Behind the Paper: Tackling Measles in Dongola, Sudan — What Surveillance and Immunization Data Revealed
By Alhaj Saad Mohamed Ahmed Ali

Our research began with a fundamental question: Why do measles outbreaks still occur, even in areas where vaccination activities are regularly implemented?
We chose Dongola locality in Northern State, Sudan, as a case study to explore the interaction between immunization efforts and measles surveillance from 2018 to 2021.

Sudan has a long-standing Expanded Programme on Immunization (EPI), supplemented by periodic campaigns. Despite these efforts, sporadic measles outbreaks continued to be reported. This prompted us to examine available data more closely to understand where additional opportunities for strengthening measles control might exist.

Why Dongola?

Dongola is relatively well-resourced compared to other localities, with regular immunization activities and a functioning disease surveillance system. However, the recurrence of measles cases suggested there was value in taking a closer look at how routine immunization and surveillance data align—and how they could be used together to inform elimination strategies.

We used a convergence analysis approach, integrating data from both the immunization program and the national disease surveillance system. Our aim was not to critique existing efforts, but to identify areas where coordination and information use could be further enhanced

What Did We Find?

Our analysis yielded several key observations:

• In some years, measles cases were reported despite high administrative coverage rates, highlighting the importance of continuous follow-up to reach all target populations, particularly children who may not be fully vaccinated

• We noted the presence of “zero-dose” children—those who had not received their first dose of measles vaccine—indicating potential gaps in access or follow-up.

• Supplementary Immunization Activities (SIAs) were conducted periodically, and there may be opportunities to further align these with surveillance findings to ensure they reach the most at-risk populations.

• The sensitivity of the surveillance system appeared to vary slightly over the years, a natural challenge in many contexts, reinforcing the need for ongoing capacity building and support at the facility level.

Why This Matters

Measles remains a key indicator of immunization system performance. While great progress has been made, identifying and reaching unreached children is essential for achieving elimination goals.
This study underscores the value of using available data in a complementary way—not only to monitor progress, but also to inform targeted interventions and planning.

Behind the Numbers

At the heart of this study are the frontline health workers and surveillance officers who continue to carry out essential work under often challenging conditions. Their dedication to recording, reporting, and serving their communities forms the foundation of public health action. This research would not have been possible without their commitment.

Looking Ahead

We hope that this analysis contributes to ongoing efforts to strengthen the use of data in immunization and surveillance systems. By promoting integrated, data-driven decision-making, we believe we can take important steps toward measles elimination in Sudan and similar settings.

Read the full article here: https://doi.org/10.1186/s12982-025-00558-x