from Somalia found that only 9.7% of the hospitalized children had taken a single dose of measles vaccine, showing the low coverage of the vaccine among children [ 13 ]. This study proposes to compare incidences and clinical outcomes of measles between vaccinated and unvaccinated children, with particular emphasis on how vaccination reduces severity in the disease in Pakistan. METHODOLOGY Study Design and Setting A cross-sectional, observational study was used across three months in the pediatric departments at Saidu Group of Teaching Hospital (SGTH), Swat. Sample Population It focused on children aged between 6 months and 15 years who were diagnosed with measles. The following defined the children in the study: 1. Vaccinated Group: Children who had at least one dose of measles vaccine. 2. Unvaccinated Group: Children who had no one dose of measles vaccine. Sample Size A total of 400 children were included in the study to provide sufficient data for meaningful analysis and to ensure statistical validity. Inclusion and Exclusion criteria Clinically and laboratory-confirmed measles infection Children whose vaccination was incomplete, and those having some vague or uncertain diagnosis of measles, were excluded from this study. Data Collection A self-structured questionnaire was the means through which data was collected: demographic part-age group, gender along with vaccination history, and severity of infection Statistical analysis All data were analyzed using SPSS-27 software. Descriptive data be displayed in tables and figures. Chi-square test statistics were used to test associations between the categorical variables. All tests were carried out at the level of significance p < 0.05. Ethical considerations The ethical clearance was obtained from the IRB for the conduct of the study, ensuring that the study abided by ethical standards. The informed consent was got from the parents/guardians of all children involved in the study. Confidentiality was maintained strictly, and all data collected were used only for this research study. RESULTS A total of 400 children were included in this study, with 55.3% Males and 44.8% females. The children's ages ranged from 4 months to 15 years. With a mean age of 3.23 years (SD=0.954). Out of the total 400 patients, 221 were diagnosed with measles, while 194 were confirmed not to have measles. 5 patients were suspected of having measles but were not confirmed. Table 1 shows the characteristics of the study participants. Table; 1 Characteristics of the Study Population Characteristics Frequency (%) Age Group 0-6 months 12(3) 6-12 months 54(13.5) 1-5 years 199(49.8) 5-10 years 83(20.8) 10-15 years 52(13) Mean (SD) 3.23 (0.95) Gender Male 221 (55.3) Female 179 (44.8) Vaccination Status Vaccinated 222 (55.5) Unvaccinated 178 (44.5) Measles Occurrence Yes 201 (50.2) No 194 (48.5) Suspected 5 (1.3) Complications Yes 115 (57.21%) No 86 (42.79) Two hundred and twenty two (55.5%) of the children were fully vaccinated against measles, while 178 (44.8%) were unvaccinated as shown in figure 2. Children of the 5-10 years age group had the highest number of measles cases (56.6%), while the 0-6 months age group had the lowest (33.3%) rate of measles. A statistically significant association was found between gender and measles status (p=0.006). Female children were more likely to have had measles (58.65%) as compared to male children. Vaccination rate was highest among children of age group 5-10 years at 73.49% while 0-6 month age group had the lowest vaccination rate at 16.67%. A chi square test was performed to assess the association between vaccination status and measles occurrence. The analysis revealed a statistically significant association (p=0.04) between being vaccinated and a lower likelihood of contracting measles. A higher proportion of cases were observed in unvaccinated children compared to vaccinated ones. Among the vaccinated children a total of 95(43.34%) contracted measles, while 125(56.7%) did not have the disease. In contrast, among the unvaccinated children, 120(67.4%) contracted measles, while 58(32.6%) were confirmed as non-measles cases. These findings suggest that a higher proportion of cases were observed in unvaccinated children as compared to vaccinated ones, reinforcing the effectiveness of measles vaccination in preventing measles infections. Table 2: Distribution of Measles Cases and Vaccination Status Among Infected Children Vaccination Status Measles (YES) Measles (NO) P- Value Vaccinated 95 (43.34%) 125(56.7%) 0.04 Unvaccinated 120(67.4%) 58(32.6%) Table 3: Types Of Complication In Measles Cases Type of Complication Frequency (%) Pneumonia 43(37.4) Diarrhea 32(27.8) Encephalitis 5 (4.3) Myocarditis 21(18.2) Other 15 (6.8) DISCUSSION This study analyzed the prevalence of measles and its association with vaccination status among 400 children aged 4 months to 15 years. The results demonstrated the effectiveness of vaccination in reducing measles cases, along with notable differences in measles occurrence based on age, gender, and vaccination status. Our findings revealed that 50.2% of children were diagnosed with measles, with the highest prevalence observed in the 5–10 years age group (56.6%). The lowest rate occurred in the 0–6 months age group (33.3%), likely due to maternal antibodies providing temporary immunity during infancy[ 14 ]. Similar findings have been reported in other studies, which emphasize the vulnerability of older children due to