Analysis of Measles Outbreaks reported to Integrated Disease Surveillance Programme (IDSP), India, 2019-2023

Analysis of Measles Outbreaks reported to Integrated Disease Surveillance Programme (IDSP), India, 2019-2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of Measles Outbreaks reported to Integrated Disease Surveillance Programme (IDSP), India, 2019-2023 Gopi Kumbha, Sushma Choudhary, Mohan Kumar Raju, Meera Dhuria, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7296427/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: In 2022, an estimated 1,36,000 measles deaths were reported worldwide, mostly in children under five. In 2022, thirty-seven countries reported extensive or disruptive measles outbreaks by the WHO, while only 22 countries reported similar outbreaks in 2021. The NFHS-5, 87.9% of children between 12 and 23 months old had received their initial dose of the measles-containing vaccine (MCV), but only 31.9% of children aged 24-35 months who received MCV2. To perform descriptive epidemiology of measles outbreaks reported in India from 2019 to 2023. Methodology : A cross-sectional study was conducted utilisj ing the Integrated Disease Surveillance Program (IDSP). Measles outbreak data from 2019-2023. We extracted data from publicly available IDSP weekly outbreak reports and analysed them using MS Excel, focusing on time, place, and person distribution. Results : Out of 259 reported outbreaks, 89 % were laboratory-confirmed, and 56.3% of outbreaks were timely, with reporting occurring in the same week. Age distribution was not available in 56.4% of IDSP outbreak reports. The median (Interquartile range) age was 6.5 (5-9.5). Sex distribution was not available in 96% of IDSP outbreak reports. The 52.8% (137/259) outbreaks were reported from Bihar (18.5%), Jharkhand (13.5%), Uttar Pradesh (11.1%), and Gujarat (9.6%). The 25 districts have reported three or more measles outbreaks over five years. These districts account for 117 out of a total of 259 reported outbreaks: Godda (Jharkhand), West Champaran (Bihar), and Nuh (Haryana). The maximum number of outbreaks (116) was recorded in 2023. Vitamin A was given during 56% (114/259) of outbreaks. Twenty deaths were reported. Conclusions: Nearly half of the outbreaks were concentrated in five states of India. The delayed reporting of outbreaks and the absence of age and sex distribution in most reports highlight areas for improvement. Recommendations include timely reporting, inclusion of age and sex data, and ensuring widespread vitamin A supplementation. Measles Outbreak IDSP Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Globally in 2022, an estimated 1,36,000 measles deaths were reported, mostly among children under 5 years old, even though a safe and affordable vaccine is available.( 1 ) In 2022, thirty-seven countries reported extensive or disruptive measles outbreaks by the WHO, while only 22 countries reported similar outbreaks in 2021. Twenty-eight were located within the WHO Africa region, six in the Eastern Mediterranean, two (India) in Southeast Asia, and one instance in the European region. However, there are still significant global disparities, ranging from 0.79% in developed countries to as high as 7.67% in developing countries. In 2021, the initial measles vaccine dose was administered to only 81% of children by the age of 12 months, the lowest coverage reported since 2008.( 2 ) In developing nations, measles continues to be a major contributor to childhood mortality. India employs multiple surveillance systems for measles, most notably the Measles Rubella (MR) surveillance and IDSP. The MR surveillance system managed under the universal immunisation Programme offers detailed case-based and laboratory-supported focused cases. According to the measles Bulletin in 2022, the data from measles and rubella surveillance in India's measles incidence was 30.23 per million population. Laboratory-confirmed measles outbreaks were 762, mainly from Uttar Pradesh (225) and Maharashtra (147), followed by Jharkhand, Bihar, Gujarat, and Delhi. Measles cases (42,988) have been detected, including lab-confirmed, mainly from Maharashtra (12,354), Uttar Pradesh (9,975), Gujarat, Jharkhand, Haryana, Bihar, West Bengal, and Delhi.( 3 ) Measles vaccination was launched in India in 1985 under the Universal Immunisation Programme (UIP) as a single-dose vaccine administered at 9–12 months of age. ( 4 ) The second dose of MCV2 was introduced in 2010 under the Measles Catch-up Campaign and later integrated into routine immunisation to enhance protection. In 2017, India launched the Measles-Rubella (MR) vaccine campaign to replace the standalone measles vaccine and eliminate both measles and rubella. The NFHS-5, 87.9% of children between 12 and 23 months old had received their initial dose of the measles-containing vaccine (MCV), but only 31.9% of children aged 24–35 months who received MCV2. ( 5 ) Any person who is non-immune, either unvaccinated or vaccinated but did not develop immunity, can become infected. Unvaccinated young children and pregnant women are at the highest risk of severe measles complications. Children with malnutrition or other causes of a weak immune system are at the highest risk of Measles deaths. ( 6 )The recent COVID-19 pandemic significantly disrupted the vaccination coverage that had been built up over the previous years. ( 7 ) Exploring the patterns of measles outbreaks to better understand their impact and response strategies is essential. This study aims to examine the occurrence of sporadic measles outbreaks across various regions of the country over time, transmission patterns, identify high-risk areas, affected populations, additional measles vaccination rounds, and interventional strategies, which would also be useful