A large measles outbreak in Zimbabwe related to vaccine hesitancy in 2022.

Introduction: Zimbabwe has been implementing measles control strategies since 1998 and has adopted the regional goal for the elimination of measles and rubella by 2030. The country was one of the countries affected by a large resurgence of measles in 2010. Methods: we reviewed immunization coverage and disease surveillance data for 2014-2023 and conducted detailed analysis of the epidemiological characteristics of the measles outbreak in 2022. Results: Zimbabwe had MCV1 and MCV2 national-level coverage of 90% and 77%, respectively in 2023. A total of 4891 confirmed measles cases and 411 deaths were reported in 2022, with a case fatality ratio of 18% among children under 5 years of age. Manicaland province had the highest incidence. Age-specific incidence rates of 678 and 649 per million were documented among children aged 1-4 years and 5-9 years, respectively. The outbreak, which was linked to a national gathering of vaccine-hesitant religious groups, declined sharply in September 2022 following a nationwide vaccination campaign. Zimbabwe has maintained relatively high vaccination coverage in the years since 2010 and succeeded in reducing annual measles incidence levels to less than one case per million population. The large outbreak of 2022 is evidence of underlying risks, especially among vaccine-hesitant groups. Conclusion: the recurrence of measles outbreaks among the same religious community and the high case fatality rate deserve programmatic focus to prevent future outbreaks. A robust advocacy and communication effort should be implemented targeting Apostolic community leaders and members. In addition, it is important to tailor the provision of routine immunisation services to members of this hesitant group.