Coverage, effectiveness, and sero-positivity of measles-containing vaccines in low- and lower middle-income countries: An umbrella review of systematic reviews and meta-analyses

Yahaya Mohammed; Ahmed Olowo-Okere; Samuel Bawa; Joseph Oihoma Onah; Abdulmumin Saad; Avuwa Oteri; Yusuf Alhaji Yusufari; Chizoba Wonodi; Zaiyanatu Abubakar Umar; Adejoke F Kolawole; Shehu Hassan; Ahmed Rufai Garba

doi:10.1016/j.ijid.2026.108569

Coverage, effectiveness, and sero-positivity of measles-containing vaccines in low- and lower middle-income countries: An umbrella review of systematic reviews and meta-analyses

Int J Infect Dis. 2026 Jun:167:108569. doi: 10.1016/j.ijid.2026.108569. Epub 2026 Mar 19.

Authors

Affiliations

¹ Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria. Electronic address: yahyakt@yahoo.com.
² Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Abuja, Abuja, Nigeria.
³ Department of Health Sciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
⁴ McKing Consulting Corporation, Chamblee, Georgia, USA.
⁵ Gates Foundation, Nigeria Country Office, Abuja, Nigeria.
⁶ International Vaccine Access Center (IVAC), Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁷ Office of the Coordinating Minister of Health and Social Welfare, Sector Wide Approach Coordination Office, Federal Ministry of Health and Social Welfare, Abuja, Nigeria.
⁸ National Primary Health Care Development Agency, Abuja, Nigeria.

PMID: 41862080
DOI: 10.1016/j.ijid.2026.108569

Abstract

Background: Despite global investments, achieving measles elimination targets remain elusive in low- and middle-income countries (LMICs). This study provides a comprehensive synthesis of measles-containing vaccine (MCV) coverage trends, effectiveness, and uptake determinants to inform strategic realignment.

Methods: We conducted an umbrella review of systematic reviews (2010-2025) and analyzed World Health Organization/UNICEF coverage data (2000-2024) for 79 LMICs. Determinants were synthesized via meta-meta-analysis.

Results: Twelve reviews and longitudinal data for 79 countries were analyzed. In 2024, mean MCV1 coverage was 79.2% (SD = 16.0%), with only 17 countries (21.5%) achieving the ≥95% elimination threshold. MCV2 coverage averaged 69.4% (SD = 19.9%) and a mean dropout gap (difference between MCV1 and MCV2) of 10.9 percentage points. Regional disparities were profound: the regions of Americas and Africa recorded the lowest mean MCV1 coverage (74.3% and 76.8%, respectively), while the African Region faced critical gaps in MCV2 (64.9%). Meta-meta-analysis identified positive maternal perception (pooled odds ratio [OR] = 4.05; 95% confidence interval: 2.89-5.66) and awareness of benefits (pooled OR = 2.99) as the strongest predictors of uptake.

Conclusion: Fewer than one-quarter of LMICs currently meet measles elimination targets. The stagnation in coverage and significant dropout rates necessitate a strategic shift to prevent measles resurgence and protect vulnerable children.

Keywords: Low- and lower middle-income countries; MCV; Measles; Umbrella review.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Developing Countries
Humans
Measles Vaccine* / administration & dosage
Measles Vaccine* / immunology
Measles* / epidemiology
Measles* / prevention & control
Vaccination Coverage* / statistics & numerical data
Vaccine Efficacy

Substances

Measles Vaccine