key: cord-1023562-55qnpxjp authors: Rana, Muhammad Suleman; Usman, Muhammad; Alam, Muhammad Masroor; Ikram, Aamer; Zaidi, Syed Sohail Zahoor; Salman, Muhammad; Sharif, Salman; Umair, Massab; Khurshid, Adnan; Mujtaba, Ghulam title: Impact of COVID-19 pandemic on Measles surveillance in Pakistan date: 2020-10-08 journal: J Infect DOI: 10.1016/j.jinf.2020.10.008 sha: fb14c0472483f377ea02bcdf9ae08a858095de4a doc_id: 1023562 cord_uid: 55qnpxjp nan Dear Editor, We read with great interest the article entitled "Decline in invasive pneumococcal disease during COVID-19 pandemic in Taiwan" by Hung-Jen Tang et at [1] . Authors discussed the decline in invasive pneumococcal disease and here we would like to present the decline in measles cases in Pakistan during the COVID-19 pandemic. Measles is a highly contagious viral disease which affects susceptible individuals of all ages and remains one of the leading causes of morbidity and mortality among young children and caused an estimated 2.6 million deaths each year across the globe. Because of vaccination, more than 21 million lives have been saved and measles deaths have been reduced by 80% since 2000. Despite the availability of a safe and effective vaccine from last fifty years many countries around the world are experiencing measles outbreaks. As of 5 November 2019, there have been 413,308 confirmed measles cases reported to WHO and more than 140,000 people died from measles in 2018 and 110,000 in 2017 [2] . The present study was conducted to compare the total number of measles cases reported during COVID-19 epidemic in the 2020 season versus same season in 2019. We comparatively analyzed the data of Measles cases reported between January to August Institute of Health (NIH), Islamabad, which is the only public sector laboratory providing free-of-cost services in diagnosing cases of clinically suspected Measles reported from all over Pakistan. In Pakistan, Measles is a notifiable disease for which the case investigation and reporting is mandatory for all public as well as private clinicians. A total of 3253 Measles cases were reported during the first 8 months in 2020 versus 6536 measles cases were reported during the same period in 2019, which were much higher than that of 2020. Comparatively in 2020, there was a 50% reduction with significant difference P<0.001 in total number of measles cases as compared to 2019. During the first quarter of 2020 percent coverage which is needed to prevent outbreaks [6] . However, during pandemics it is very important to maintain good immunization coverage to avoid outbreaks of vaccine-preventable diseases that could increase the burden on fragile health care system. It is concluded that, the health authorities must ensure that the surveillance systems do not collapse. Continuous surveillance and monitoring in the coming months will help to better understand the epidemiology of Measles, in particular any resurgence of cases once containment measures are lifted. Under-diagnoses and under-reporting during the coronavirus disease (COVID-19) pandemic should be ruled out before concluding the decline in measles circulation. Decline in invasive pneumococcal disease during COVID-19 pandemic in Taiwan Measles -Global situation: Available at The COVID-19 Pandemic and Tuberculosis in Taiwan Seasonal influenza activity during the SARS-CoV-2 outbreak in Japan COVID-19 policies: Remember measles Pakistan, missed immunizations drive new disease fears: Available at The authors extend their gratitude to the World Health Organization surveillance staff and National Institute of Health Islamabad for their technical support. MSR, AI, SSZZ and MS conceived and designed the study. MSR, MU, MMA, MT and AD were responsible for data collection, lab testing, data analysis. MSR and MMA wrote the manuscript draft.