Measles in Nigeria
Nigeria carries one of the world's highest measles burdens, with the unvaccinated birth cohort accumulating rapidly in states with chronically low routine immunisation coverage. With over 220 million people, Nigeria's sheer population size means even modest coverage gaps produce hundreds of thousands of unprotected children each birth year.
Key Statistic
Nigeria reports 10,000–30,000 confirmed measles cases annually and is estimated to account for approximately 35% of measles deaths in sub-Saharan Africa
Vaccination Coverage
National MCV1 coverage: ~56% (2023); Katsina, Sokoto, and Zamfara states record coverage below 40% — among the lowest globally for a high-burden country
Control & Response
NPHCDA and GAVI-supported SIAs have periodically vaccinated 30+ million children, but inter-campaign susceptibility build-up continues to drive cyclical outbreaks
Highest Burden in Africa
Nigeria is consistently ranked as Africa's highest measles-burden country. The WHO African Region reports that Nigeria, the Democratic Republic of Congo, and Ethiopia together account for the majority of the continent's measles cases and fatalities. In years with major Nigerian outbreaks — such as 2017, 2019, and 2021 — the country alone has driven global case count spikes reported by WHO's weekly epidemiological record.
The root causes are structural: approximately 2.7 million Nigerian children are born each year in the country's north-west and north-east zones, where routine immunisation system performance is weakest. Vaccine hesitancy, driven in part by historical distrust of immunisation campaigns following the 2003 polio vaccine boycott in Kano, has lingered in some communities and continues to complicate outreach efforts.
The 2021–2022 Outbreaks
The 2021–2022 period saw Nigeria's most severe measles resurgence in years. WHO Nigeria and the Nigeria Centre for Disease Control (NCDC) jointly reported outbreaks spanning 26 of Nigeria's 36 states, with the north-west and north-east geopolitical zones most severely affected. Borno State, already managing a complex humanitarian crisis from Boko Haram insurgency, recorded among the highest case counts — with laboratory-confirmed outbreaks in Maiduguri and surrounding local government areas.
Kano State, Nigeria's most populous northern state, simultaneously confirmed outbreaks in multiple LGAs, with cases concentrated in unvaccinated children under five. Both states operated under Vaccine-Preventable Disease (VPD) outbreak response protocols activated by the National Primary Health Care Development Agency (NPHCDA), including emergency ring vaccination and enhanced case-based surveillance.
The 2022 surge was exacerbated by COVID-19-related disruptions to routine immunisation services in 2020–2021, which had left a cohort of over three million children in northern Nigeria without their scheduled MCV1 dose.
NPHCDA Campaigns
The National Primary Health Care Development Agency (NPHCDA) is Nigeria's lead body for routine immunisation and SIA planning. Working with UNICEF, WHO, and Gavi — the Vaccine Alliance, NPHCDA has organised large-scale catch-up campaigns targeting children aged 9 months to 5 years in high-risk northern states. A notable 2022 integrated campaign vaccinated an estimated 25 million children in 10 states against measles and other vaccine-preventable diseases simultaneously.
Despite these efforts, Nigeria's coverage surveys consistently reveal post-SIA immunity gaps. Many children in hard-to-reach communities and urban slums are missed by fixed-facility and door-to-door outreach alike. NPHCDA's 2023–2025 strategic plan identifies defaulter tracking and community health extension worker (CHEW) deployment as priority mechanisms to improve last-mile coverage.
Borno and Kano: Outbreak Epicentres
Borno State's prolonged security crisis has disrupted health systems for over a decade. An estimated 1.8 million people remain internally displaced within the state, many in camps where vaccine cold-chain logistics are extremely challenging. Measles case-fatality rates in Borno's humanitarian settings are elevated by co-existing acute malnutrition and limited access to supportive care including vitamin A supplementation — a proven intervention that reduces measles mortality.
Kano, by contrast, faces urban outbreak dynamics: rapid population growth, high population density in old city wards, and pockets of unvaccinated children in communities with historical vaccine hesitancy. WHO Nigeria and Kano State Ministry of Health have implemented ward-level micro-plans and social mobilisation campaigns in response, with community and religious leader engagement identified as critical to improving acceptance.
VPD Surveillance
Nigeria operates a Vaccine-Preventable Disease (VPD) surveillance system coordinated by the NCDC, NPHCDA, and WHO Nigeria. Case-based surveillance for measles is conducted through the Integrated Disease Surveillance and Response (IDSR) framework, with suspected cases investigated using clinical and laboratory criteria at state public health laboratories. The WHO Global Measles and Rubella Laboratory Network (WHO GMRLN) supports Nigeria's labs with quality assurance and genotyping capacity.
Surveillance quality remains uneven across states. High-performing states like Lagos and Rivers have strong laboratory networks, while several northern states rely on clinical diagnosis alone in remote areas, likely undercounting true case burden. Improving completeness and timeliness of VPD reporting is a stated WHO Nigeria priority for 2024–2025.
Prevention for Travellers & Residents
WHO and CDC recommend that all travellers to Nigeria, especially those visiting northern states, be fully vaccinated with two doses of MMR. Children travelling to Nigeria should receive their first MMR dose at 6 months of age if they are 6–11 months old — earlier than the standard schedule — for additional protection. Nigerian residents in low-coverage areas should seek measles vaccination at the nearest primary health centre.
For broader context on measles transmission, symptoms, and global epidemiology, see our full Measles disease overview.
Frequently Asked Questions
Why does Nigeria have such a high measles burden?
Nigeria's measles burden is driven by a combination of factors: very low routine immunisation coverage in the north-west and north-east (below 40% in some states), a large annual birth cohort, vaccine hesitancy in some communities, security crises limiting health access in Borno State, and a large under-5 population that builds up susceptibility between SIA campaigns.
Which Nigerian states have the highest measles risk?
The north-west states (Katsina, Sokoto, Zamfara, Kebbi, Kano, Jigawa, Kaduna) and north-east states (Borno, Yobe, Adamawa) consistently record the lowest vaccination coverage and highest outbreak incidence. Urban settlements in these states with large displaced populations are particularly high risk.
What is NPHCDA and how does it respond to outbreaks?
The National Primary Health Care Development Agency (NPHCDA) is the federal body responsible for immunisation programs and primary health care delivery in Nigeria. During outbreaks, NPHCDA activates rapid response teams, coordinates ring vaccination in affected LGAs, and works with UNICEF, WHO, and state governments to organise emergency SIA campaigns reaching millions of children.
How does measles surveillance work in Nigeria?
Nigeria uses the Integrated Disease Surveillance and Response (IDSR) system, with suspected measles cases reported weekly from health facilities to state epidemiological units and then to the NCDC. The WHO GMRLN supports laboratory confirmation and genotyping. VPD surveillance quality varies significantly by state, with northern states generally having lower reporting completeness.
What should I do if I suspect measles in Nigeria?
If a child develops fever followed by rash, cough, runny nose, and red eyes — the hallmark measles presentation — seek care at the nearest health facility immediately. Isolate the affected person to limit spread. Health workers should report to the state epidemiology unit under IDSR protocols. Provide vitamin A supplementation if instructed by a health worker, as it significantly reduces measles complications in children. This is educational information only — not medical advice.