Changing Measles Epidemiology in Ghana, 2018–2023: Exploring Impact of COVID-19-Related Disruptions on Vaccination Coverage and Incidence

Background: Measles remains a public health threat in Ghana due to persistent immunity gaps and suboptimal vaccination coverage. The COVID-19 pandemic disrupted routine immunization and may have altered measles transmission. This study assessed measles burden, vaccination status of confirmed cases, and spatiotemporal trends in Ghana, and examined the pandemic’s impact on measles control. Methods: We analyzed measles cases reported in Ghana from 2018 to 2023, including age, sex, vaccination status, and region, alongside national measles–rubella (MR) vaccination coverage. Cumulative incidence was calculated as confirmed cases per million population. Interrupted time series analysis assessed pandemic-related disruptions in vaccination coverage and case reporting. Multivariable logistic regression identified factors associated with infection and vaccination status. Results: Ghana reported 1688 confirmed measles cases, a cumulative incidence of 51.9 per million, with a case fatality rate of 0.1%. Incidence rose from 1.1 per 1,000,000 in 2018 to 28.3 per 1,000,000 in 2023, with wide geographic variation. The odds of measles infection were higher among those aged 5–14 years (aOR = 1.41; 95% CI: 1.19–1.68, p < 0.001) and 15–44 years (aOR = 1.74; 95% CI: 1.37–2.22, p < 0.001) than among infants under one year. Compared with no vaccination, one dose was associated with lower odds of measles infection (aOR = 0.41; 95% CI: 0.34–0.48, p < 0.001), as was two doses (aOR = 0.38; 95% CI: 0.33–0.44, p < 0.001). MR1 coverage fell from 91.7% to 86.2%, and MR2 coverage stayed below the 95% herd immunity threshold throughout, with both showing an inverse relationship with incidence. The COVID-19 pandemic caused an immediate 64% decline in confirmed cases (IRR 0.36, 95%CI 0.17–0.75, p = 0.007). MR2 coverage dropped 3.66 percentage points at pandemic onset while MR1 rose slightly; neither change was significant. Conclusions: Measles burden in Ghana rose substantially between 2018 and 2023, with geographic variation and an inverse relationship between MR coverage and incidence. Suboptimal two-dose coverage and pandemic disruptions sustained transmission despite vaccination’s protective effect. Strengthening routine immunization and surveillance during emergencies is critical to detect outbreaks early and achieve measles elimination.