Global and regional burden of measles and vaccine coverage among children under 5 years, 1990-2023: a Global Burden of Disease Study.

Measles remains a leading cause of vaccine-preventable burden among children, particularly in low-income settings. Despite decades of progress, there are indications of measles resurgence due to stagnation in vaccine coverage. Here, using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2023, we systematically assessed measles incidence, mortality, disability-adjusted life years (DALYs) and vaccine coverage (measles-containing vaccine 1 (MCV1) and measles-containing vaccine 2 (MCV2)) among children under 5 years of age across 204 countries and territories from 1990 to 2023. Between 1990 and 2019, global measles incidence and mortality declined by approximately 80% and 90%, respectively, but rebounded sharply after 2020, with 15.6 million cases and 118,000 deaths estimated in 2023 (+40% and +12% increases, respectively, between 2019 and 2023). Sub-Saharan Africa and South Asia continue to bear the highest burden. Global MCV1 coverage rose from 67.2% in 1990 to 83.6% in 2019 but stalled and declined slightly to 81.0% by 2023; MCV2 coverage increased from 14.4% in 1990 to 68.4% in 2019 and reached 71.4% by 2023. Several regions remain well below the Immunization Agenda 2030 (IA2030) target of 90% coverage. The recent measles resurgence underscores the fragility of global immunization progress and the urgent need to restore routine vaccination, close immunity gaps and strengthen outbreak preparedness.