Post-Pandemic Measles Resurgence in Indonesia: Longitudinal Evidence of Immunisation Debt Across 34 Provinces, 2018–2024

Dwiva Wulan Guri (1), Anggita Rana Sasmita Lestari (2)
(1) Magister ilmu biomedis, FK UIN syarif hidayatullah jakarta, Indonesia,
(2) Magister ilmu biomedis, FK UIN syarif hidayatullah jakarta, Indonesia
https://doi.org/10.30651/jqm.v10i02.31842

Article Sidebar

Issue
Vol. 10 No. 02 (2026): Qanun Medika Vol 10 No 02 July 2026
Submitted
May 26, 2026
Accepted
July 21, 2026
Published
July 31, 2026
Keywords:
    outbreak, post-pandemic
PDF

Abstract

The COVID-19 pandemic disrupted routine immunisation services globally, creating immunisation debt that may drive measles resurgence. This longitudinal ecological study examined measles outbreak (KLB) frequency and MR1 vaccination coverage across 34–38 Indonesian provinces from 2018 to 2024, divided into pre-pandemic (2018–2019), pandemic (2020–2021), and post-pandemic (2022–2024) phases. Data were extracted from the Profil Kesehatan Indonesia 2018–2024. KLB frequency differed significantly across phases (Kruskal-Wallis H = 32.530, p < 0.001): pandemic-era KLB was suppressed to 6–8 events/year, then rebounded to pre-pandemic levels in 2022–2024 (Mann-Whitney U = 3563.5, p = 0.578) despite lower MR1 coverage, peaking at 137 events in 2023. Negative binomial regression indicated the pandemic phase was associated with an 88.0% reduction in KLB frequency (IRR = 0.120, p < 0.001). Exploratory Spearman correlation between MR1 coverage and KLB frequency was non-significant across all strata (pooled rₛ = +0.089, p = 0.165). Thirty-one high-risk province-year observations were identified across 13 provinces, concentrated in Aceh and Papua. Post-pandemic KLB trends are consistent with the immunisation debt hypothesis. Targeted catch-up vaccination and province-specific strategies for Aceh and Papua are urgently needed.

Full text article

Generated from XML file

References

Burgess, C., Lisul, B., Pawaskar, M., Petigara, T., Murtagh, J., Kanazir, M., Loncarevic, G., & Carias, C. (2024). Impact of the COVID-19 pandemic on measles vaccination coverage and estimated catch-up efforts for Serbia. Pediatric Infectious Disease Journal, 43(10), 1011–1017. https://doi.org/10.1097/INF.0000000000004487

Burton, A., Monasch, R., Lautenbach, B., Gacic-Dobo, M., Neill, M., Karimov, R., Wolfson, L., Jones, G., & Birmingham, M. (2009). WHO and UNICEF estimates of national infant immunization coverage: Methods and processes. Bulletin of the World Health Organization, 87(7), 535–541. https://doi.org/10.2471/BLT.08.053819

Chacko, S., Kamal, M., Hastuti, E. B., Mildya, F., Kelyombar, C., Voronika, V., Yosephine, P., Tandy, G., Anisiska, D., Karolina, S., Dewi, L. A., Khanal, S., Bahl, S., Wijayanti, F., Merrill, R. D., Hsu, C. H., & Morales, M. (2023). Progress toward measles and rubella elimination — Indonesia, 2013–2022. Morbidity and Mortality Weekly Report, 72(42), 1134–1139. https://doi.org/10.15585/mmwr.mm7242a2

Dabbagh, A., Laws, R. L., Steulet, C., Dumolard, L., Mulders, M. N., Kretsinger, K., Alexander, J. P., Rota, P. A., & Goodson, J. L. (2018). Progress toward regional measles elimination — Worldwide, 2000–2017. Morbidity and Mortality Weekly Report, 67(47), 1323–1329. https://doi.org/10.15585/mmwr.mm6747a6

Hermawan, A., Irawan, I. R., Widiyanti, M., Rosnani, R., & Arifin, H. (2025). Association of socio-demographic factors with measles vaccination coverage among Indonesian children aged 12–23 months. Turkish Journal of Pediatrics, 67(3), 304–316. https://doi.org/10.24953/turkjpediatr.5886

Kementerian Kesehatan Republik Indonesia. (2010). Peraturan Menteri Kesehatan No. 1501/Menkes/Per/X/2010 tentang jenis penyakit menular tertentu yang dapat menimbulkan wabah dan upaya penanggulangan. Kemenkes RI.

