Background:
Measles is a leading cause of death among young children in Sudan. Coronavirus Disease 2019 (COVID-19) has increased the risk of vaccine-preventable disease outbreaks due to disruptions of Routine Immunization (RI) services, which leaves many children without protection against measles in Sudan. This study aimed to assess the impact of the COVID-19 pandemic on measles epidemiology in Gezira state, from January 2020 to October 2022.

Methods:
We extracted variables of time, place, person, and vaccination status from measles surveillance records of all reported suspected cases and laboratory-confirmed cases(suspected measles cases with positive serum immunoglobulin M(IgM). suspected cases (Anyone with fever and maculopapular rash, at any age)and laboratory-confirmed cases(suspected measles cases with positive serum Immunoglobulin M(IgM). Missing or incomplete records were excluded. Data were analyzed using Epi info 7. A descriptive analysis informs of Attack Rates (AR), Case Fatality Rate (CFR) percentages, frequencies, and percentages were performed.

Results:
A total of 273 suspected and 24 laboratory-confirmed measles cases were reported in the period. Overall, the measles AR has decreased from 0.20 per 100,000 population in 2020, to 0.09 per 100,000 population in 2022. However, Subgroup analysis by age showed around 67% increase in measles AR among children under five (6 per 100,000 in 2020 and 10 per 100000 in 2022 respectively). 16% of confirmed measles cases died during 2020, compared to a 14% CFR in 2021 and zero death in 2022.RI coverage for the first and second doses of measle vaccine decreased by 5% and 21%, in 2020 and 2022 respectively.

Conclusions:
The first year of the Covid-19 pandemic marked the highest measles morbidity among children under five years. Although the measles AR has decreased in 2022, a cohort of susceptible to measles infection has accumulated over the three years. Measles immunization .coverage should be strengthened to prevent future outbreaks