Nepal’s rapid detection and response to a measles outbreak in Malangwa Municipality, Sarlahi District, in January 2026 demonstrates how speed in surveillance and action can prevent wider transmission.
Early Detection and Laboratory Confirmation
On 6 January 2026, a pediatrician from a private clinic in Malangwa Municipality reported a suspected measles case to WHO’s surveillance and immunization medical officer (SIMO). A blood sample was collected the same day and transported to the National Public Health Laboratory (NPHL). By 9 January — within 72 hours of detection — laboratory confirmation was received, and shared with local health authorities.
On 12 January, WHO’s immunization field officer, in coordination with municipal health authorities, conducted a joint household visit. Follow-up investigations and rapid case searches among family members and close contacts were initiated immediately, limiting potential silent transmission.
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A WHO Surveillance and Immunization Medical Officer supporting the local Rapid Response Team (RRT) in orienting Female Community Health Volunteers (FCHVs) on measles surveillance, prevention strategies and community awareness measures. Photo credit: WHO Nepal
Escalation and Outbreak Declaration
On 20 January, the same pediatrician notified WHO’s surveillance and immunization medical officer (SIMO) of additional suspected cases within the same community. Municipal health officers and SIMO, along with an immunization field officer (IFO), conducted a joint field investigation on the same day, identifying six suspected cases. Samples were sent to NPHL on 21 January, and vitamin A supplementation was provided without delay.
On 22 January — within 48 hours of notification — NPHL confirmed all samples as measles. Based on laboratory evidence, the National Immunization Programme (NIP) informed Malangwa Municipality Health Section, which officially declared a measles outbreak. Rapid confirmation enabled immediate activation of containment measures.
Coordinated Field Response
Following the outbreak declaration, a WHO team comprising a national level Surveillance Officer, two surveillance and immunization medical officers (SIMOs), three immunization field officers (IFOs), and 11 independent field monitors (IFMs), were deployed to support field investigation and response activities in the affected areas.
A field outbreak response team was quickly formed, including representatives from the community members to ensure trust and access. House-to-house case searches were conducted in 1945 households of affected wards and 271 children were monitored for routine immunization, along with visits to public and religious schools. These intensified efforts identified 34 measles cases — the majority unvaccinated or partially vaccinated.
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Rapid Decision-Making and Outbreak Response Immunization (ORI)
On 23 January WHO supported the National Immunization Program in facilitating a meeting of the National Immunization Advisory Committee (NIAC) to determine the need for outbreak response immunization (ORI) in six high-priority wards.
Following NIAC recommendations, WHO supported NIP in planning and implementing ORI from 26–31 January 2026. Within 4 days of the measles outbreak declaration, a vaccination campaign was rolled out, targeting 7519 children aged 6 months to under 15 years.
The campaign achieved 100% administrative coverage, prioritizing equity and reaching vulnerable populations.
WHO also supported intensive community engagement efforts, sensitizing local leaders, teachers, and Female Community Health Volunteers (FCHVs) to promote measles-rubella vaccination and timely reporting of suspected cases.
Monitoring and Addressing Gaps
Immediately after ORI completion, WHO mobilized Independent Field Monitors to conduct Rapid Convenience Monitoring in all six targeted wards to ensure reach of immunization response in the community.
- Coverage exceeded 95% in each ward
- Over 10,032 eligible children were vaccinated (133% of the initial target).
- Monitoring of 807 children revealed that 15% had missed vaccination during ORI.
Lists of missed children were promptly shared with local authorities for follow-up. The primary reasons for missed doses were gaps in information and communication and service uptake challenges, reinforcing the need for strengthened risk communication strategies.
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Interaction meeting with religious leaders on the measles–rubella vaccination campaign held at Malangwa Municipality, Sarlahi District, to strengthen community engagement and promote vaccine acceptance. Photo credit: WHO Nepal
Expanding Protection to Prevent Further Spread
Recognizing the risk of measles spread to adjoining areas, WHO supported the Ministry of Health and Population (MoHP) in submitting a proposal to the Measles and Rubella Partnership to rapidly implement ORI in neighbouring municipalities of Sarlahi District.
A Collective Responsibility
“This outbreak highlights the risks faced by unvaccinated children. Protecting children from measles requires collective action. Parents, caregivers, teachers, and religious leaders all play a vital role in encouraging vaccination and reporting suspected cases,” said Dr Allison Gocotano, WHO Representative to Nepal, a.i.
Strengthening Systems for the Future
This rapid and coordinated response underscores a critical lesson: Early detection, swift laboratory confirmation, immediate field mobilization, and timely immunization were key to protecting vulnerable children and limiting further spread.
Through close collaboration with the Ministry of Health and Population, provincial and local governments, WHO remains committed to strengthening outbreak preparedness, surveillance systems, and routine immunization services across Nepal.
About Measles:
Measles is one of the most contagious diseases and one of the leading causes of childhood mortality globally. It is spread when an infected person sneezes or coughs. Initial symptoms usually occur 10–14 days after infection and comprise high fever, runny nose, red eyes. Within 3-4 days of fever, a rash develops on the face and neck and will gradually spread downwards. The most severe complications of measles include blindness, encephalitis (an infection that causes brain swelling), severe diarrhea, and pneumonia. Unvaccinated young children and pregnant women are at highest risk of severe measles complications.
Measles and rubella infections are preventable through immunization. The Government of Nepal provides two doses of measles-rubella vaccine free of cost at the age of 9 months and 15 months. In case a child has missed any doses, the child can be vaccinated as early or until 5 years of age. For additional information, contact your nearest health facility.