in measles control and elimination strategies at the country level. The study objective is to describe the epidemiology of measles outbreaks reported in India through the IDSP from 2019 to 2023. Methodology Study setting: The study was conducted using data from the IDSP, which monitors and reports infectious disease outbreaks across nationwide in India. Surveillance for suspected measles cases encompasses a multi-tiered reporting system involving medical colleges, government hospitals, primary health centres, community health workers, and other designated reporting units. Serum samples will be collected from the suspected measles cases, and these samples will be sent to designated measles-rubella laboratories for serological confirmation. The IDSP utilises a decentralised system for data collection, with district-level health authorities submitting outbreak reports for verification at the national and state levels. The study included all measles outbreaks reported in the IDSP weekly reports from 2019–2023. This study adopted a cross-sectional design. This study utilised data from January 2019 to December 2023. Operational definitions: the suspected measles outbreak: Five or more suspected measles cases reported in a block or an urban ward/planning unit in the past four consecutive weeks OR five or more suspected cases in an area bordering multiple contiguous blocks/urban wards/planning units in the past four consecutive weeks OR one or more suspected measles- deaths in a block or an urban ward/planning unit. Laboratory confirmatory outbreak with at least one case confirmed by laboratory testing as measles IgM positive. ( 8 ) As per the weekly outbreak reporting in IDSP, a delay is noted if a measles outbreak is not reported within seven days from the start of the outbreak. ( 9 ) Data collection and updates in the portal encompass field investigations, laboratory confirmation, and epidemiological assessments. Consolidated outbreak data is published weekly by the IDSP in publicly accessible reports, incorporating details such as data source, abstraction methods, unique outbreak ID, reporting state, district, reporting type, number of cases, deaths, and implemented actions. Data for this analysis were extracted from publicly available weekly measles outbreak reports from the IDSP from January 2019 to December 2023. These reports, originally in PDF format, were converted to an Excel sheet. Data analysis We analysed time and person distribution by calculating the median (range), proportions, and an epi curve to visualise the trends. Epi Info software was used for descriptive data analysis, and place analysis was represented through area maps created using QGIS at the state and district levels. Ethical considerations This study involved the publicly available secondary data of the IDSP weekly outbreak, with no direct involvement of human participants. No personally identifiable information (e.g., patient names and addresses) was collected or analysed to ensure ethical compliance. The study follows ethical guidelines for data confidentiality and responsible use. Results Table 1 : A total of 259 laboratory or clinically compatible measles outbreaks were reported from 2019 to 2023, with a median (IQR) annual outbreak count of 44 (42). Among these, 89% (231) of the outbreaks were laboratory-confirmed. The measles cases reported during these outbreaks were 3,370 (median: 8 (IQR: 9). Overall, 20 deaths were recorded. Table 1 Description of reported measles outbreaks in India (2019–2023) Variable n % Outbreaks reported 259 Median annual outbreaks (Interquartile range) 44 (42) Median number of cases per outbreak (IQR) 8 ( 9 ) Median duration of outbreak (IQR) days 1 ( 4 ) Outbreaks * • Laboratory confirmed • Clinically compatible Measles 231 28 89 11 Total cases 3370 Total deaths 20 *Mutually exclusive Figure 1 : The number of outbreaks reported in various (23) states. 72% of outbreaks were reported from seven states: Bihar (48), Jharkhand (35), Uttar Pradesh (29), Gujarat (25), Assam (18), Kerala (16), and Madhya Pradesh (15). Figure 2 : The number of outbreaks reported annually from 2019 to 2023. In 2021, the trend remained stable, with a comparatively lower number of outbreaks. However, in 2022, there was a noticeable increase, with outbreaks rising to approximately 40. The upward trend continued into 2023 when the number of outbreaks surged to around 120. Figure 3 that 25 districts have reported three or more measles outbreaks over five years. These districts account for 117 out of a total of 259 reported outbreaks. Godda district (Jharkhand) has the highest number of measles outbreaks (13), and West Champaran (Bihar) has 11. Figure 4 : The monthly reported measles outbreaks from 2019 to 2023, categorised by the timeliness of reporting. 2019 : January shows a notable peak in reported outbreaks. A gradual decline is seen from February onwards, with minimal outbreaks during mid-2019. 2020: Outbreak reporting is minimal throughout the year, likely indicating fewer reported outbreaks. 2022: Outbreak reports rise steadily from mid-year (April–July), with a more noticeable increase in reported outbreaks. 