waning immunity and missed vaccinations[ 15 ]. Female children had a significantly higher likelihood of contracting measles (58.65%) compared to males (p = 0.006). Although the underlying reasons are unclear, potential explanations include sociocultural factors affecting healthcare access and immunity differences[ 16 ]. Further research is necessary to explore this gender disparity in measles incidence. The analysis revealed a statistically significant association between vaccination status and measles occurrence (p = 0.04). Among vaccinated children, 43.34% contracted measles compared to 67.4% of unvaccinated children. These results strongly support the effectiveness of measles vaccination in preventing disease, consistent with studies from both developed and developing countries[ 17 , 18 ]. However, the presence of measles in vaccinated children raises concerns about secondary vaccine failure, cold chain issues, or waning immunity over time. Addressing these factors through booster doses and better vaccine storage infrastructure is crucial to enhance vaccine efficacy. The vaccination rate was highest in the 5–10 years age group (73.49%) and lowest in the 0–6 months group (16.67%). This pattern highlights the need for timely vaccination, especially in infants, as delayed immunization increases the risk of disease[ 19 ]. Strengthening immunization programs and community outreach can improve coverage rates, particularly in underserved populations. The study underscores the critical role of vaccination in measles control. Despite global efforts to eliminate measles, gaps in vaccination coverage persist, especially in low-resource settings. To address these challenges, strategies such as improving vaccine access, addressing vaccine hesitancy, and enhancing awareness campaigns are essential [ 20 , 21 ]. CONCLUSION This study highlights the significant role of vaccination in reducing the incidence of measles among children. A statistically significant association was observed between vaccination status and a lower likelihood of contracting measles, reaffirming the efficacy of measles immunization programs. Unvaccinated children were disproportionately affected, emphasizing the need to strengthen routine immunization efforts. The findings also underscore critical disparities, such as higher measles prevalence in older children and among females, necessitating further investigation into the underlying causes. Additionally, the relatively high measles incidence among vaccinated children warrants exploration of secondary vaccine failure, cold chain issues, or waning immunity. To achieve measles elimination goals, targeted interventions are needed to improve vaccination coverage, particularly in younger age groups and underserved populations. Strengthening health education campaigns, addressing vaccine hesitancy, and enhancing vaccine delivery systems are essential strategies. Policymakers and healthcare providers must collaborate to ensure equitable access to vaccination, thereby reducing the burden of measles and advancing public health. This study will provide insights into the protective role of vaccination in measles prevention and highlight the differences in disease burden between vaccinated and unvaccinated children. The results are expected to reinforce the importance of vaccination programs in public health strategies to combat measles outbreaks. LIMITATIONS This study has several limitations that should be considered when interpreting the findings. First, the study's observational design restricts the ability to establish causal relationships between vaccination status and measles incidence. Second, the reliance on clinical diagnoses, without widespread use of laboratory confirmation, may have led to misclassification of measles cases, particularly in the "suspected" category. Additionally, data collection was limited to a single center, which may not be representative of the broader population. Sociocultural and regional factors influencing vaccination rates and healthcare access were not assessed, which could have provided deeper insights into disparities observed in gender and age groups. Declarations CONFLICT OF INTEREST The authors declare no conflict of interest regarding the publication of this study. Author Contribution 1) WAJEEH UR REHMAN: Conceptualization, data collection, and manuscript drafting2) SHAFIQ UR RAHMAN: Methodology, data analysis, and manuscript review.3) MUHAMMAD IBRAHIM:Data curation, statistical analysis, and interpretation.4) MUHAMMAD HARIS KHAN: Literature review, data acquisition, and manuscript drafting.5) JAVED IQBAL: Supervision, funding acquisition, and final approval of the manuscript.6) MUHAMMAD SALIH: data collection, and manuscript writing7) SYED MUHAMMAD ALI:Conceptualization, manuscript drafting, and critical revision.8) BRIJESH SATHIAN: Research design, manuscript editing, and final review.All authors reviewed the manuscript. Acknowledgement Open access funding provided by Qatar national library. References Schulz H., Hiebert J., Frost J., McLachlan E., Severini A.J.Jo.V.M. Optimisation of methodology for whole genome sequencing of Measles Virus directly from patient specimens. 