---
title: "Progress toward measles and rubella elimination in Lesotho, 2011–2025"
id: "plos-one-4-progress-towards-measles-and-rubella-elimination-in-lesotho-2011-2025"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-4-progress-towards-measles-and-rubella-elimination-in-lesotho-2011-2025"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555"
published_at: "2026-09-16T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Progress toward measles and rubella elimination in Lesotho, 2011–2025
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-4-progress-towards-measles-and-rubella-elimination-in-lesotho-2011-2025
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555)
- **Published At:** 2026-09-16T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- Lesotho (population ~2.38 million in 2026) has long supported routine immunization and introduced **MCV1** at 9 months and **MCV2** at 18 months; **RCV** was added in 2017 replacing monovalent measles vaccine with the combined **MR** vaccine. - This retrospective review used WHO/UNICEF coverage estimates (WUENIC), SIA administrative and post-campaign survey data, and WHO AFRO case-based surveillance records for 2011–2025 to assess progress toward WHO measles-rubella elimination targets. - From 2011–2016 **MCV1** coverage was ≥90% but consistently below the 95% elimination target; MCV1 dipped to 84% (2022) and 76% (2023) then rebounded to 90% in 2024. **MCV2** coverage exceeded 80% only in 2011–2012 and was persistently lower thereafter with high MCV1–MCV2 dropouts. - SIAs were conducted every 2–5 years; administrative campaign coverage varied (45.1% in 2022 to 91.0% in 2010) and PCCS estimates (where available) ranged from 83.7% (2025) to 94.3% (2010). The 2022 campaign lacked a PCCS; reported 2022 administrative coverage was very low. - Case-based surveillance met the principal performance indicators for most years: non-measles febrile rash illness rate exceeded the 2/100,000 target and ≥80% of districts reported ≥1 suspected case with specimen in most years. Lesotho lacks CRS sentinel surveillance and has not documented measles or rubella genotypes in global databases. - Measles incidence was <1 per million in 2011–2015 and <5 per million in 2016–2019, but increased after the COVID-19 period with incidence of 7.4 (2023) and 9.7 (2025) per million. Rubella incidence was high before MR introduction (33.4–142.3 per million in 2012–2014), declined after RCV introduction in 2017, but rose again in 2022–2023. - Main programmatic gaps: low and inconsistent **MCV2** uptake, SIA planning and implementation shortfalls (notably 2022), population denominator inaccuracies affecting coverage estimates, lack of CRS surveillance and viral genotyping, and periodic accumulation of susceptible children leading to outbreaks. - Recommended actions reported: strengthen second-year-of-life platform to improve **MCV2**, enhance social mobilisation and SIA planning, resolve denominator issues via robust methods, implement CRS surveillance and systematic measles/rubella virus genotyping, and pursue regional coordination to limit cross-border importations.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0358555) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#citedHeader) * 0 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555#discussedHeader) Open Access Peer-reviewed Research Article # Progress towards measles and rubella elimination in Lesotho, 2011–2025 * Yankuba Singhateh , Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Writing – original draft, Writing – review & editing * E-mail: ysinghateh@yahoo.com Affiliations Vaccine Preventable Disease Program, East and Southern Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe, Epidemiology and Disease Control Unit, Directorate of Public Health Services, Ministry of Health, Banjul, The Gambia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-4008-5999 ](https://orcid.org/0000-0002-4008-5999 "ORCID Registry") ⨯ * Tshepiso Mechele Matoko, Roles Conceptualization, Data curation, Methodology, Writing – review & editing Affiliation National Immunisation Program, Ministry of Health, Maseru, Lesotho ⨯ * Mannini Shaabe, Roles Conceptualization, Data curation, Methodology, Writing – review & editing Affiliation World Health Organization Lesotho Country Office, Maseru, Lesotho ⨯ * Selloane Amelia Maepe, Roles Conceptualization, Resources, Writing – review & editing Affiliation Independent Consultant, Maseru, Lesotho ⨯ * Francis Dumobong Ngmenasong Abobo, Roles Methodology, Resources, Validation, Writing – review & editing Affiliation World Health Organization Lesotho Country Office, Maseru, Lesotho ⨯ * Sarah Waithera Wanyoike Roles Supervision, Validation, Writing – review & editing Affiliation Vaccine Preventable Disease Program, East and Southern Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe ⨯ # Progress towards measles and rubella elimination in Lesotho, 2011–2025 * Yankuba Singhateh, * Tshepiso Mechele Matoko, * Mannini Shaabe, * Selloane Amelia Maepe, * Francis Dumobong Ngmenasong Abobo, … * Sarah Waithera Wanyoike ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 16, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0358555) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358555) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0358555) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0358555) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0358555) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#abstract0) * [1. Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#sec005) * [2. Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#sec006) * [3. Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#sec010) * [4. Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#sec014) * [5. Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#sec016) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0358555) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555) ## Abstract ### Background Lesotho, a lower middle-income country in southern Africa, has historically had relatively high routine immunization coverage over the last three decades. Since 1996, the country has been implementing measles elimination strategies. This manuscript evaluates Lesotho’s performance, from 2011 to 2025, against the World Health Organization’s criteria for measles and rubella elimination. ### Methods We conducted a retrospective review of Lesotho’s immunization and surveillance data during 2011–2025. This included Lesotho’s annual WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) for routine measles-containing vaccine (MCV) doses; performance in the periodic measles rubella vaccination campaigns and case-based surveillance; and the trends of measles and rubella incidences. ### Results During 2011–2025, MCV1 coverage generally remained ≥90% but failed to reach the 95% elimination target. MCV2 coverage reached 80% in 2011 and 2012 before declining in subsequent years. Lesotho has mostly attained the targets for surveillance performance according to the two principal performance indicators – non-measles febrile rash illness rate and the proportion of districts that report a minimum of one suspected case. From 2011 to 2015, measles incidence stayed below one per 1 million population in Lesotho. However rubella incidence ranged between 33.4 in 2012 to 142.3 in 2014, and declined significantly after MR introduction in 2017. ### Conclusion Lesotho has made significant progress in measles and rubella elimination efforts. To sustain the gains made, the country should work to strengthen vaccination in the second year of life, reinforce demand generation during preventive campaigns, address population denominator inaccuracies that hinder accurate coverage tracking, and systematically document measles and rubella virus genotypes. ## Figures ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.t003) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.t003) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.t002) **Citation:** Singhateh Y, Matoko TM, Shaabe M, Maepe SA, Abobo FDN, Wanyoike SW (2026) Progress towards measles and rubella elimination in Lesotho, 2011–2025. PLoS One 21(9): e0358555. https://doi.org/10.1371/journal.pone.0358555 **Editor:** Omar Enzo Santangelo, Regional Health Care and Social Agency of Lodi, ITALY **Received:** July 15, 2026; **Accepted:** September 2, 2026; **Published:** September 16, 2026 **Copyright:** © 2026 Singhateh et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** All relevant data for this study are publicly available from the WHO/UNICEF estimates of national immunization coverage website ( ). **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## 1. Introduction Lesotho is a mountainous landlocked country with an estimated total population of 2,379,237 people as of 2026 [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref001)]. It is a lower-middle-income country with a GDP per capita of 1,001 USD by 2024 [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref002)]. Lesotho has one of the world’s highest HIV infection rates with a 25.6% adult prevalence as of 2022 [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref003)]. The country is divided into 10 districts each managed by a district health management team that oversees implementation of public health activities including immunization. Immunization is one of the pillars of Lesotho’s national health policy and a primary strategy for improving child survival. Lesotho has an estimated 42,540 annual live births, as of 2025 [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref001)]. Since the launch of the Expanded Program on Immunization (EPI), immunization services have been provided free-of-charge. Of the 315 total functional health facilities, 214 were providing immunization services as of 2023 [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref002)]. The health facility-based service delivery is the predominant service delivery strategy for routine immunization. But non-facility-based strategies (including outreach and mobile sites) remain essential for reaching remote and hard-to-reach communities [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref002),[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref004)]. The first dose of measles-containing vaccine (MCV1) has been part of the EPI schedule since its inception and is administered at nine months of age. The second MCV dose (MCV2), given at 18 months, was introduced in 2001. Rubella-containing vaccine (RCV) was introduced in 2017, leading to the replacement of the monovalent MCV with the combined measles-rubella (MR) vaccine, as recommended by WHO [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref004)]. The African Regional goal of measles elimination, is defined by the programmatic targets of achieving a minimum of 95% coverage of 2 timely administered MCV doses, attaining the performance standards for measles case based surveillance, and reducing measles incidence to less than 1 case per million population. This goal has been included and endorsed in the global Immunization Agenda 2030 (IA2030) [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref005),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref006)]. The commitment towards measles elimination has been made by all 6 WHO regions and over 60 million measles-related deaths have been prevented by immunization worldwide between 2000 and 2025 [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref006)]. Despite global progress in reducing measles cases and deaths, member countries of the WHO African Region have had challenges in meeting the regional measles-rubella elimination targets [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref005),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref006)]. A significant milestone was achieved in 2025 when Cabo Verde, Seychelles and Mauritius became the first sub-Saharan African countries to join the 94 and 133 other countries around the world to have attained measles and rubella elimination statuses, respectively. This means that the 3 countries, as documented by a standard functional case-based surveillance system, were able to confirm they have interrupted endemic measles and rubella transmission for at least 36 months [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref007)]. The verification of the three countries comes in the background of Regional progress registered in measles elimination over the years, with an estimated 91% reduction in measles-related deaths in the African Region between the years 2000 and 2024 [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref006)]. Countries in the southern African sub-region have historically had relatively high routine immunization coverage and lower