2023: A significant surge in outbreaks is observed starting in January, with the most reported outbreaks. The overall trend shows a general increase in reported outbreaks, particularly from 2022 onwards. A winter peak was observed in January 2019 and 2023, suggesting a possible seasonal influence. A total of 259 measles outbreaks were reported by IDSP during this period, categorised into two groups: outbreaks reported on time (N = 146) and outbreaks reported late, more than 7 days from the start of the outbreak (N = 113). Early 2019 shows a high number of outbreaks, with a substantial portion being reported late. In 2020-21, the number of outbreaks declined significantly, with few outbreaks reported late. The years 2022 and 2023 show around equal distribution between on-time and late reports, but with notable peaks of outbreaks in late 2022 and early 2023. Table 2 provides information on the data types reported in weekly outbreak data by the IDSP for 259 outbreaks. Health education was provided in 236 (91%) outbreaks. Post-rash Vitamin A prophylaxis was administered in 144 (56%) outbreaks. Age data was collected in 113 (44%) of the total. Age in years Median (range) 6.5 (1–31). Sex information was reported in 11 outbreaks. In 107 (41%) reported outbreaks, active case search activities were conducted. Table 2 Completeness of IDSP weekly outbreak data reports (N-259) Variable n % Provided health education 236 91 Laboratory details 231 89 Clinical details 160 62 Post-rash Vitamin A prophylaxis 144 56 Age 113 44 House-to-house survey 107 41 Extra MR rounds conducted (n-91) 58 64 Fully vaccinated (n-91) 13 14 Sex 11 4 Discussion Our analysis of 259 measles outbreaks reported from 2019 to 2023 highlights significant epidemiological trends and surveillance gaps. The median annual outbreak count was 44 (range: 17–116), with 89% (231) of outbreaks laboratory-confirmed and a total of 3,370 reported cases (median: 8, range: 1–167). The outbreaks were concentrated in seven states, accounting for 72% of cases, with Jharkhand’s Godda district (13 outbreaks) reporting the highest burden. Seasonal patterns were evident, with winter peaks in January (2019 and 2023) potentially indicating a seasonal influence on measles transmission. Health interventions varied, with Vitamin A prophylaxis in 56% of active case searches and 41%. These findings underscore the need for enhanced surveillance, timely outbreak response, and improved immunisation strategies to mitigate measles transmission and outbreak severity. In 2023, the World Health Organisation (WHO) surveillance bulletin reported 1,120 lab-confirmed measles outbreaks in India. Most of these outbreaks were concentrated in Uttar Pradesh, Bihar, Jharkhand, Punjab, Madhya Pradesh, Karnataka, Maharashtra, West Bengal, and Delhi. ( 3 ) In 2021, MR surveillance changed the case definition from fever to rash. Our study found the regional distribution of measles outbreaks and identified Bihar, Jharkhand, Uttar Pradesh, Gujarat, Assam, and Kerala as the primary affected areas. This data is consistent with WHO data for Bihar, Jharkhand, and Uttar Pradesh, which are consistent hotspots for measles outbreaks. In 2019, there were around 60 measles outbreaks. This number decreased significantly in 2020, dropping to about 20 outbreaks. The periods of low or no outbreak reports, particularly in 2020-21, might correspond with global events such as the COVID-19 pandemic, which may have impacted the incidence of measles and reporting. The shift to staff focuses on COVID-19 surveillance, which led to a diversion from measles surveillance. Despite this progress, India continues to face challenges in eliminating measles and rubella by 2023. During the COVID-19 pandemic, according to the NFHS-5 survey, national routine MRCV1 coverage decreased from 95% in 2019 to 89% in 2021. ( 5 ) Our study found that 64% of outbreaks had conducted an additional MR round. The World Health Organisation (WHO) reported that India had 61,562 measles cases from September 2022 to February 2023. More recently, between August 2023 and January 2024, the country ranked fourth globally with 13,220 reported cases.( 10 ) A significant proportion of these outbreaks were reported in the latter half of the year. Our study examined the monthly distribution of measles outbreaks from 2019 to 2023, revealing 259 outbreaks and 3370 cases. Notably, more than half of these outbreaks occurred during the latter part of the year, specifically between October and April. This seasonal clustering suggests potential contributing factors such as immunisation coverage. The IDSP was launched by the government of India to enhance/sustain a decentralised, IT-supported disease surveillance. Its goal is to track epidemic-prone diseases, to detect and respond to outbreaks early with trained Rapid Response Teams (RRTs). ( 11 ) Measles is a preventable disease; prompt investigation and reporting can significantly lessen its potential to spread widely. An effective communicable disease reporting and surveillance system should ensure rapid identification, timely response, and accurate data on disease incidence and prevalence. ( 9 ) However, our study found that nearly half of the measles outbreaks were reported late. Conclusions : Fourteen districts accounted for almost half of the reported outbreaks. More than three measles outbreaks and ≥ 2 years were reported in 14 districts. Over half of the outbreaks occurred in the latter part of the year, specifically from October to April. More than half of the reported outbreaks lacked active case search activities. Nearly three-fourths of the outbreak reports did not include critical demographic information, such as age and sex. Almost three-fourths of the outbreak reports are missing information on assessing MR vaccination status. Nearly half of the outbreak reports are missing information on post-rash vitamin A prophylaxis. Recommendations To enable timely interventions, develop a focused outbreak preparedness and response plan for high-risk periods (October to April) when most outbreaks are reported. Ensure an active case search is conducted systematically in all reported outbreaks to identify the actual burden of measles. Strengthen outbreak investigation protocols to include complete critical demographic information, such as age and sex, for all cases to targeted intervention. Mandate the collection and documentation of