Objective To analyze the spatial distribution characteristics of measles in different periods from 2005 to 2020 in China, and provide evidence and suggestions for the development of measles prevention and control measures.

Methods The incidence data of measles in 31 provincial administrative regions (excluding Hong Kong, Macao and Taiwan) in China from 2005 to 2020 were collected from National Population Health Sciences Data-Public Health Sciences data Center. The overall incidence trend of measles in China from 2005 to 2020 was analyzed with SPSS 20.0. Described epidemiological analysis was conducted on the incidence of measles in different periods and ArcGIS 10.8 was used to explore the spatial autocorrelation and cold hot-spot areas of measles incidence during 2005−2008, 2009−2013, and 2014−2020.

Results From 2005 to 2020, the incidence of measles showed a decrease trend in China during different periods, and the difference were significant (trend χ² =536.347, P<0.001). Measles mainly occurred during March-May, and the younger the age, the higher the incidence of measles and the greater the male-to-female sex ratio. The average annual incidence of measles during 2005−2008, 2009−2013 and 2014−2020 were 8.16/100 000, 2.00/100 000 and 1.38/100 000, respectively. The global autocorrelation results showed that the distribution of measles incidence showed spatial autocorrelation and clustering distribution from 2005 to 2008, from 2009 to 2013 and from 2014 to 2020, and the global Moran's I index was 0.20, 0.30 and 0.43, respectively (Z=2.138, P=0.032; Z=2.866, P=0.004; Z=4.375, P<0.001); Local spatial autocorrelation analysis showed that the “high−high” correlation pattern of measles incidence was mainly observed in western China in different periods from 2005 to 2020, but also in Beijing and Tianjin from 2009 to 2013. The results of measles hot spot analysis were basically consistent with the results of local spatial autocorrelation analysis, and the cold spots only existed in Guizhou, Chongqing and Hunan in the central China from 2009 to 2013.

Conclusion The overall incidence of measles in China from 2005 to 2020 showed a downward trend, the measles control effects differed in different age groups, and the incidence of measles in different periods showed obvious spatial clustering, especially in western China. Therefore, the age factor and the western region should be the focus of measles prevention and control in the future.