Measles in Ethiopia

Ethiopia experiences recurring measles outbreaks in both urban and rural settings due to gaps in routine immunisation, large displaced populations in outbreak-prone camps, and chronic underfunding of primary health care. The country remains one of Africa's highest measles-burden nations, with the WHO African Region consistently flagging Ethiopia in its outbreak bulletins.

Outbreak History

Measles has been endemic in Ethiopia for decades. The country's 115+ million population, high birth rate, and persistently low second-dose (MCV2) uptake create large susceptible cohorts that fuel cyclical outbreaks every two to three years. Historically, the Somali, Afar, and Oromia regions bear the greatest burden, driven by pastoral mobility, low health-facility density, and limited cold-chain infrastructure.

Between 2014 and 2018, Ethiopia reported over 40,000 confirmed measles cases to the WHO African Region. A sharp resurgence in 2019 saw more than 7,000 cases detected in a single cluster spanning Somali region refugee and internally-displaced-person (IDP) camps near Dollo Ado. Case-fatality rates in these settings exceeded the national average due to acute malnutrition among affected children.

The 2022 Outbreak

The 2022–2023 measles resurgence was the largest Ethiopia had seen in several years. Outbreaks were confirmed simultaneously in Somali, Oromia, Amhara, and SNNPR regions. The Tigray conflict (2020–2022) had effectively paused routine immunisation in large parts of northern Ethiopia, creating a two-year backlog of unvaccinated children. By mid-2022, WHO Ethiopia reported multi-district outbreak responses were underway in over 50 woredas, with laboratory-confirmed measles among children aged 6 months to 5 years accounting for the majority of hospitalised cases.

The Ethiopian Public Health Institute (EPHI) activated its Rapid Response Team (RRT) mechanism and coordinated ring vaccination campaigns in affected woredas. UNICEF pre-positioned measles vaccines and vitamin A supplements, while WHO provided epidemiological surge support. Despite these efforts, transmission continued into early 2023 in areas with disrupted health systems.

WHO Africa Region Context

The WHO African Region accounts for more than half of global measles cases and nearly 60% of global measles deaths in most years. Ethiopia is consistently among the top five countries driving regional case counts, alongside Nigeria, Democratic Republic of Congo, Guinea, and Chad. The WHO Regional Office for Africa (AFRO) publishes weekly outbreak bulletins in which Ethiopia appears as a priority country for supplemental immunisation support.

Regionally, the Measles & Rubella Initiative — a partnership of WHO, UNICEF, US CDC, UN Foundation, and the American Red Cross — has provided strategic support to Ethiopia, funding catch-up campaigns and laboratory capacity building at the EPHI National Reference Laboratory in Addis Ababa.

The Ethiopian Public Health Institute (EPHI)

EPHI is Ethiopia's national public health authority responsible for disease surveillance, laboratory confirmation, and outbreak response coordination. It operates the Integrated Disease Surveillance and Response (IDSR) system, through which health facilities across all regions report suspected measles cases weekly. EPHI publishes annual disease burden reports and coordinates with WHO AFRO and WHO headquarters on global measles elimination milestones.

A central challenge for EPHI is data completeness from pastoralist and conflict-affected zones. Remote health posts often have unreliable reporting channels, meaning official case counts likely underestimate true burden in Ethiopia's most affected areas.

Vaccination Coverage & Gaps

WHO and UNICEF's 2023 national immunisation coverage estimates place Ethiopia's first-dose measles coverage (MCV1) at approximately 72%, well below the 95% threshold needed for herd immunity. Second-dose coverage (MCV2), introduced into Ethiopia's routine schedule in 2019, remains substantially lower — estimated at 40–50% nationally. The lowest coverage is in the Somali region (~38% MCV1) and parts of Afar, where nomadic lifestyles make fixed health-post delivery ineffective.

To close these gaps, Ethiopia has implemented GAVI co-financed SIAs targeting children aged 9 months to 5 years in high-risk districts. The 2022–2023 SIA rounds aimed to vaccinate over 12 million children, though coverage audits are still ongoing.

Prevention for Travellers & Residents

WHO and CDC advise that all travellers to Ethiopia should be up to date on the MMR (measles-mumps-rubella) vaccine. Two doses are recommended for adults who have not previously received them. Children travelling to Ethiopia should receive their first MMR dose at age 6–11 months (earlier than the standard schedule) if travelling to high-risk areas. Residents in rural or IDP-adjacent communities should seek vaccination through local health centres and report suspected cases immediately to the nearest health post.

For further disease-level detail, see our full Measles disease overview.

Frequently Asked Questions