measles-rubella (MR) vaccination status during outbreak investigations to identify immunity gaps and guide vaccination campaigns. Ensure that post-rash vitamin A prophylaxis is administered and documented for all eligible cases to reduce complications and improve clinical outcomes. Improve the timeliness and quality of reporting through enhanced surveillance systems, ensuring that outbreaks are monitored continuously across all districts, especially those with recurrent outbreaks over the years. Declarations Conflict of Interest: No Funding: Nil Author Contribution G, S, M: Wrote the concepts, design, literature search, Data acquisition, Data analysis, manuscript writing M, A: Manuscript preparation, manuscript editing, Manuscript review Acknowledgement: We sincerely thank all the healthcare workers, surveillance officers, and data reporters involved in the IDSP for their diligent efforts in collecting, documenting, and reporting measles outbreak data. References Measles. Vaccine Preventable Diseases Surveillance Standards [Internet]. [cited 2024 Dec 6]. Available from: https://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-measles Global measles threat continues. to grow as another year passes with millions of children unvaccinated [Internet]. [cited 2024 Dec 6]. Available from: https://www.who.int/news/item/16-11-2023-global-measles-threat-continues-to-grow-as-another-year-passes-with-millions-of-children-unvaccinated Measles & Rubella. Bulletin_Oct 2023 [Internet]. [cited 2024 Dec 6]. Available from: https://iris.who.int/handle/10665/366144 Ministry of Health. and Family Welfare | GOI [Internet]. [cited 2025 Feb 24]. Available from: https://mohfw.gov.in/ NFHS [Internet]. [cited 2024 Dec 6]. Available from: http://www.nfhsiips.in/nfhsnew/nfhsuser/nfhs5.php Minta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B et al. Progress Toward Measles Elimination — Worldwide, 2000–22. 2023;72(46). Kumar A, Das S, Tripathy SK. Measles Elimination in India—Shifting Goal Post. Indian J Pediatr. 2023;90(4):420–420. Ministry of Health and Family Welfare, Government of India. Guidelines for Measles and Rubella Surveillance in India [Internet]. New Delhi: MoHFW. 2019 [cited 2025 Jun 10]. Available from: https://www.mohfw.gov.in/ Integrated Disease Surveillance Programme (IDSP). Weekly Outbreak Reports [Internet]. [Internet]. [cited 2024 Dec 6]. Available from: https://idsp.nic.in/index4.php?lang=1&level=0&linkid=406&lid=3689 CDC, Global Measles V. 2024 [cited 2024 Dec 6]. Global Measles Outbreaks. Available from: https://www.cdc.gov/global-measles-vaccination/data-research/global-measles-outbreaks/index.html National Centre for Disease Control. Integrated Disease Surveillance Programme (IDSP) [Internet]. [cited 2024 Dec 6]. [Internet]. [cited 2024 Dec 6]. Available from: https://ncdc.mohfw.gov.in/integrated-disease-surveillance-programme/ Additional Declarations No competing interests reported. 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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-7296427","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495757881,"identity":"65300244-f311-492a-89cb-e2d97dfc4411","order_by":0,"name":"Gopi 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(N-259)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7296427/v1/40bf6c7a1c6944bc79820d4d.png"},{"id":88415217,"identity":"565d275d-61d5-4a86-befe-7da880f0a5dd","added_by":"auto","created_at":"2025-08-06 08:52:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":50218,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrend of reported measles outbreaks in India (2019-23)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7296427/v1/2b403e92dc5b2b3ce8479f92.png"},{"id":88415214,"identity":"f39480ce-3a99-4130-8389-2ab0abe4efb9","added_by":"auto","created_at":"2025-08-06 08:52:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71010,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistricts that reported ≥3 Measles outbreaks 2019-2023, (N-25)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7296427/v1/2d880f8c33e32d4177101c30.png"},{"id":88414052,"identity":"59464f9c-09d9-4672-8516-0f777a16ac4f","added_by":"auto","created_at":"2025-08-06 08:44:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":46887,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasles Outbreak by time of reporting 2019-23 (N-259)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7296427/v1/8bb5c7357f09d5a84ffbab3b.png"},{"id":95193806,"identity":"f6bc9035-5844-4565-a386-ec2db6cdac78","added_by":"auto","created_at":"2025-11-05 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Twenty-eight were located within the WHO Africa region, six in the Eastern Mediterranean, two (India) in Southeast Asia, and one instance in the European region. However, there are still significant global disparities, ranging from 0.79% in developed countries to as high as 7.67% in developing countries. In 2021, the initial measles vaccine dose was administered to only 81% of children by the age of 12 months, the lowest coverage reported since 2008.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) In developing nations, measles continues to be a major contributor to childhood mortality.\u003c/p\u003e\u003cp\u003eIndia employs multiple surveillance systems for measles, most notably the Measles Rubella (MR) surveillance and IDSP. The MR surveillance system managed under the universal immunisation Programme offers detailed case-based and laboratory-supported focused cases. According to the measles Bulletin in 2022, the data from measles and rubella surveillance in India's measles incidence was 30.23 per million population. Laboratory-confirmed measles outbreaks were 762, mainly from Uttar Pradesh (225) and Maharashtra (147), followed by Jharkhand, Bihar, Gujarat, and Delhi. Measles cases (42,988) have been detected, including lab-confirmed, mainly from Maharashtra (12,354), Uttar Pradesh (9,975), Gujarat, Jharkhand, Haryana, Bihar, West Bengal, and Delhi.