ArticleDiscover public health2026
School-associated measles outbreak driven by vaccination gaps, sociocultural barriers, and delayed detection in Gomba District, Uganda 2025.
Article in Discover public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: On May 27, 2025 a measles outbreak was confirmed in Kabulasoke Subcounty, Gomba District, Uganda, following a suspected measles-related death. We investigated the outbreak to determine its magnitude, identify risk factors for transmission, estimate measles-rubella vaccination coverage (VC) and vaccine effectiveness (VE), and inform control measures. Methods: We defined a suspected case as onset of fever and maculopapular rash plus ≥ 1 of cough, coryza, or conjunctivitis, in a Kabulasoke Subcounty resident during March-August, 2025; confirmed cases had measles-specific IgM antibodies. We compared exposures of 80 case-patients with 160 age- and sex-matched controls. Vaccination coverage was estimated as the proportion of vaccinated controls; VE was calculated as (1-aOR) *100%, using conditional logistic regression. Sociocultural factors were explored through 15 in-depth and key informant interviews, analysed by inductive thematic analysis. Results: We identified 106 cases (5 laboratory-confirmed, 1 death); overall attack rate (AR):2.4/1,000 population. Children aged 9-17 months were most affected (13/1,000), with clustering in infant school X. Response was initiated 33 days after detection. School attendance (aOR = 1.67; 95% CI: 1.05-2.71) and contact with symptomatic peers (aOR = 2.12; 95% CI: 1.21-3.70) were associated with infection, while vaccination was protective (aOR = 0.39; 95% CI: 0.27-0.55). Vaccination coverage was 72%, and VE was 60%. Qualitative findings revealed male-dominated decision-making, vaccine mistrust, and cultural framing of measles as a self-resolving illness as vaccination barriers. Conclusion: This outbreak was driven by suboptimal vaccination coverage, school-based transmission, and delayed detection. Strengthening routine immunisation, integrating schools into outbreak prevention, and addressing sociocultural barriers are essential to prevent future outbreaks.
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