measles incidences compared to the rest of the African Region. In 2002, following the initial few years of implementation of measles mortality reduction strategies in southern Africa, including in Lesotho, it was reported that measles incidence declined to less than one per million population [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref008)]. However, in the past two decades, recurrent measles outbreaks have been documented in countries in the southern African subregion [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref009)]. This manuscript examines Lesotho’s performance through the end of 2025, against the World Health Organization’s criteria for measles elimination. ## 2. Methods ### Routine immunization The study utilized a retrospective design to evaluate Lesotho’s immunization landscape. Routine immunization data were analyzed using the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) for MCV1 and MCV2 from 2011 to 2025. These estimates are derived from administrative data aggregated from health facility records to the national level and supplemented by available survey results [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref010),[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref011)]. ### Supplemental immunization Due to the sub-optimal routine immunization coverage, there is continuous accumulation of measles susceptible children. Supplemental immunization activities (SIAs) are therefore implemented periodically; every 2–4 years using different strategies to reach every eligible child. During SIAs, vaccination teams do tally each vaccine dose given and at the end of each vaccination day, aggregate data is transmitted to the next higher levels (district and national levels). This study reviewed and analysed the MCV administrative coverage and post-campaign coverage survey (PCCS) estimates of SIAs conducted in Lesotho during 2011–2025. ### Measles surveillance and disease incidence Measles and rubella case-based surveillance data were extracted from the WHO AFRO database for the 2011–2025 period. Vaccine preventable diseases surveillance, including measles case-based surveillance, is under the purview of the National Immunisation Program of Lesotho. Measles case-based surveillance reports originate at and are passed from the health facility level to the respective upper levels until it reaches the national level. Samples collected from suspected cases are processed at the national measles serology lab. The Measles Serology Laboratory of Lesotho is part of the network of laboratories in the WHO African Region using a standardized testing protocol [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref012)]. According to the protocol, samples taken from suspected measles cases who meet the standard case definition should first be tested for measles-specific immunoglobulin M (IgM) antibodies. Sample specimens that test negative for measles are tested for rubella IgM. In addition to measles IgM positivity, measles cases are confirmed by epidemiological linkage and based on clinical compatibility, as per the WHO African regional measles surveillance guidelines [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref013)]. Surveillance sensitivity was measured against two principal performance indicators. The non-measles febrile rash illness rate which has a target of at least 2 cases per 100,000 population; and the proportion of districts reporting at least one case of suspected measles with a blood specimen, with a target of at least 80% per year [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone.0358555.ref013)]. The impact of measles and rubella elimination is monitored by calculating the annual incidence rate of confirmed measles and confirmed rubella, expressed as rates per 1 million population. ## 3. Results ### Immunization activities From 2011 to 2016, first dose of measles-containing vaccine (MCV1) coverage consistently reached ≥90% in Lesotho but fell short of the 95% coverage target. The lowest MCV1 performance levels, for the period under review, were recorded in 2022 and 2023 at 84% and 76% respectively. The country’s MCV1 coverage recovered back to 90% in 2024. During 2011–2024, MCV2 coverage of ≥ 80% was registered in 2011 and 2012 with MCV1-MCV2 dropouts of 10% and 9% respectively. Thereafter, MCV2 coverage was consistently lower than 80% with high MCV1-MCV2 dropout rates (>10%) during 2013–2024 except for 2023 ([Fig 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358555#pone-0358555-g001)). [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358555.g001)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0358555.g001 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=10.1371/journal.pone.0358555.g001) * [TIFF original image](https://journals.plos.org/plosone/article/figure/image?download&size=original&id=10.1371/journal.pone.0358555.g001) Fig 1. WHO UNICEF Coverage Estimates for First and Second Dose Measles Vaccination, Lesotho, 2011–2024. [ https://doi.org/10.1371/journal.pone.0358555.g001](https://doi.org/10.1371/jour
## Related Clinical Research

- [COVID-19 mortality among people with HIV in Florida before and after COVID-19 vaccine availability](https://medichelpline.com/clinical-feed/plos-one-13-covid-19-mortality-risk-among-people-with-hiv-in-florida-before-and-after-the.md)
- [HIV-1 Transmitted Drug Resistance in Shanghai (2018–2024): Mobility Fuels Cross-Population Spread](https://medichelpline.com/clinical-feed/pubmed-42758933.md) (DOI: 10.1080/22221751.2026.2731504)
- [ADAMTS13 as a thromboinflammatory brake at the vascular–immune interface — article content not pre](https://medichelpline.com/clinical-feed/frontiers-in-immunology-18-adamts13-as-a-thromboinflammatory-brake-at-the-vascular-immune-interface-from.md)
- [HIV self-testing (HIVST) and the diagnostic gap: a decade of missed scale-up](https://medichelpline.com/clinical-feed/plos-medicine-0-hiv-self-testing-and-the-global-diagnostic-gap-addressing-a-decade-of-missed.md)
- [Temporal patterns of tuberculosis-associated hyperglycaemia and effects on treatment outcomes in n](https://medichelpline.com/clinical-feed/plos-one-0-temporal-patterns-of-tuberculosis-associated-hyperglycaemia-and-its-effect-on.md)

## Navigation
- [← Back to Infectious Disease Feed](https://medichelpline.com/clinical-feed/infectious-disease.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.