Kementerian Kesehatan Republik Indonesia. (2019). Profil Kesehatan Indonesia 2018. Kemenkes RI. https://www.kemkes.go.id

Kementerian Kesehatan Republik Indonesia. (2020). Profil Kesehatan Indonesia 2019. Kemenkes RI. https://www.kemkes.go.id

Kementerian Kesehatan Republik Indonesia. (2021). Profil Kesehatan Indonesia 2020. Kemenkes RI. https://www.kemkes.go.id

Kementerian Kesehatan Republik Indonesia. (2022). Profil Kesehatan Indonesia 2021. Kemenkes RI. https://www.kemkes.go.id

Kementerian Kesehatan Republik Indonesia. (2023). Profil Kesehatan Indonesia 2022. Kemenkes RI. https://www.kemkes.go.id

Kementerian Kesehatan Republik Indonesia. (2024). Profil Kesehatan Indonesia 2023. Kemenkes RI. https://www.kemkes.go.id

Kementerian Kesehatan Republik Indonesia. (2025). Profil Kesehatan Indonesia 2024. Kemenkes RI. https://www.kemkes.go.id

Minta, A. A., Ferrari, M., Antoni, S., Portnoy, A., Sbarra, A., Lambert, B., Hatcher, C., Hsu, C. H., Ho, L. L., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Bose, A. S., Perea Caro, W., O'Connor, P., & Crowcroft, N. S. (2023). Progress toward measles elimination — Worldwide, 2000–2022. Morbidity and Mortality Weekly Report, 72(46), 1262–1268. https://doi.org/10.15585/mmwr.mm7246a3

Minta, A. A., Ferrari, M., Antoni, S., Lambert, B., Sayi, T. S., Hsu, C. H., Steulet, C., Gacic-Dobo, M., Rota, P. A., Mulders, M. N., Wimmer, A., Bose, A. S., O'Connor, P., & Crowcroft, N. S. (2024). Progress toward measles elimination — Worldwide, 2000–2023. Morbidity and Mortality Weekly Report, 73(45), 1036–1042. https://doi.org/10.15585/mmwr.mm7345a4

Murphy, A. A., Indah, R., Yufika, A., Wardati, F., Fitriani, F., Mulyani, L., Harahap, I. U., Sari, C., Asrizal, F., & Harapan, H. (2025). Understanding the influence of religious and safety concerns on childhood measles and pertussis vaccination in Aceh, Indonesia. BMC Infectious Diseases, 25, 1140. https://doi.org/10.1186/s12879-025-11540-8

Ristić, M., Ilić, S., Rajčević, S., Štrbac, M., Medić, S., Pustahija, T., Vuković, V., Koprivica, M., Dragovac, G., & Petrović, V. (2025). Measles epidemiology and coverage of immunization against measles in the Autonomous Province of Vojvodina, Serbia: Local trends in a regional context. Vaccines, 13(7), 711. https://doi.org/10.3390/vaccines13070711

Torjesen, I. (2021). Measles outbreaks likely as COVID pandemic leaves millions of world's children unvaccinated, WHO warns. BMJ, 375, n2755. https://doi.org/10.1136/bmj.n2755

Tripathy, J. P.(2013). Secondary data analysis: Ethical issues and challenges. Iranian Journal of Public Health, 42(12), 1478–1479. https://pmc.ncbi.nlm.nih.gov/articles/PMC4441947/

von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X

World Health Organization. (2023). Disease outbreak news: Measles-Indonesia. https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON462

World Health Organization. (2025). Measles. https://www.who.int/news-room/fact-sheets/detail/measles

Authors

Dwiva Wulan Guri
Magister ilmu biomedis, FK UIN syarif hidayatullah jakarta
dwivawguri@gmail.com (Primary Contact)
Anggita Rana Sasmita Lestari
Magister ilmu biomedis, FK UIN syarif hidayatullah jakarta
Wulan Guri, D., & Lestari, A. R. S. (2026). Post-Pandemic Measles Resurgence in Indonesia: Longitudinal Evidence of Immunisation Debt Across 34 Provinces, 2018–2024. Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya, 10(02). https://doi.org/10.30651/jqm.v10i02.31842
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

Copyright (c) 2026 Dwiva Wulan Guri, Anggita Rana Sasmita Lestari

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Lisensi Creative Commons
Qanun Medika by FK UM Surabaya is liscence under Lisensi Creative Commons Atribusi 4.0 Internasional.
Authors retain all their rights to the article published by this journal, such as (but not limited to) the copyright and other proprietary rights relating to the article, such as patent rights; the right to use the substance of the article in own future works, including lectures and books; the right to reproduce the article for own purposes, the right to self-archive the article; the right to enter into separate, additional contractual arrangements for the non-exclusive distribution of the article's published version (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
.

Article Details

No Related Submission Found