Background: Measles and rubella remain major public health concerns in the Eastern Mediterranean Region (EMR), despite regional elimination goals. In 2023, the region experienced an increase in measles outbreaks. This study assessed outbreak detection and response challenges in either case definition or data analysis, in addition to gaps in laboratory and genotyping data integration to improve preparedness and response. Method: A retrospective epidemiological study was conducted using official World Health Organization (WHO) data on measles and rubella (MR) in EMR countries, from 1 January to 31 December 2023. Routine MR surveillance line list, genotyping data and supplemental immunization activity (SIA) reported by countries were used. Results: In 2023, 1206 suspected measles outbreaks were reported in 13 countries; 942 (78%) were confirmed. Rubella accounted for 158 confirmed outbreaks. Children under 5 years old comprised 76% of cases, with 62% zero dose. Timely detection was achieved in only 46% of outbreaks, with wide national variation. Genotype B3 predominated, but missing genotyping data limited verification. Six immunization campaigns occurred; however, outbreaks persisted due to high zero dose, limited targeting, and delayed responses. Conclusions: Persistent immunity gaps, under detection, inconsistent genotyping, and delayed response hindered MR control in EMR. Strengthening surveillance, integrating epidemiological and molecular data, expanding targeted supplementary immunization activities, and ensuring timely response are essential tasks. Standardized outbreak definitions, capacity building, and regular subnational analyses remain critical to regional elimination goals.

Background: Measles and rubella remain key indicators of immunization system performance and are central to the Immunization Agenda 2030 (IA2030). Disruptions caused by the COVID-19 pandemic have widened immunity gaps and accelerated resurgence of vaccine-preventable diseases across multiple regions. This study assesses progress toward measles and rubella elimination in the WHO Eastern Mediterranean Region (EMR) during 2023–2024. Methods: We conducted a retrospective descriptive analysis of measles and rubella surveillance data, WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), and Joint Reporting Form (eJRF) data for all 22 EMR countries and territories. Key indicators included disease incidence, MCV1 and MCV2 coverage, surveillance performance metrics, and verified elimination status. Results: Regional measles incidence increased from 110.8 to 116.3 per million population, while rubella incidence more than doubled from 1.9 to 4.3 per million. Large outbreaks in Yemen, Iraq, and Afghanistan disproportionally drove regional trends. MCV1 coverage remained stable at approximately 80%, while MCV2 coverage increased marginally from 73% to 75%. Only nine of 22 countries achieved ≥95% coverage for both doses in 2024. Persistent zero-dose populations, high dropout rates, and ongoing immunity gaps sustained transmission across multiple settings. Conclusions: The EMR remains off track to achieve measles and rubella elimination by 2030. Accelerated, equity-focused efforts are urgently needed to strengthen routine immunization systems, reduce zero-dose population, enhance surveillance capacity, and improve outbreak response—particularly in fragile and conflicted-affected settings.