Background: After COVID-19 pandemic, Uzbekistan has faced renewed challenges in maintaining high routine immunization coverage. After several years of relative stability, measles has re-emerged as a public health concern, with outbreaks reported across multiple regions since early 2023. The situation reflects both the lingering effects of disrupted vaccination services and a noticeable rise in vaccine refusal among adults. Understanding these trends is crucial for rebuilding the country’s progress toward measles elimination. Objective:

This study aimed to describe the epidemiological features of measles outbreaks in Uzbekistan from 2023 to 2025 and to assess the impact of vaccine refusal and the healthcare system’s response on disease dynamics. Methods: We conducted a nationwide, registry-based analysis using official data from the Republican Measles Registry of the Ministry of Health of Uzbekistan. All laboratory-confirmed cases (IgM ELISA) reported between January 2023 and November 2024 were included. Data were analyzed by age, vaccination status, and geographic region. Additional information on national immunization coverage and outbreak control measures was obtained from reports by the WHO, UNICEF, and Gavi. Results: During the study period, 20,790 measles cases were confirmed across Uzbekistan. The most significant numbers were recorded in Tashkent City (4,148 cases), Kashkadarya (3,283), and Khorezm (2,875). Adults accounted for approximately 46% of all cases, with the highest proportion observed among individuals aged 20–39 years. About 41 % of all patients were unvaccinated, and around one in ten reported active refusal of vaccination, primarily due to misinformation or distrust of medical advice. The Ministry of Health responded with nationwide catch-up campaigns, mobile immunization units, and targeted communication in high-risk districts. By mid-2024, first-dose coverage among children under five had again reached above 95 %, though adult immunity gaps persisted. Conclusion: The recent measles outbreaks in Uzbekistan underscore the rapid erosion of immunity gaps when vaccination programs are disrupted and public confidence wanes. Although emergency immunization measures helped to curb transmission, strengthening public trust and expanding adult vaccination remain vital for preventing future outbreaks.

Measles, Vaccine refusal, Vaccine hesitancy

Basina, V. V., Esaulenko, E. V., Novak, K. E., & Bryantseva, E. V. (2021). Clinical and epidemiological features of measles in adults in the modern period. Journal of Infectology, 13(2), 70–78. https://doi.org/10.22625/2072-6732-2021-13-2-70-78

Centers for Disease Control and Prevention (CDC). (2023). Progress Toward Measles Elimination — Worldwide, 2000–2022. Morbidity and Mortality Weekly Report, 72(49), 1201–1207. https://www.cdc.gov/mmwr/volumes/72/wr/mm7249a3.htm

Gavi, the Vaccine Alliance. (2023, September 12). Measles is surging, and Uzbekistan is bolstering its defences. https://www.gavi.org/vaccineswork/measles-surging-and-uzbekistan-bolstering-its-defences

Ivanova, I. A., Ponezheva, Zh. B., Kozlova, M. S., & Terekhov, A. M. (2018). Features of the course of measles in adults. Lechashchiy Vrach, 11, 12–18.

Kharchenko, G. A., & Kimirilova, O. G. (2019). Clinical and epidemiological features of measles in children of the Astrakhan region. Children’s Infections, 18(3), 31–36. https://doi.org/10.22627/2072-8107-2019-18-3-31-36

Ministry of Health of the Republic of Uzbekistan. (2024). Republican Measles Registry: Annual Epidemiological Bulletin (January 2023 – November 2024). Tashkent: Department of Epidemiological Surveillance and Immunoprophylaxis.

Rakhmatullaeva, Sh. B., & Okhunjonova, K. X. (2025). Features of measles course in adults at the modern stage. Clinical Medicine (Tashkent Medical Academy Journal), 5, 114–116. ISSN 2181-7812. https://www.tma-journals.uz

State Committee of the Republic of Uzbekistan on Statistics. (2024). Population and demographic data. https://stat.uz/en/

UNICEF. (2024). In Focus: Immunization in Europe and Central Asia. Geneva: United Nations Children’s Fund. https://www.unicef.org/eca/reports/focus-immunization-2024

World Health Organization & UNICEF. (2023). Uzbekistan: WHO–UNICEF estimates of national immunization coverage (WUENIC). Geneva: WHO. https://immunizationdata.who.int/pages/profiles/uzb.html

World Health Organization. (2024). Measles and rubella surveillance data. Geneva: WHO. https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/surveillance/data