2022;299:114348 https://www.who.int/news/item/14-11-2024-measles-cases-surge-worldwide--infecting-10.3-million-people-in-2023 World Health Organization: State of the World's Vaccines and Immunization. Geneva; 2002. World Health Organization¸ Expanded Programme on Immunization: Immunization policy: global programme for vaccines and immunization. Geneva 1996, WHOGPV/GEN/95.03 Rev. 1. Ali SZ. Health for all in Pakistan: achievements, strategies and challenges. East Mediterr Health J 2000; 6:832-7 Mason WH. Measles. In: Kliegman RM, Stanton B, Geme JS, Schor N, Behrman RE, editors. Nelson Text Book of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Inc., USA 2011; p. 1069-73. Irfan, Khan., Muhammad, Osama., Muhammad, Mohsin, Khan., Ahmad, Waqas., Anwar, Khan, Wazir., Zahid, Irfan, Marwat., Muhammad, Mohsin., Ahmad, Khan., Anwar, Waqas., Khan, Wazir., Zahid, Irfan., Khan.Ext-All. (2024). Prevalence Of Measles In Vaccinated And Unvaccinated Children In QHAMC, Nowshera.. doi: 10.69837/pjammr.v1i02.23 Muhammad, Asif, Zahoor., Muhammad, Hidayat, Rasool., Muhammad, Waseem., Bilal, Aslam., Muhammad, Kashif, Zahoor., Muhammad, Saqalein., Zeeshan, Nawaz., Rabia, Sahar. (2015). Prevalence of measles in vaccinated and non-vaccinated children.. Excli Journal, 14:504-507. doi: 10.17179/EXCLI 2015-170 Ervia, Fahma, Dhony., Bhisma, Murti., Hanung, Prasetya. (2024). Correlations between History of Contact with Infected Person and Measles Vaccination Status on the Risk of Measles Incidence in Children: Meta-Analysis. Journal of epidemiology and public health, 9(2):156-169. doi: 10.26911/jepublichealth.2024.09.02.03 Syed, Sohail, Zahoor, Zaidi., Abdul, Hameed., Abdul, Hameed., Naeem, Ali., Massab, Umair., Muhammad, Masroor, Alam., Muhammad, Suleman, Rana., Salmaan, Sharif., Uzma, Bashir, Aamir., S., Shahid, Shaukat., Mehar, Angez., Adnan, Khurshid., Ribqa, Akhtar., Nayab, Mehmood., Nazish, Badar. (2017). A measles outbreak in Sindh, Pakistan caused by a genotype B3 virus. Archives of Virology, 162(12):3603-3610. doi: 10.1007/S00705-017-3524-9 Rahul, Bawankule., Abhishek, Singh., Kaushalendra, Kumar., Sadanand, Shetye. (2017). Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study?. PLOS ONE, 12(1) doi: 10.1371/JOURNAL.PONE.0169713 Badara, Samb., Peter, Aaby., Hilton, Whittle., Awa, Marie, Coll, Seck., Seedy, Rahman., John, V., Bennett., Lauri, E., Markowitz., François, Simondon. (1995). Serologic status and measles attack rates among vaccinated and unvaccinated children in rural Senegal.. Pediatric Infectious Disease Journal, 14(3):203-209. doi: 10.1097/00006454-199503000-00007 Omar, Abdullahi, Ahmed., Ikran, Ali., Najib, Isse, Dirie. (2023). Demographical, clinical, and complication differences between vaccinated and unvaccinated hospitalized children with measles in mogadishu somalia: a hospital-based retrospective cohort study. Annals of medicine and surgery, 85:1550-1555. doi: 10.1097/MS9.0000000000000672 WHO. Measles key facts. Retrieved from https://www.who.int Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16. doi: 10.1086/377712. PMID: 15106083. Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. PMID: 28673424. Patel MK, Goodson JL, Alexander JP Jr, Kretsinger K, Sodha SV, Steulet C, Gacic-Dobo M, Rota PA, McFarland J, Menning L, Mulders MN, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2019. MMWR Morb Mortal Wkly Rep. 2020 Nov 13;69(45):1700-1705. doi: 10.15585/mmwr.mm6945a6. PMID: 33180759; PMCID: PMC7660667. Nic Lochlainn LM, de Gier B, van der Maas N, Strebel PM, Goodman T, van Binnendijk RS, de Melker HE, Hahné SJM. Immunogenicity, effectiveness, and safety of measles vaccination in infants younger than 9 months: a systematic review and meta-analysis. Lancet Infect Dis. 2019 Nov;19(11):1235-1245. doi: 10.1016/S1473-3099(19)30395-0. Epub 2019 Sep 20. PMID: 31548079; PMCID: PMC6838664. Biset G, Woday A, Mihret S, Tsihay M. Full immunization coverage and associated factors among children age 12-23 months in Ethiopia: systematic review and meta-analysis of observational studies. Hum Vaccin Immunother. 2021 Jul 3;17(7):2326-2335. doi: 10.1080/21645515.2020.1870392. Epub 2021 Mar 24. PMID: 33760689; PMCID: PMC8189140. https://www.cdc.gov/measles/hcp/vaccine-considerations/index.html#:~:text=Routine%20recommendations-,Children,6%20years%20(before%20school%20entry) https://www.unicef.org/pakistan/topics/immunization Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5650818","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":391547480,"identity":"bc53069b-caec-478a-a596-83e8b5cdaf9e","order_by":0,"name":"Wajeeh ur Rehman","email":"","orcid":"","institution":"Saidu Medical College","correspondingAuthor":false,"prefix":"","firstName":"Wajeeh","middleName":"ur","lastName":"Rehman","suffix":""},{"id":391547481,"identity":"68f37088-7d12-49d9-9612-822062c28f07","order_by":1,"name":"Shafiq ur rehman","email":"","orcid":"","institution":"Saidu Medical 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1","display":"","copyAsset":false,"role":"figure","size":32055,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of Measles occurrence among Patients (n=400)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5650818/v1/2b73dbbdd0b14c2c4f6ca01d.png"},{"id":72205367,"identity":"488e9c0c-ba32-4514-abcc-0cc835ef0854","added_by":"auto","created_at":"2024-12-23 16:35:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16123,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of Children Vaccination Status\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5650818/v1/ad42d769b5592bb99e04ba77.png"},{"id":72207262,"identity":"17ce9752-dffe-4876-8b14-57f9e3ec7fc9","added_by":"auto","created_at":"2024-12-23 