Basic Epidemiology of Measles in Sub-Saharan Africa

DLHA Staff Writer

African child with typical measles rash on the face.

Measles is a highly contagious, acute viral illness and is a leading cause of death among young children globally and more so in Sub-Saharan Africa (SSA).

It affects people across all age groups.

The incubation period typically ranges from 10 to 14 days

Burden of measles in Africa

According to the WHO, the incidence of measles in the Sub-Saharan Africa has been steadily increasing, with a reported increase from 69.2 per 1 million population in 2017 to 81.9 in 2021. 

The disease affects male and female African children in almost equal proportion and remains a leading cause of death in children, with an estimated 28,000 measles-related deaths occurring annually in SSA. 

Recurrent and deadly measles outbreaks occur in many SSA countries for many reasons including, weak health system, on-going regional or intra-national conflicts and/or natural disasters. 

Mode of transmission

Transmission occurs via airborne droplets or direct contact with respiratory secretions from infected individuals.

Infectious period

Individuals are considered infectious from approximately four days before and until four days after the rash appears.

Symptoms

Early symptoms of measles include:

• High fever
• Cough
• Coryza (head cold and running nose)
• Conjunctivitis (“red eyes”)
• Koplik spots (small white lesions on the buccal mucosa, i.e. the thin and delicate tissue covering the inside of the mouth)
• A characteristic skin rash that emerges approximately 2–4 days after fever onset, beginning on the face and upper neck before progressing to the trunk and lower limbs.

Prevention and Care

Vaccination remains the cornerstone of measles prevention. It not only prevents measles but also significantly reduces the risk of its potentially life-threatening complications.

The measles-containing vaccine is among the most effective vaccines available, with a two-dose schedule providing approximately 97% lifelong protection.

Although vaccination coverage has improved, many countries in Sub-Saharan Africa still struggle to achieve the recommended coverage of 95% for measles-containing vaccines.

While there is no specific antiviral therapy for measles, the majority of patients recover within 2–3 weeks with supportive care.

Complications

Measles can result in severe complications, including:

• Pneumonia
• Diarrhoea
• Otitis media (Middle ear infection)
• Acute encephalitis (Acute brain infection)
• Post-infectious encephalitis (Occurs in 1 in 1000 cases)
• Blindness
• Immune amnesia (Lowered immune memory, which increases the odds of contracting other infections many years following recovery)
• Possible death.

Source: World Health Organization

Related: What is measles?

Published: May 16, 2025

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