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.
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