16:51:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":503907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5650818/v1/984521dd-3965-4b73-b262-5a3fe53849f4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence of Measles in Vaccinated and Unvaccinated Children: a Cross Sectional Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMeasles is a major public health problem, and that is caused by a very contagious, measles virus that is a periodic menace in low- income and developing countries like Pakistan, occurring even though an effective vaccine exists. Measles is a contagious viral disease that may cause serious complications like pneumonia, encephalitis and death, especially in children under five years of age. Measles still causes significant morbidity and mortality worldwide[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. By 2023, WHO estimates that measles affected nearly 10.3\u0026nbsp;million people across the globe, calculated to be a 20% hike from 2022, according to new facts by the World Health Organization (WHO) and the CDC [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Immunization is considered the most vital vitality in preventive medicine and now it is really a crying need. Through immunization, cost of treatment for diseases can be minimized, in turn poverty alleviation and socio-economic development of the country [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].WHO started immunization against measles in 1974 around the globe. This was first initiated in Pakistan in 1978 with the specific goal of eradicating measles along with other diseases like tetanus, diphtheria, tuberculosis, pertussis, and even polio, which can be prevented through vaccination [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Pakistan, the Expanded Programme on Immunization provides measles vaccination in two doses, with one dose administered at the 9th month and the other at 15 months[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, low coverage has resulted in outbreaks affecting mostly unvaccinated children. The causes of these outbreaks include low immunization coverage, vaccine hesitancy, and limited access to health services. Despite a worldwide goal of measles elimination, Pakistan still does not provide immunity against measles because of lapses in coverage, vaccine hesitancy, and socio-economic barriers. The WHO recommends that at least 95% of the population should be vaccinated to create herd immunity to prevent outbreaks; vaccination coverage in Pakistan is below this target, particularly in rural areas (WHO, 2021).\u003c/p\u003e \u003cp\u003eHighly efficacious vaccination against measles neglects the public health of Pakistan. Numerous studies have marked the challenges of achieving and maintaining high vaccination coverage in the country. High prevalence rates obviously affect health outcomes between immunized and unimmunized children, with a higher risk for unvaccinated children to develop measles and suffer severe complications from it compared to their vaccinated counterparts.\u003c/p\u003e \u003cp\u003eAn analysis of a 2022-23 study, with 606 children from Nowshera in Pakistan, found out that positive measles cases among vaccinated children had a percent of 43.36, whereas unvaccinated children had that of 62.92% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, a meta-analysis indicated that the risk of measles in vaccinated children was reduced by seventy percent than that of unvaccinated children[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].An additional study conducted on cases of measles in 2020 from the province of Sindh confirmed that 59.1 percent of measles case confirmations were unvaccinated, while 29.6 percent had the first dose, and 10.3 percent took two doses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA study done inside Karachi showed that only 30.94% of new cases of measles were said to have been vaccinated against measles[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Clinical outcomes also differ; unvaccinated children experience more severe complications, with 81.8% of complicated cases occurring in this study[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEstimations from Faisalabad and Jhang have determined that in a population of 1053 surveyed children, a highly significant number of measles cases reported are among unvaccinated individuals [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Measles outbreaks in a country like Pakistan depend on vaccination coverage, public awareness of the disease, and socio-economic factors. According to studies, low vaccination coverage among children aged between 1 to 2 years is the highest risk factor for susceptibility toward infection among unvaccinated individuals, which is also higher with infection in the way of outbreak occurrence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious global studies have raised concern regarding these issues to health systems for preventing and controlling future epidemics. Factors associated with measles outbreaks in different parts of the world have been described in several studies. In a multicountry study vaccinating children had a 15\u0026ndash;30% reduction in ARI, and a 12\u0026ndash;22% decrease in diarrhea across countries, such as India and Pakistan [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In rural Senegal, a study showed that vaccine efficacy was 90%, protecting even those with low antibody levels considerably [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another study from Somalia found that only 9.7% of the hospitalized children had taken a single dose of measles vaccine, showing the low coverage of the vaccine among children [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study proposes to compare incidences and clinical outcomes of measles between vaccinated and unvaccinated children, with particular emphasis on how vaccination reduces severity in the disease in Pakistan.