Attachments
What happened, where and when?
According to the Republican Center for Immunoprophylaxis of the Ministry of Health of the Kyrgyz Republic (RCI), since the beginning of 2025, the epidemiological situation in the country for measles and rubella has deteriorated.
The RCI informs that, as of 18 March 2025, 4,369 suspected cases of measles and rubella have been registered. Of these, 4,055 cases have been classified as measles, including 570 cases confirmed by laboratory tests, 1,562 cases confirmed clinically, and 1,922 cases epidemiologically linked. The incidence rate per 100,000 population is 57.6. In comparison, 14,380 cases of measles and three cases of rubella were reported in 2024 and 7,046 cases of measles and 12 cases of rubella were reported in 2023.
The government of the Kyrgyz Republic has not officially declared an outbreak. However, Deputy Minister of Health Bubuzhan Arykbaeva referred to the situation of an outbreak during the briefing for press held on 19 March 2025 (1).
For reference, the World Health Organization's (WHO) definition of outbreak is a suspected five or more cases of measles (with dates of rash onset occurring 7-21 days apart) that are epidemiologically linked, and the definition of a laboratory-confirmed measles outbreak is two or more laboratory-confirmed measles cases that are temporally related (with dates of rash onset occurring 7-21 days apart) and epidemiologically or virologically linked, or both.
- The distribution of measles cases by regions and cities is as follows:
- Bishkek: 2,567 cases (incidence rate of 224.2 per 100,000 population)
- Osh: 211 cases (58.4 per 100,000 population)
- Osh Region: 303 cases (20.7 per 100,000 population)
- Batken Region: 87 cases (15.2 per 100,000 population)
- Chuy Region: 545 cases (51.0 per 100,000 population)
- Jalal-Abad Region: 80 cases (6.1 per 100,000 population)
- Issyk-Kul Region: 70 cases (13.0 per 100,000 population)
- Nary Region: 97 cases (31.5 per 100,000 population)
- Talas Region: 95 cases (34.7 per 100,000 population)
The analysis of age distribution of measles cases shows that the small children under 9 years are the most affected (86%). The age distribution is as follows:
- Under 1 year: 1,262 cases (31%)
- Ages 1-4 years: 1,573 cases (39%)
- Ages 5-9 years: 646 cases (16%)
- Ages 10-14 years: 166 cases (4%)
- Ages 15-19 years: 62 cases (2%)
- Ages 20-29 years: 180 cases (4%)
- Ages 30 years and older: 166 cases (4%)
Most number of measles cases among children below one year were among children aged between five to nine months (49%) of all cases reported among children in this age group.
On 18 March, the government announced eight confirmed deaths due to complications of measles (2). Out of those, four deaths were reported in Bishkek, one in Chui, two in Osh and one in Osh city. Out of eight fatal cases, six were not vaccinated due to age (children under one year), one case due to the medical exemption and 1 case due to the refusal of vaccinations. In comparison, nine measles related deaths were reported in 2023 and five deaths in 2024.
Analysis of vaccination status of patients diagnosed with measles by the RCI shows that the majority of them (95%, or 3,865 people) were not vaccinated and only 5% (190 people) were vaccinated. A closer analysis shows that of those who were vaccinated, 116 patients received one dose of the MMR vaccine, which protects against measles, mumps, and rubella (3%) and 74 patients received two doses of the MMR vaccine (2%), which shows the protective nature of the full dose of vaccination.
The majority of those who got sick with measles were getting sick before they reach their vaccine-eligible age (31%, or 1,262 children) or due to refusals of vaccination (44%, or 1,790 children). The remaining reasons for not getting vaccinated were medical exemptions (10% or 397 cases) and migration (1% or 58 cases). 358 patients had an unknown vaccination status (9%).
In the previous epidemic of measles that happened in 2023 and 2024, a similar age distribution was observed and therefore, the Ministry of Health of the Kyrgyz Republic has lowered a vaccine eligible age for the first dose of MMR vaccine from two years to one year old and for the second dose, from six years old to two years old in 2024.
