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# Since 2021, low vaccine coverage predicts larger measles outbreaks in US counties
- URL: https://www.coios.me/since-2021-low-vaccine-coverage-predicts-larger-measles/
- Published: 2026-10-17T09:15:16.000Z
- Updated: 2026-10-18T12:16:00.000Z
- Description: Since 2021, US counties with lower vaccine coverage have had larger measles outbreaks, and spread to neighbouring counties has increased.
- Author: Daniel Ryan
- Tags: Tomorrow's world, Changing behaviour at scale, Infection and pandemics, United States, #preprint, #refines, #item, #source-2026-10, #score-72

The study analysed annual county-level measles cases and vaccine coverage across United States counties from 2011 to 2025\. In 2011-2020, county vaccine coverage was only weakly associated with outbreak size, and outbreaks mostly stayed within single counties. In 2021-2025, counties with lower coverage had larger outbreaks, and spread to neighbouring counties increased. A spatial statistical model validated over 2021-2025 predicted counties with 10 or more cases with 95% sensitivity and 83% specificity. Mechanistic models using coverage alone performed worse, particularly for larger outbreaks. Intervention effects are projections: a 5-point coverage rise in the top risk decile cut long-term nationwide risk by over 90%.

*Why it is interesting: Measles re-emergence is analysed at county level across 2011 to 2025\. The shift from clustered to wider transmission marks a change in how falling coverage translates into outbreaks.*

Source

[medRxiv, 16 October 2026](https://doi.org/10.64898/2026.10.14.26365590?ref=coios.me)

Paper

Epidemiologic shifts predict spatial patterns of measles re-emergence in the United States

Authors

Kumar CK, Stoffel LA, Warren JL, Blumberg S, Schechter R, Bubar KM et al.

DOI

10.64898/2026.10.14.26365590

Type

Preprint

Design

Ecological analysis of annual US county-level measles cases and vaccine coverage, 2011-2025, with spatial statistical prediction model validated 2021-2025

Verdict

Refines prior evidence

Driver

[Changing behaviour at scale](https://www.coios.me/d-behaviour-change/)

Driver

[Infection and pandemics](https://www.coios.me/d-infectious-disease/)