Time Series Forecasting of Measles Incidence in Pakistan, 2014–2024

Measles remains endemic in Pakistan despite global vaccine efforts to prevent its transmission. This study sought to identify the patterns of measles cases in Pakistan, understand the reasons for its recurrence, and determine the optimal timing for measles vaccine campaigns in Pakistan to be most effective. As such, a time series analysis of the monthly measles incidence in Pakistan from 2014 to 2024, obtained from World Health Organization's international measles database, was performed to identify temporal patterns in infections. An increasing trend was identified in the monthly measles cases overtime, along with seasonal swings of low occurrences during the summer, with average lows reaching 304 cases, and a rise during the winter months, with average highs reaching 1038 cases. An automated Seasonal Auto-Regressive Integrated Moving Average (SARIMA) model was further applied to forecast the future incidence of measles, which revealed a three-fold increase in measles cases in the next two years, compared with 2023-2024. Low routine vaccine coverage, topped with climate change related migration and subsequent crowding in urban spaces were found to be major contributors to measles transmission in the country. Findings suggest that supplementary vaccination campaigns are essential and if held in August-September, can mitigate the anticipated rise in measles transmission beginning October every year.