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003eStudy \u0026nbsp;Design and Setting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional, observational study was used across three months in the pediatric departments at Saidu Group of Teaching Hospital (SGTH), Swat.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt focused on children aged between 6 months and 15 years who were diagnosed with measles.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe following defined the children in the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Vaccinated Group:\u0026nbsp;\u003c/strong\u003eChildren who had at least one dose of measles vaccine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Unvaccinated Group:\u0026nbsp;\u003c/strong\u003eChildren who had no one dose of measles vaccine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 400 children were included in the study to provide sufficient data for meaningful analysis and to ensure statistical validity.\u003cstrong\u003e\u0026nbsp;Inclusion and Exclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinically and laboratory-confirmed measles infection Children whose vaccination was incomplete, and those having some vague or uncertain diagnosis of measles, were excluded from this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA self-structured questionnaire was the means through which data was collected: demographic part-age group, gender along with vaccination history, and severity of infection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data were analyzed using SPSS-27 software. Descriptive data be displayed in tables and figures. Chi-square test statistics were used to test associations between the categorical variables. All tests were carried out at the level of significance p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical clearance was obtained from the IRB for the conduct of the study, ensuring that the study abided by ethical standards. The informed consent was got from the parents/guardians of all children involved in the study. Confidentiality was maintained strictly, and all data collected were used only for this research study.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 400 children were included in this study, with 55.3% Males and 44.8% females. The children\u0026apos;s ages ranged from 4 months to 15 years. With a mean age of 3.23 years (SD=0.954). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Out of the total 400 patients, 221 were diagnosed with measles, while 194 were confirmed not to have measles. 5 patients were suspected of having measles but were not confirmed. Table 1 shows the characteristics of the study participants.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable; 1 Characteristics of the Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"462\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eCharacteristics\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFrequency (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eAge Group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e0-6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e12(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e6-12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e54(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e1-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e199(49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e5-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e83(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e10-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e52(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.23 (0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e221 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e179 (44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eVaccination Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eVaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e222 (55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eUnvaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e178 (44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eMeasles Occurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e201 (50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e194 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eSuspected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e5 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e115 (57.21%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e86 (42.79)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Two hundred and twenty two (55.5%) of the children were fully vaccinated against measles, while 178 (44.8%) were unvaccinated as shown in figure 2.