The situation in Kyrgyzstan is reflecting a wider regional trend of the increasing number of measles cases across WHO Europe and Central Asia region (3) (4). It is possible that the current numbers of measles in the country are underestimated.
The primary cause of the ongoing measles situations in the country s the large number of susceptible children who have not received full vaccination doses according to the national immunization schedule. According to the latest available data on the UNICEF Database on monitoring the situation of children and women globally, percentage of children who received the 2nd dose of measles-containing vaccine, as per administered in the national schedule in 2023, was 93% and it shows a general downward trend for the past 5 years (the same indicator was 95% in 2022, 97% in 2021, 93% in 2020 and 98% in 2019) (5). According to the latest available data from the MoH, in 2024, 91% of vaccine eligible age children were vaccinated with the first dose of the MMR vaccine (MCV1 at the age of one year old) and 90% with the second dose (MCV2 at the age of two years old). This is despite the intensification of vaccination work throughout 2023 and 2024 in connection with the measles outbreak in 2023.
Multiple Indicator Cluster Survey conducted by National Statistics Committee of the Kyrgyz Republic in 2023 shows even lower coverage: 89% of children age 12-23 months and 24-35 months were vaccinated against MMR at any time before the survey (crude coverage) (6).
According to WHO, 95% or greater coverage of two doses of measles-containing vaccine is needed to create herd immunity (7).
The main reason for this level of sub-optimal coverage is growing vaccine hesitancy in the country and high level of migration (internal and external).
There is a growing anti-vaccination sentiment in the country. The Republican Immunoprophylaxis Centre has received a growing number a of reports of vaccination refusals since 2016. In 2021, there were more than 10,000 refusals, in 2023, there were 20,496 refusals reported, and in 2024 19,760 refusals were reported. Out of those 19,760 refusals, 9,664 cases were reported in Bishkek city (49% of all refusals) and 4,292 cases in Chui region (21% of all refusals) alone. Reasons for parents and caregivers refusal of vaccination are often due to religious beliefs, lack of trust in health system and misinformation.
Children in Kyrgyzstan are offered 2 doses of measles-containing vaccine as part of the routine immunization schedule and in line with WHO recommendations. As the immunization schedule was changed in 2024, there is a lack of awareness among the population of the revised immunization schedule and many children who were above the age of two in 2024 remain in the risk group.
As it has been in the previous epidemics of measles, there is a spike of cases after major holidays, after the start of the academic year in September and during the cold seasons. Starting from 20 March, the country is celebrating Nowruz, which is a major public holiday.
During this traditional celebration, many people return to their home towns to celebrate the holidays with their families and families organize large gatherings which can further facilitate the spread of the cases from the major cities like Bishkek and Osh where the majority of cases are concentrated across all regions. In May, the government announced nearly two-week long public holidays, which can again increase the number of cases.
Sources: (1) https://24.kg/english/323334_Measles_outbreak_Additional_immunization_campaign_to_be_held_in_April/#:~:text=Recall%2C%204%2C055 %20cases%200f%20measles, makes%20up%2063%20percent%20only (2) https://vesti.kg/obshchestvo/item/136833-za-dva-mesyatsa-ot-kori-v-kyrgyzstane-umerli-8-detej-vlasti-byut-trevogu.html (3) European Region reports highest number of measles cases in more than 25 years UNICEF,
WHO/Europe (https://www.unicef.org/press-releases/european-region-reports-highest-number-measles-cases-more-25-years-unicef-whoeurope) (4) Europe grapples with highest number of measles cases in more than 25 years (https://news.un.org/en/story/2025/03/1161086) (5) https://data.unicef.org/ (6) https://www.unicef.org/kyrgyzstan/publications/mics-kyrgyz-republic-2023 (7) https://www.who.int/news/item/23-11-2022-nearly-40-million-children-are-dangerously-susceptible-to-growing-measles-threat