The Paradox of Prevention: Why Measles and Rubella Persist in the Era of Effective Vaccines
Christopher Ononiwu Elemuwa
*
Department of Medical Microbiology, Immunology & Parasitology, Federal University, Otuoke, Bayelsa State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Measles and rubella remain major vaccine-preventable diseases that continue to cause significant morbidity and mortality, especially in Nigeria and other resource-limited settings of the Global South. This comprehensive review integrates molecular virology, epidemiology, immunology, and public health perspectives to assess the biology, transmission dynamics, and control strategies for these viruses. Measles, a highly contagious Morbillivirus with a basic reproduction number (R₀) of 12–18, and rubella, a teratogenic Rubivirus responsible for congenital rubella syndrome (CRS), both persist due to gaps in vaccination coverage, surveillance, and health system capacity. In Nigeria, suboptimal immunization—only about 54% first-dose measles vaccine coverage—combined with regional disparities and vaccine hesitancy, continues to fuel recurrent outbreaks. The introduction of the measles-rubella (MR) vaccine in 2023 represents a crucial milestone for CRS prevention. Molecular epidemiology shows that measles genotype B3 and rubella genotype 1 predominate in Africa, with molecular surveillance central to elimination verification.
The review highlights the economic benefits of vaccination, showing that measles-rubella immunization is highly cost-effective, averting millions of cases and disability-adjusted life years (DALYs) at minimal cost per DALY averted. Persistent immunosuppression following measles infection (“immune amnesia”) and rubella’s teratogenic impact underscore the urgency of sustained control efforts.
Policy recommendations emphasize strengthening routine and supplementary immunization, scaling up molecular surveillance, addressing vaccine hesitancy through community engagement, and bolstering health system resilience. Achieving measles and rubella elimination in Nigeria will require coordinated action across scientific, socioeconomic, and policy domains—linking advanced virological knowledge with equitable, community-driven public health delivery.
Keywords: Disease biology, measles virus, rubella virus, pathogenesis, host–pathogen interaction, immune response, immunosuppression, congenital rubella syndrome (CRS), epidemiology, vaccination, vaccine hesitancy, global health, Nigeria, infectious diseases, disease control