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Hidden Burden of a Measles Outbreak Revealed by Genomic and Transmission Models

Marye, A.; Toth, D. J. A.; Vega Yon, G.; Wagoner, J.; Lofgren, E. T.; Samore, M. H.; