Measles is a disease that has resurfaced as a public health concern in Malaysia. Malaysia has had a Measles Elimination Program in place since 2004, but the incidence of measles in Pahang has not improved significantly. The purpose of this study was to describe the incidence and trend of measles in Pahang, as well as to identify the risk factors. The five-year population-based surveillance data of the entire Pahang state was extracted and analyzed for the trend and incidence of measles from January 2016 to December 2020. Multiple logistic regression was used to examine the relationship between measles and available sociodemographic data. A total of 2844 reported measles cases were investigated. Out of the measles cases reported, 7.41 percent were confirmed. According to the five-year fluctuating trend, the incidence rate ranges from 13.51 to 50.97 per 1,000,000 population. Confirmed measles was significantly associated with an indigenous background (AdjOR = 4.90, 95% CI: 1.74, 13.78), history of contact with measles cases (AdjOR = 14.03, 95% CI: 8.23, 23.90), and incomplete vaccination (AdjOR = 3.38, 95% CI: 2.28, 5.01). In conclusion, the incidence of measles in Pahang remains sporadic, owing to sporadic outbreaks. Vaccination is an important preventive measure that must reach out to the isolated populations such as indigenous people.

Objectives: Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions.Methods: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, PM2.5 levels, relative humidity, and temperature, to determine their impact on measles infection risk.Results: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02–1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42–141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07–2.69), travel history (aOR, 2.30; 95% CI, 1.13–4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72–0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16–2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97–0.99) were significant determinants.Conclusion: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

Measles remains a significant global public health concern, particularly in Malaysia. Despite national vaccination coverage exceeding 90%, measles continues to persist, highlighting the need for a deeper understanding of the multifaceted factors influencing its transmission dynamics. This study aimed to explore the determinants of measles incidence in Malaysia, focusing on local demographic profiles, healthcare-related factors, and environmental factors at the district level from 2018 to 2022. Data for this study were collected from the e-measles database of Malaysia’s Ministry of Health, including statistics on the number of cases reported in each district. Additionally, vaccination coverage data were obtained from the Malaysian Health Informatics Centre. Local demographic profiles, such as median household income, population density, and urbanisation, were sourced from the Department of Statistics Malaysia (DOSM). Data on the number of health and rural clinics were also extracted from DOSM. Environmental data, including relative humidity, temperature, and PM2.5 levels, were obtained from the Department of Environment (DOE). A negative binomial mixed-effects model was employed for data analysis using R software, and the results were interpreted to identify significant determinants of measles incidence. The analysis revealed that median household income (adjusted incidence rate ratio [aIRR] 1.02, 95% confidence interval [CI]: 1.01, 1.03) and the number of health and rural clinics (aIRR 1.02, 95% CI: 1.01, 1.04) were positively associated with measles incidence. Conversely, temperature (aIRR 0.85, 95% CI: 0.74, 0.99) and the year of observation (aIRR 0.51, 95% CI: 0.47, 0.56) were negatively correlated with measles incidence. These findings highlight the complex interplay between socioeconomic, healthcare, and environmental factors in measles transmission, underscoring the need for comprehensive public health strategies to maintain high vaccination rates and adapt to varying local conditions.

The distribution of measles varies worldwide. Malaysia has seen fluctuating incidence rates of measles across its districts, highlighting the persistent challenge of measles control despite national vaccination efforts. This study aimed to map the incidence rates of measles and identify hotspots areas of measles in Malaysia between 2018 and 2022. The study utilized secondary data from the Disease Control Division, Ministry of Health Malaysia, and was analyzed through spatial autocorrelation techniques. Choropleth map applied to the incidence rate of measles and Global Moran’s I statistics quantified spatial autocorrelation, supplemented by local indicators of spatial association (LISA) for localized analysis. The measles incidence rate exceeded 500 per million population in Bintulu, Marudi, and Miri, Sarawak in 2018 and in Gua Musang, Kelantan in 2019. There is a downward trend in the incidence rate across the districts in Malaysia. The Global Moran’s I statistic revealed significant positive spatial autocorrelation of measles cases in Malaysia from 2018 to 2022. Districts, specifically in Klang Valley, have been identified as persistent hotspot areas. There is a need for continuous surveillance, adequate vaccination coverage, and supplementary public health measures, especially in identified hotspot areas, in order to achieve measles elimination goals in Malaysia.