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eMeasles vaccination was launched in India in 1985 under the Universal Immunisation Programme (UIP) as a single-dose vaccine administered at 9–12 months of age. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The second dose of MCV2 was introduced in 2010 under the Measles Catch-up Campaign and later integrated into routine immunisation to enhance protection. In 2017, India launched the Measles-Rubella (MR) vaccine campaign to replace the standalone measles vaccine and eliminate both measles and rubella. The NFHS-5, 87.9% of children between 12 and 23 months old had received their initial dose of the measles-containing vaccine (MCV), but only 31.9% of children aged 24–35 months who received MCV2. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Any person who is non-immune, either unvaccinated or vaccinated but did not develop immunity, can become infected. Unvaccinated young children and pregnant women are at the highest risk of severe measles complications. Children with malnutrition or other causes of a weak immune system are at the highest risk of Measles deaths. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)The recent COVID-19 pandemic significantly disrupted the vaccination coverage that had been built up over the previous years. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eExploring the patterns of measles outbreaks to better understand their impact and response strategies is essential. This study aims to examine the occurrence of sporadic measles outbreaks across various regions of the country over time, transmission patterns, identify high-risk areas, affected populations, additional measles vaccination rounds, and interventional strategies, which would also be useful in measles control and elimination strategies at the country level. The study objective is to describe the epidemiology of measles outbreaks reported in India through the IDSP from 2019 to 2023.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eStudy setting: The study was conducted using data from the IDSP, which monitors and reports infectious disease outbreaks across nationwide in India. Surveillance for suspected measles cases encompasses a multi-tiered reporting system involving medical colleges, government hospitals, primary health centres, community health workers, and other designated reporting units. Serum samples will be collected from the suspected measles cases, and these samples will be sent to designated measles-rubella laboratories for serological confirmation. The IDSP utilises a decentralised system for data collection, with district-level health authorities submitting outbreak reports for verification at the national and state levels. The study included all measles outbreaks reported in the IDSP weekly reports from 2019–2023.\u003c/p\u003e\u003cp\u003eThis study adopted a cross-sectional design. This study utilised data from January 2019 to December 2023. Operational definitions: the suspected measles outbreak: Five or more suspected measles cases reported in a block or an urban ward/planning unit in the past four consecutive weeks OR five or more suspected cases in an area bordering multiple contiguous blocks/urban wards/planning units in the past four consecutive weeks OR one or more suspected measles- deaths in a block or an urban ward/planning unit. Laboratory confirmatory outbreak with at least one case confirmed by laboratory testing as measles IgM positive. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) As per the weekly outbreak reporting in IDSP, a delay is noted if a measles outbreak is not reported within seven days from the start of the outbreak. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eData collection and updates in the portal encompass field investigations, laboratory confirmation, and epidemiological assessments. Consolidated outbreak data is published weekly by the IDSP in publicly accessible reports, incorporating details such as data source, abstraction methods, unique outbreak ID, reporting state, district, reporting type, number of cases, deaths, and implemented actions. Data for this analysis were extracted from publicly available weekly measles outbreak reports from the IDSP from January 2019 to December 2023. These reports, originally in PDF format, were converted to an Excel sheet.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe analysed time and person distribution by calculating the median (range), proportions, and an epi curve to visualise the trends. Epi Info software was used for descriptive data analysis, and place analysis was represented through area maps created using QGIS at the state and district levels.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis study involved the publicly available secondary data of the IDSP weekly outbreak, with no direct involvement of human participants. No personally identifiable information (e.g., patient names and addresses) was collected or analysed to ensure ethical compliance. The study follows ethical guidelines for data confidentiality and responsible use.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: A total of 259 laboratory or clinically compatible measles outbreaks were reported from 2019 to 2023, with a median (IQR) annual outbreak count of 44 (42). Among these, 89% (231) of the outbreaks were laboratory-confirmed. The measles cases reported during these outbreaks were 3,370 (median: 8 (IQR: 9). Overall, 20 deaths were recorded.