Progress towards measles and rubella elimination in Lesotho, 2011-2025

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.

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.

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.

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.