Effectiveness of Follow-Up Mass Vaccination Campaigns Against Measles and Rubella to Mitigate Epidemics in West Africa (2024–2025): A Cross-Sectional Analysis of Surveillance and Coverage Data

Abstract

BACKGROUND/OBJECTIVES: Despite large-scale measles and rubella (MR) vaccination campaigns in West Africa, measles outbreaks persist, raising concerns about campaign effectiveness, coverage, and underlying determinants. This study assesses the impact of MR follow-up campaigns in 12 of 17 West African countries (2024-2025) and examines the factors contributing to post-campaign outbreaks. The main objective of this study is to evaluate the impact of MR campaigns on measles transmission, identify the characteristics of post-campaign outbreaks, and propose strategies to improve campaign effectiveness and accelerate progress toward measles elimination in West Africa. METHODS: We conducted a cross-sectional and ecological analytical study to examine spatial and temporal variations based on measles surveillance data from 2024 to 2025, post-campaign coverage surveys (PCCS), district-level outbreak reports, and administrative coverage reports. Trends in measles cases before and after the MMR campaigns were assessed, along with demographic characteristics and spatial analyses of confirmed cases. RESULTS: In 2024, 70.5% (12/17) of countries conducted measles vaccination campaigns, but measles outbreaks increased in 2025 (64 districts in 2024 versus 383 in 2025). Children under five remained the most affected (54%), with 85% of cases being either unvaccinated (57%) or of unknown status (28%). Administrative coverage exceeded 95% in most countries, but measles PCCS revealed gaps, with only Senegal (93%) and Guinea-Bissau (94%) achieving high verified coverage. No country achieved 95% national MPCC. CONCLUSIONS: Suboptimal campaign quality, gaps in immunity beyond target age groups, and unreliable administrative data contributed to the persistence of outbreaks. Recommendations include extending Measles vaccination campaigns to older children (5-14 years), improving preparedness by drawing on experiences from other programs such as polio, standardizing PCCS data survey and analysis methodologies across all countries, and integrating Measles vaccination campaigns with other services such as nutrition.