Fauzi, Mohd Fittri Fahmi (2025) Distribution and incidence of confirmed measles infection and its relationship with vaccination status in Kelantan, 2016-2023. Project Report. Universiti Sains Malaysia. (Submitted)
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Abstract
Background: Despite Malaysia’s long-standing measles elimination programme and good vaccination coverage, Kelantan has recorded recurrent outbreaks, calling into question the adequacy of local population immunity and the role of vaccination to contracting measles risk in Kelantan population. Objective: To describe the distribution of confirmed measles infection, to examine the state and specific incidence rate trends of confirmed measles infection, and to describe the relationship between vaccination status and confirmed measles infection in Kelantan from 2016 to 2023. Methods: A cross-sectional study of surveillance data from the SM2 eMeasles system was undertaken. All 5495 suspected cases notified from January 2016 to December 2023 were analysed. Incidence rates were calculated with Department of Statistics mid-year population denominators and presented by year, district, sex, age and ethnicity. Multivariable logistic regression examined the relationship between vaccination status and confirmed infection, adjusting for age, sex, ethnicity and contact history. Results: Only 398 notifications (7.2%) were laboratory-confirmed. Annual incidence fell from 21.1 per million (2016) to 17.5 (2017), rose sharply to xxi 69.0 (2019) driven by an Orang Asli outbreak in Gua, declined to zero in 2021 during COVID-19 restrictions, and rebounded to 28.5 in 2023, with Pasir Puteh emerging as a new hotspot (11.3 / 100 000). Infants less than 1 year persistently recorded the highest incidence, peaking at 127.4 / 100 000 in 2020. Although the Orang Asli ethnic constitute only a small proportion of all notifications, more than half of the Orang Asli cases investigated (56.4%) were confirmed measles, compared with 6.0% among Malays and 2.1% in other ethnic groups. After adjustment with each covariate, incomplete vaccination (AOR 3.97, 95% CI: 2.69, 5.97) and unvaccinated (AOR 3.51, 95% CI 2.39, 5.27) remained strong predictors of confirmed measles infection compared to complete vaccination. Contact with a measles positive case (AOR 14.80, 95%CI: 9.36, 23.40) and Orang Asli ethnicity (AOR 15.4, 95%CI: 10.5, 22.6) were the other major independent risk factors. Conclusions: This epidemiological analysis of confirmed measles cases in Kelantan from 2016 to 2023 highlights that, despite high national vaccination coverage, significant immunity gaps remain, especially among unvaccinated or partially vaccinated individuals and within marginalized communities such as the Orang Asli. The findings highlighted the crucial role of complete vaccination in reducing confirmed measles infection risk and the need for targeted immunization drives, culturally tailored outreach, and enhanced surveillance efforts to prevent future outbreaks and achieve sustained elimination of measles in the state.
| Item Type: | Monograph (Project Report) |
|---|---|
| Uncontrolled Keywords: | confirmed measles, incidence rate, measles vaccination |
| Subjects: | R Medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RA Public aspects of medicine > RA643-645 Disease (Communicable and noninfectious) and public health |
| Divisions: | Kampus Kesihatan (Health Campus) > Pusat Pengajian Sains Kesihatan (School of Health Sciences) > Monograph |
| Depositing User: | Mr Abdul Hadi Mohammad |
| Date Deposited: | 09 Feb 2026 01:35 |
| Last Modified: | 23 Feb 2026 01:11 |
| URI: | http://eprints.usm.my/id/eprint/63554 |
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