Missed Routine Vaccination Leading to Measles Outbreak: A Single Center Study from King Abdullah Teaching Hospital, Mansehra, Pakistan

Background: In Pakistan, measles is experiencing a particularly dangerous resurgence, with cases rising steadily since 2021. This study was performed to assess the frequency of missed routine measles vaccination among children with measles during the recent outbreak reported at King Abdullah Teaching Hospital, Mansehra, Pakistan. Methods: This analytical, cross-sectional study was conducted at King Abdullah Teaching Hospital, Mansehra, Pakistan, from January to June 2024, using non-probability consecutive sampling. Inclusion criteria were children aged 6 months to 10 years, with clinical features of measles, and accompanied by cough, coryza, or conjunctivitis. Vaccination status was classified as updated for children who received all age-appropriate measles vaccine doses, unvaccinated for those with no dose, and incomplete for those who received only the first dose or did not complete the full schedule. Analyses were performed in SPSS v26, with significance set at p<0.05, using appropriate comparative statistical tests. Results: A total of 261 children were included, with a median age of 13.0 (8.0–24.0) months, while 150 (57.5%) were male. Measles-containing vaccine (MCV) status was updated in 70 (26.8%), unvaccinated in 135 (51.7%), and incomplete in 56 (21.5%) children. Urban residence was highest among updated cases (60.0%), while 77.0% unvaccinated children lived in rural areas (p<0.001). Hospital-acquired measles was observed only among unvaccinated children (8.1%). Facility unavailability (30.9%), and parental negligence (30.4%) were leading reasons for missed vaccination. Conclusion: A high frequency of missed routine measles vaccination was observed among hospitalized children in Mansehra and demonstrated significant differences in clinical and demographic features by vaccination status.