\u003c/p\u003e\n\u003cp\u003eChildren of the 5-10 years age group had the highest number of measles cases (56.6%), while the 0-6 months age group had the lowest (33.3%) rate of measles. A statistically significant association was found between gender and measles status (p=0.006). Female children were more likely to have had measles (58.65%) as compared to male children. Vaccination rate was highest among children of age group 5-10 years at 73.49% while 0-6 month age group had the lowest vaccination rate at 16.67%. A chi square test was performed to assess the association between vaccination status and measles occurrence. The analysis revealed a statistically significant association (p=0.04) between being vaccinated and a lower likelihood of contracting measles. A higher proportion of cases were observed in unvaccinated children compared to vaccinated ones. \u0026nbsp; Among the vaccinated children a total of 95(43.34%) contracted measles, while 125(56.7%) did not have the disease. In contrast, among the unvaccinated children, 120(67.4%) contracted measles, while 58(32.6%) were confirmed as non-measles cases. These findings suggest that a higher proportion of cases were observed in unvaccinated children as compared to vaccinated ones, reinforcing the effectiveness of measles vaccination in preventing measles infections.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Distribution of Measles Cases \u0026nbsp;and Vaccination Status Among Infected Children\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaccination Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasles (YES)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasles (NO)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaccinated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e95 (43.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e125(56.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnvaccinated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e120(67.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e58(32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Types Of Complication In Measles Cases\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"279\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e43(37.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e32(27.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eEncephalitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e5 (4.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eMyocarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e21(18.2)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e15 (6.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study analyzed the prevalence of measles and its association with vaccination status among 400 children aged 4 months to 15 years. The results demonstrated the effectiveness of vaccination in reducing measles cases, along with notable differences in measles occurrence based on age, gender, and vaccination status. Our findings revealed that 50.2% of children were diagnosed with measles, with the highest prevalence observed in the 5\u0026ndash;10 years age group (56.6%). The lowest rate occurred in the 0\u0026ndash;6 months age group (33.3%), likely due to maternal antibodies providing temporary immunity during infancy[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similar findings have been reported in other studies, which emphasize the vulnerability of older children due to waning immunity and missed vaccinations[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFemale children had a significantly higher likelihood of contracting measles (58.65%) compared to males (p\u0026thinsp;=\u0026thinsp;0.006). Although the underlying reasons are unclear, potential explanations include sociocultural factors affecting healthcare access and immunity differences[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Further research is necessary to explore this gender disparity in measles incidence.\u003c/p\u003e \u003cp\u003eThe analysis revealed a statistically significant association between vaccination status and measles occurrence (p\u0026thinsp;=\u0026thinsp;0.04). Among vaccinated children, 43.34% contracted measles compared to 67.4% of unvaccinated children. These results strongly support the effectiveness of measles vaccination in preventing disease, consistent with studies from both developed and developing countries[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the presence of measles in vaccinated children raises concerns about secondary vaccine failure, cold chain issues, or waning immunity over time. Addressing these factors through booster doses and better vaccine storage infrastructure is crucial to enhance vaccine efficacy.\u003c/p\u003e \u003cp\u003eThe vaccination rate was highest in the 5\u0026ndash;10 years age group (73.49%) and lowest in the 0\u0026ndash;6 months group (16.67%). This pattern highlights the need for timely vaccination, especially in infants, as delayed immunization increases the risk of disease[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Strengthening immunization programs and community outreach can improve coverage rates, particularly in underserved populations.\u003c/p\u003e \u003cp\u003eThe study underscores the critical role of vaccination in measles control. Despite global efforts to eliminate measles, gaps in vaccination coverage persist, especially in low-resource settings. To address these challenges, strategies such as improving vaccine access, addressing vaccine hesitancy, and enhancing awareness campaigns are essential [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights the significant role of vaccination in reducing the incidence of measles among children. A statistically significant association was observed between vaccination status and a lower likelihood of contracting measles, reaffirming the efficacy of measles immunization programs. Unvaccinated children were disproportionately affected, emphasizing the need to strengthen routine immunization efforts. The findings also underscore critical disparities, such as higher measles prevalence in older children and among females, necessitating further investigation into the underlying causes. Additionally, the relatively high measles incidence among vaccinated children warrants exploration of secondary vaccine failure, cold chain issues, or waning immunity.