Measles-Rubella Time Series Analysis and Forecasting: India's Path Toward Who Elimination Targets

Abstract Background & Objectives: Measles elimination requires maintaining incidence <1 case per 100,000 population for at least 36 months. India's reported cases surged from 2,238 in 2023 to ~47,000 in 2024, contradicting WHO-verified elimination claims. This study analyzed measles-rubella (MR) vaccination impact, incidence trends, and parameters affecting elimination sustainability using an auto-updating time series forecasting system.Methods: One-way sensitivity analysis with tornado diagrams assessed 10 key parameters. Real data sources (70%) included NFHS-5 surveys, Government health reports, and Census statistics; modeled data (30%) used vaccine efficacy studies and migration patterns. Auto-updating system integrates WHO Global Health Observatory, UNICEF immunization database, and government surveillance APIs with 6-hour update cycles.Results: Critical finding: India has NOT achieved measles elimination despite repeated claims. Vaccine coverage shows MR1 protection at 91% (94% peak) but MR2 uptake at 86%. Sensitivity analysis reveals contact rates (+35%) and importation risk (+40%) as highest transmission drivers. Probability of sustained elimination: 65-75% with current parameters. Every 1% vaccination increase prevents ~10,000 annual cases.Conclusions: Evidence-based policy recommendations: Immediate MR2 coverage acceleration, enhanced border surveillance, and digital contact tracing. The auto-updating forecasting system provides continuous real-time elimination monitoring. Independent research validates WHO elimination verification requires 36+ months of zero indigenous transmission, not merely low incidence periods.Keywords: Measles elimination, Vaccine impact analysis, Time series forecasting, Sensitivity analysis, Public health surveillance, WHO elimination criteria