The World Health Organization (WHO) says that the "immunity gap" in routine childhood immunisation over the past two years in Bangladesh is the primary reason behind the current measles outbreak. The disease has spread to 56 districts across the country.
The WHO’s Dhaka office shared this information in writing with Prothom Alo on Thursday. The newspaper had contacted the WHO regarding the measles situation, and in response, the organisation provided its latest available data.
According to the WHO, 69 per cent of measles-infected children are under the age of two, while 34 per cent are under nine months. The United Nations’ specialised health agency has expressed deep concern over the measles situation in Bangladesh.
In line with the WHO South-East Asia region’s targets, Bangladesh aims to eliminate endemic (continuous presence) transmission of measles and rubella viruses by 2026. This means ensuring the absence of measles and rubella transmission for at least 12 months.
In this context, Bangladesh had been making good progress toward elimination. The measles incidence per one million populations was 1.41 per cent in 2022, 1.60 in 2023, 1.43 in 2024, and 0.72 in 2025. Currently, it has risen to 16.8 per cent.
The WHO reported that as of 30 March, a total of 2,190 suspected measles cases have been identified in the country, of which 676 have been laboratory-confirmed. The infection has spread to 56 districts. Measles cases have not been detected in eight districts—Rangamati, Bagerhat, Meherpur, Joypurhat, Gaibandha, Lalmonirhat, Panchagarh, and Bandarban.
At the national level, the incidence rate is currently around 16.8 per one million population, which the WHO says clearly indicates nationwide spread. The Dhaka office informed the WHO headquarters in Geneva about the situation on 18 March.
Meanwhile, according to information collected by Prothom Alo correspondents across the country, the number of deaths from measles has exceeded 50.
In Bangladesh, the WHO works closely with the Ministry of Health and Family Welfare, the Directorate General of Health Services, and the Expanded Programme on Immunisation (EPI).
Why the outbreak
Bangladesh’s Expanded Programme on Immunisation (EPI) has long been considered successful. So why has such an outbreak occurred now? In response to this question, the WHO said its preliminary assessment points to immunity gaps as the main cause.
Children under two years of age—especially those who missed one or more doses of the measles vaccine over the past two years for various reasons—are the most affected. Of those infected, 69 per cent are under two years old, including 34 per cent who are under nine months, indicating high vulnerability among the youngest population.
This deterioration in the public health situation is occurring at a time when the country had set a target to eliminate measles and rubella by 2026. Although infection rates remained largely under control between 2022 and 2025 (below 1 per million), they have now surged sharply.
Although infections have spread to 56 districts, some areas have been identified as hotspots. The highest number of cases has been detected in Dhaka division, while higher incidence rates are being observed in Rajshahi, Mymensingh, and Barishal divisions. Several districts and city corporation areas have become centres of infection.
Bangladesh had previously achieved high vaccination coverage through the EPI. According to assessment surveys in 2019 and 2023, the full immunisation rate by 12 months of age was 83.9 per cent and 81.6 per cent, respectively. Like many other countries, Bangladesh faced challenges in maintaining high vaccination coverage during the COVID-19 pandemic, which contributed to an increase in zero-dose and partially vaccinated children.
In addition, limitations in the first and second doses of the measles vaccine and lower coverage rates can collectively create a susceptible population that grows at or above the birth rate. As a result, a specific age group develops immunity gaps. When vaccination coverage is insufficient across populations or when the number of under-vaccinated children increases over time, measles outbreaks can occur.
The WHO’s assessment is that the current outbreak reflects immunity gaps resulting from a combination of missed routine doses, unequal vaccination coverage across areas and populations, and barriers to accessing services in recent years.
In response to a question about where the situation might lead, the WHO said it will depend on the speed and quality of response activities, particularly supplementary immunisation campaigns. If case detection and surveillance are strengthened and rapid, high-coverage vaccination campaigns are implemented in affected and high-risk areas, the outbreak can be controlled. However, if immunity gaps persist, there is a risk of further increases in cases and spread to new areas.
Recommendations for the government
In light of the nationwide spread of measles, the WHO has advised the Bangladesh government to strengthen and accelerate response measures. These include: rapidly implementing high-quality nationwide measles and rubella vaccination campaigns targeting children aged six months to five years; strengthening surveillance, rapid notification, and laboratory confirmation; enhancing case management with appropriate clinical care including vitamin A supplementation; improving risk communication and community engagement alongside accurate information dissemination; and strengthening routine immunisation services.
Former chief scientific officer of the government’s Institute of Epidemiology, Disease Control and Research, Mushtaq Hossain—who has experience working on WHO committees on epidemiology, outbreaks, and pandemics—told Prothom Alo that the recommendations should be properly implemented.
He noted that there are shortages of appropriate personnel not only at the field level but also at central and district levels. These gaps must be addressed by placing the right people in the right positions, and without community engagement, the objectives will not be achieved.