\u003c/p\u003e \u003cp\u003eTo achieve measles elimination goals, targeted interventions are needed to improve vaccination coverage, particularly in younger age groups and underserved populations. Strengthening health education campaigns, addressing vaccine hesitancy, and enhancing vaccine delivery systems are essential strategies. Policymakers and healthcare providers must collaborate to ensure equitable access to vaccination, thereby reducing the burden of measles and advancing public health.\u003c/p\u003e \u003cp\u003eThis study will provide insights into the protective role of vaccination in measles prevention and highlight the differences in disease burden between vaccinated and unvaccinated children. The results are expected to reinforce the importance of vaccination programs in public health strategies to combat measles outbreaks.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. First, the study's observational design restricts the ability to establish causal relationships between vaccination status and measles incidence. Second, the reliance on clinical diagnoses, without widespread use of laboratory confirmation, may have led to misclassification of measles cases, particularly in the \"suspected\" category.\u003c/p\u003e \u003cp\u003eAdditionally, data collection was limited to a single center, which may not be representative of the broader population. Sociocultural and regional factors influencing vaccination rates and healthcare access were not assessed, which could have provided deeper insights into disparities observed in gender and age groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest regarding the publication of this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1) WAJEEH UR REHMAN: Conceptualization, data collection, and manuscript drafting2) SHAFIQ UR RAHMAN: Methodology, data analysis, and manuscript review.3) MUHAMMAD IBRAHIM:Data curation, statistical analysis, and interpretation.4) MUHAMMAD HARIS KHAN: Literature review, data acquisition, and manuscript drafting.5) JAVED IQBAL: Supervision, funding acquisition, and final approval of the manuscript.6) MUHAMMAD SALIH: data collection, and manuscript writing7) SYED MUHAMMAD ALI:Conceptualization, manuscript drafting, and critical revision.8) BRIJESH SATHIAN: Research design, manuscript editing, and final review.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eOpen access funding provided by Qatar national library.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSchulz H., Hiebert J., Frost J., McLachlan E., Severini A.J.Jo.V.M. Optimisation of methodology for whole genome sequencing of Measles Virus directly from patient specimens. 2022;299:114348\u003c/li\u003e\n \u003cli\u003ehttps://www.who.int/news/item/14-11-2024-measles-cases-surge-worldwide--infecting-10.3-million-people-in-2023\u003c/li\u003e\n \u003cli\u003eWorld Health Organization: State of the World\u0026apos;s Vaccines and Immunization. Geneva; 2002.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization\u0026cedil; Expanded Programme on Immunization: Immunization policy: global programme for vaccines and immunization. Geneva 1996, WHOGPV/GEN/95.03 Rev. 1.\u003c/li\u003e\n \u003cli\u003eAli SZ. Health for all in Pakistan: achievements, strategies and challenges. East Mediterr Health J 2000; 6:832-7\u003c/li\u003e\n \u003cli\u003eMason WH. Measles. In: Kliegman RM, Stanton B, Geme JS, Schor N, Behrman RE, editors. Nelson Text Book of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Inc., USA 2011; p. 1069-73.\u003c/li\u003e\n \u003cli\u003eIrfan, Khan., Muhammad, Osama., Muhammad, Mohsin, Khan., Ahmad, Waqas., Anwar, Khan, Wazir., Zahid, Irfan, Marwat., Muhammad, Mohsin., Ahmad, Khan., Anwar, Waqas., Khan, Wazir., Zahid, Irfan., Khan.Ext-All. (2024). Prevalence Of Measles In Vaccinated And Unvaccinated Children In QHAMC, Nowshera.. doi: 10.69837/pjammr.v1i02.23\u003c/li\u003e\n \u003cli\u003eMuhammad, Asif, Zahoor., Muhammad, Hidayat, Rasool., Muhammad, Waseem., Bilal, Aslam., Muhammad, Kashif, Zahoor., Muhammad, Saqalein., Zeeshan, Nawaz., Rabia, Sahar. (2015). Prevalence of measles in vaccinated and non-vaccinated children.. Excli Journal, 14:504-507. doi: 10.17179/EXCLI 2015-170\u003c/li\u003e\n \u003cli\u003eErvia, Fahma, Dhony., Bhisma, Murti., Hanung, Prasetya. (2024). Correlations between History of Contact with Infected Person and Measles Vaccination Status on the Risk of Measles Incidence in Children: Meta-Analysis. Journal of epidemiology and public health, 9(2):156-169. doi: 10.26911/jepublichealth.2024.09.02.03\u003c/li\u003e\n \u003cli\u003eSyed, Sohail, Zahoor, Zaidi., Abdul, Hameed., Abdul, Hameed., Naeem, Ali., Massab, Umair., Muhammad, Masroor, Alam., Muhammad, Suleman, Rana., Salmaan, Sharif., Uzma, Bashir, Aamir., S., Shahid, Shaukat., Mehar, Angez., Adnan, Khurshid., Ribqa, Akhtar., Nayab, Mehmood., Nazish, Badar. (2017). A measles outbreak in Sindh, Pakistan caused by a genotype B3 virus. Archives of Virology, 162(12):3603-3610. doi: 10.1007/S00705-017-3524-9\u003c/li\u003e\n \u003cli\u003eRahul, Bawankule., Abhishek, Singh., Kaushalendra, Kumar., Sadanand, Shetye. (2017). Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study?. PLOS ONE, 12(1) doi: 10.1371/JOURNAL.PONE.0169713\u003c/li\u003e\n \u003cli\u003eBadara, Samb., Peter, Aaby., Hilton, Whittle., Awa, Marie, Coll, Seck., Seedy, Rahman., John, V., Bennett., Lauri, E., Markowitz., Fran\u0026ccedil;ois, Simondon. (1995). Serologic status and measles attack rates among vaccinated and unvaccinated children in rural Senegal.. Pediatric Infectious Disease Journal, 14(3):203-209. doi: 10.1097/00006454-199503000-00007\u003c/li\u003e\n \u003cli\u003eOmar, Abdullahi, Ahmed., Ikran, Ali., Najib, Isse, Dirie. (2023). Demographical, clinical, and complication differences between vaccinated and unvaccinated hospitalized children with measles in mogadishu somalia: a hospital-based retrospective cohort study. Annals of medicine and surgery, 85:1550-1555. doi: 10.1097/MS9.0000000000000672\u003c/li\u003e\n \u003cli\u003eWHO. Measles key facts. Retrieved from https://www.who.int\u003c/li\u003e\n \u003cli\u003ePerry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16. doi: 10.1086/377712. PMID: 15106083.\u003c/li\u003e\n \u003cli\u003eMoss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. PMID: 28673424.\u003c/li\u003e\n \u003cli\u003ePatel MK, Goodson JL, Alexander JP Jr, Kretsinger K, Sodha SV, Steulet C, Gacic-Dobo M, Rota PA, McFarland J, Menning L, Mulders MN, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2019. MMWR Morb Mortal Wkly Rep. 2020 Nov 13;69(45):1700-1705. doi: 10.15585/mmwr.mm6945a6. PMID: 33180759; PMCID: PMC7660667.\u003c/li\u003e\n \u003cli\u003eNic Lochlainn LM, de Gier B, van der Maas N, Strebel PM, Goodman T, van Binnendijk RS, de Melker HE, Hahn\u0026eacute; SJM. Immunogenicity, effectiveness, and safety of measles vaccination in infants younger than 9 months: a systematic review and meta-analysis. Lancet Infect Dis. 2019 Nov;19(11):1235-1245. doi: 10.1016/S1473-3099(19)30395-0. Epub 2019 Sep 20. PMID: 31548079; PMCID: PMC6838664.\u003c/li\u003e\n \u003cli\u003eBiset G, Woday A, Mihret S, Tsihay M. Full immunization coverage and associated factors among children age 12-23 months in Ethiopia: systematic review and meta-analysis of observational studies. Hum Vaccin Immunother. 2021 Jul 3;17(7):2326-2335. doi: 10.1080/21645515.2020.1870392. Epub 2021 Mar 24. PMID: 33760689; PMCID: PMC8189140.\u003c/li\u003e\n \u003cli\u003ehttps://www.cdc.gov/measles/hcp/vaccine-considerations/index.html#:~:text=Routine%20recommendations-,Children,6%20years%20(before%20school%20entry)\u003c/li\u003e\n \u003cli\u003ehttps://www.unicef.org/pakistan/topics/immunization\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Measles, immunization, non vaccination, children","lastPublishedDoi":"10.21203/rs.3.rs-5650818/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5650818/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeasles is a highly contagious viral disease that continues to pose a public health challenge, particularly in developing countries like Pakistan. Despite the availability of effective vaccines, measles outbreaks remain common, exacerbated by gaps in vaccination coverage and other socioeconomic factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to determine the prevalence of measles and its association with vaccination status among children aged 4 months to 15 years presenting at Saidu Group of Teaching Hospital, Swat.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted on 400 children diagnosed with measles. Data were collected using a structured questionnaire and analyzed with SPSS-27. Children were categorized into vaccinated and unvaccinated groups, and associations with demographic and clinical variables were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 400 children, the prevalence of measles was 50.2%. The highest prevalence was observed in the 5–10 years age group (56.6%). A significant association was found between vaccination status and measles prevalence, with 43.34% of vaccinated and 67.4% of unvaccinated children affected (p = 0.04). Females had a significantly higher prevalence (58.65%) than males (p = 0.006). Complications occurred in 57.2% of cases, with pneumonia (37.4%) and diarrhea (27.8%) being the most frequent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study highlights the effectiveness of measles vaccination in reducing disease incidence. However, cases among vaccinated children point to issues such as secondary vaccine failure and cold chain management. Enhanced immunization programs, improved healthcare access, and strategies to address vaccine hesitancy are critical to achieving measles elimination in Pakistan.\u003c/p\u003e","manuscriptTitle":"Prevalence of Measles in Vaccinated and Unvaccinated Children: a Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-23 16:27:35","doi":"10.21203/rs.3.rs-5650818/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed20600b-4190-41a6-baa2-5154608943dc","owner":[],"postedDate":"December 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:27:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-23 16:27:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5650818","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5650818","identity":"rs-5650818","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}