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of reported measles outbreaks in India (2019\u0026ndash;2023)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutbreaks reported\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian annual outbreaks (Interquartile range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian number of cases per outbreak (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian duration of outbreak (IQR) days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutbreaks *\u003c/p\u003e\u003cp\u003e\u0026bull; Laboratory confirmed\u003c/p\u003e\u003cp\u003e\u0026bull; Clinically compatible Measles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e231\u003c/p\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3370\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal deaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Mutually exclusive\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: The number of outbreaks reported in various (23) states. 72% of outbreaks were reported from seven states: Bihar (48), Jharkhand (35), Uttar Pradesh (29), Gujarat (25), Assam (18), Kerala (16), and Madhya Pradesh (15).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: The number of outbreaks reported annually from 2019 to 2023. In 2021, the trend remained stable, with a comparatively lower number of outbreaks. However, in 2022, there was a noticeable increase, with outbreaks rising to approximately 40. The upward trend continued into 2023 when the number of outbreaks surged to around 120.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e that 25 districts have reported three or more measles outbreaks over five years. These districts account for 117 out of a total of 259 reported outbreaks. Godda district (Jharkhand) has the highest number of measles outbreaks (13), and West Champaran (Bihar) has 11.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: The monthly reported measles outbreaks from 2019 to 2023, categorised by the timeliness of reporting. \u003cb\u003e2019\u003c/b\u003e: January shows a notable peak in reported outbreaks. A gradual decline is seen from February onwards, with minimal outbreaks during mid-2019. 2020: Outbreak reporting is minimal throughout the year, likely indicating fewer reported outbreaks. 2022: Outbreak reports rise steadily from mid-year (April\u0026ndash;July), with a more noticeable increase in reported outbreaks. 2023: A significant surge in outbreaks is observed starting in January, with the most reported outbreaks. The overall trend shows a general increase in reported outbreaks, particularly from 2022 onwards. A winter peak was observed in January 2019 and 2023, suggesting a possible seasonal influence.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA total of 259 measles outbreaks were reported by IDSP during this period, categorised into two groups: outbreaks reported on time (N\u0026thinsp;=\u0026thinsp;146) and outbreaks reported late, more than 7 days from the start of the outbreak (N\u0026thinsp;=\u0026thinsp;113). Early 2019 shows a high number of outbreaks, with a substantial portion being reported late. In 2020-21, the number of outbreaks declined significantly, with few outbreaks reported late. The years 2022 and 2023 show around equal distribution between on-time and late reports, but with notable peaks of outbreaks in late 2022 and early 2023.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides information on the data types reported in weekly outbreak data by the IDSP for 259 outbreaks. Health education was provided in 236 (91%) outbreaks. Post-rash Vitamin A prophylaxis was administered in 144 (56%) outbreaks. Age data was collected in 113 (44%) of the total. Age in years Median (range) 6.5 (1\u0026ndash;31). Sex information was reported in 11 outbreaks. In 107 (41%) reported outbreaks, active case search activities were conducted.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCompleteness of IDSP weekly outbreak data reports (N-259)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProvided health education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaboratory details\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical details\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-rash Vitamin A prophylaxis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHouse-to-house survey\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtra MR rounds conducted (n-91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully vaccinated (n-91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur analysis of 259 measles outbreaks reported from 2019 to 2023 highlights significant epidemiological trends and surveillance gaps. The median annual outbreak count was 44 (range: 17\u0026ndash;116), with 89% (231) of outbreaks laboratory-confirmed and a total of 3,370 reported cases (median: 8, range: 1\u0026ndash;167). The outbreaks were concentrated in seven states, accounting for 72% of cases, with Jharkhand\u0026rsquo;s Godda district (13 outbreaks) reporting the highest burden. Seasonal patterns were evident, with winter peaks in January (2019 and 2023) potentially indicating a seasonal influence on measles transmission. Health interventions varied, with Vitamin A prophylaxis in 56% of active case searches and 41%. These findings underscore the need for enhanced surveillance, timely outbreak response, and improved immunisation strategies to mitigate measles transmission and outbreak severity.\u003c/p\u003e\u003cp\u003eIn 2023, the World Health Organisation (WHO) surveillance bulletin reported 1,120 lab-confirmed measles outbreaks in India. Most of these outbreaks were concentrated in Uttar Pradesh, Bihar, Jharkhand, Punjab, Madhya Pradesh, Karnataka, Maharashtra, West Bengal, and Delhi. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) In 2021, MR surveillance changed the case definition from fever to rash. Our study found the regional distribution of measles outbreaks and identified Bihar, Jharkhand, Uttar Pradesh, Gujarat, Assam, and Kerala as the primary affected areas. This data is consistent with WHO data for Bihar, Jharkhand, and Uttar Pradesh, which are consistent hotspots for measles outbreaks.\u003c/p\u003e\u003cp\u003eIn 2019, there were around 60 measles outbreaks. This number decreased significantly in 2020, dropping to about 20 outbreaks. The periods of low or no outbreak reports, particularly in 2020-21, might correspond with global events such as the COVID-19 pandemic, which may have impacted the incidence of measles and reporting. The shift to staff focuses on COVID-19 surveillance, which led to a diversion from measles surveillance.\u003c/p\u003e\u003cp\u003eDespite this progress, India continues to face challenges in eliminating measles and rubella by 2023. During the COVID-19 pandemic, according to the NFHS-5 survey, national routine MRCV1 coverage decreased from 95% in 2019 to 89% in 2021. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Our study found that 64% of outbreaks had conducted an additional MR round.\u003c/p\u003e\u003cp\u003eThe World Health Organisation (WHO) reported that India had 61,562 measles cases from September 2022 to February 2023. More recently, between August 2023 and January 2024, the country ranked fourth globally with 13,220 reported cases.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) A significant proportion of these outbreaks were reported in the latter half of the year. Our study examined the monthly distribution of measles outbreaks from 2019 to 2023, revealing 259 outbreaks and 3370 cases. Notably, more than half of these outbreaks occurred during the latter part of the year, specifically between October and April. This seasonal clustering suggests potential contributing factors such as immunisation coverage.\u003c/p\u003e\u003cp\u003eThe IDSP was launched by the government of India to enhance/sustain a decentralised, IT-supported disease surveillance. Its goal is to track epidemic-prone diseases, to detect and respond to outbreaks early with trained Rapid Response Teams (RRTs). (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Measles is a preventable disease; prompt investigation and reporting can significantly lessen its potential to spread widely. An effective communicable disease reporting and surveillance system should ensure rapid identification, timely response, and accurate data on disease incidence and prevalence. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) However, our study found that nearly half of the measles outbreaks were reported late.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e: Fourteen districts accounted for almost half of the reported outbreaks. More than three measles outbreaks and \u0026ge;\u0026thinsp;2 years were reported in 14 districts. Over half of the outbreaks occurred in the latter part of the year, specifically from October to April. More than half of the reported outbreaks lacked active case search activities. Nearly three-fourths of the outbreak reports did not include critical demographic information, such as age and sex. Almost three-fourths of the outbreak reports are missing information on assessing MR vaccination status. Nearly half of the outbreak reports are missing information on post-rash vitamin A prophylaxis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003cp\u003eTo enable timely interventions, develop a focused outbreak preparedness and response plan for high-risk periods (October to April) when most outbreaks are reported. Ensure an active case search is conducted systematically in all reported outbreaks to identify the actual burden of measles. Strengthen outbreak investigation protocols to include complete critical demographic information, such as age and sex, for all cases to targeted intervention. Mandate the collection and documentation of measles-rubella (MR) vaccination status during outbreak investigations to identify immunity gaps and guide vaccination campaigns. Ensure that post-rash vitamin A prophylaxis is administered and documented for all eligible cases to reduce complications and improve clinical outcomes. Improve the timeliness and quality of reporting through enhanced surveillance systems, ensuring that outbreaks are monitored continuously across all districts, especially those with recurrent outbreaks over the years.\u003c/p\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of Interest:\u003c/h2\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNil\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eG, S, M: Wrote the concepts, design, literature search, Data acquisition, Data analysis, manuscript writing M, A: Manuscript preparation, manuscript editing, Manuscript review\u003c/p\u003e\u003ch2\u003eAcknowledgement:\u003c/h2\u003e\u003cp\u003eWe sincerely thank all the healthcare workers, surveillance officers, and data reporters involved in the IDSP for their diligent efforts in collecting, documenting, and reporting measles outbreak data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMeasles. Vaccine Preventable Diseases Surveillance Standards [Internet]. [cited 2024 Dec 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-measles\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-measles\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlobal measles threat continues. to grow as another year passes with millions of children unvaccinated [Internet]. [cited 2024 Dec 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/16-11-2023-global-measles-threat-continues-to-grow-as-another-year-passes-with-millions-of-children-unvaccinated\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/16-11-2023-global-measles-threat-continues-to-grow-as-another-year-passes-with-millions-of-children-unvaccinated\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeasles \u0026amp; Rubella. Bulletin_Oct 2023 [Internet]. [cited 2024 Dec 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/366144\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/366144\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of Health. and Family Welfare | GOI [Internet]. [cited 2025 Feb 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://mohfw.gov.in/\u003c/span\u003e\u003cspan address=\"https://mohfw.gov.in/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNFHS [Internet]. [cited 2024 Dec 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.nfhsiips.in/nfhsnew/nfhsuser/nfhs5.php\u003c/span\u003e\u003cspan address=\"http://www.nfhsiips.in/nfhsnew/nfhsuser/nfhs5.php\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B et al. Progress Toward Measles Elimination \u0026mdash; Worldwide, 2000\u0026ndash;22. 2023;72(46).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKumar A, Das S, Tripathy SK. Measles Elimination in India\u0026mdash;Shifting Goal Post. Indian J Pediatr. 2023;90(4):420\u0026ndash;420.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of Health and Family Welfare, Government of India. Guidelines for Measles and Rubella Surveillance in India [Internet]. New Delhi: MoHFW. 2019 [cited 2025 Jun 10]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mohfw.gov.in/\u003c/span\u003e\u003cspan address=\"https://www.mohfw.gov.in/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIntegrated Disease Surveillance Programme (IDSP). Weekly Outbreak Reports [Internet]. [Internet]. [cited 2024 Dec 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://idsp.nic.in/index4.php?lang=1\u0026amp;level=0\u0026amp;linkid=406\u0026amp;lid=3689\u003c/span\u003e\u003cspan address=\"https://idsp.nic.in/index4.php?lang=1\u0026amp;level=0\u0026amp;linkid=406\u0026amp;lid=3689\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCDC, Global Measles V. 2024 [cited 2024 Dec 6]. Global Measles Outbreaks. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/global-measles-vaccination/data-research/global-measles-outbreaks/index.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/global-measles-vaccination/data-research/global-measles-outbreaks/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Centre for Disease Control. Integrated Disease Surveillance Programme (IDSP) [Internet]. [cited 2024 Dec 6]. [Internet]. [cited 2024 Dec 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ncdc.mohfw.gov.in/integrated-disease-surveillance-programme/\u003c/span\u003e\u003cspan address=\"https://ncdc.mohfw.gov.in/integrated-disease-surveillance-programme/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"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, Outbreak, IDSP","lastPublishedDoi":"10.21203/rs.3.rs-7296427/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7296427/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIn 2022, an estimated 1,36,000 measles deaths were reported worldwide, mostly in children under five. In 2022, thirty-seven countries reported extensive or disruptive measles outbreaks by the WHO, while only 22 countries reported similar outbreaks in 2021. The NFHS-5, 87.9% of children between 12 and 23 months old had received their initial dose of the measles-containing vaccine (MCV), but only 31.9% of children aged 24-35 months who received MCV2. To perform descriptive epidemiology of measles outbreaks reported in India from 2019 to 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: A cross-sectional study was conducted utilisj ing the Integrated Disease Surveillance Program (IDSP). Measles outbreak data from 2019-2023. We extracted data from publicly available IDSP weekly outbreak reports and analysed them using MS Excel, focusing on time, place, and person distribution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Out of 259 reported outbreaks, 89 % were laboratory-confirmed, and 56.3% of outbreaks were timely, with reporting occurring in the same week. Age distribution was not available in 56.4% of IDSP outbreak reports. The median (Interquartile range) age was 6.5 (5-9.5). Sex distribution was not available in 96% of IDSP outbreak reports. The 52.8% (137/259) outbreaks were reported from Bihar (18.5%), Jharkhand (13.5%), Uttar Pradesh (11.1%), and Gujarat (9.6%). The 25 districts have reported three or more measles outbreaks over five years. These districts account for 117 out of a total of 259 reported outbreaks: Godda (Jharkhand), West Champaran (Bihar), and Nuh (Haryana). The maximum number of outbreaks (116) was recorded in 2023. Vitamin A was given during 56% (114/259) of outbreaks. Twenty deaths were reported.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eNearly half of the outbreaks were concentrated in five states of India. The delayed reporting of outbreaks and the absence of age and sex distribution in most reports highlight areas for improvement. Recommendations include timely reporting, inclusion of age and sex data, and ensuring widespread vitamin A supplementation.\u003c/p\u003e","manuscriptTitle":"Analysis of Measles Outbreaks reported to Integrated Disease Surveillance Programme (IDSP), India, 2019-2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:44:12","doi":"10.21203/rs.3.rs-7296427/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":"020eff13-ae60-413d-8ed4-0459b34d656e","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-05T10:54:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:44:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7296427","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7296427","identity":"rs-7296427","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}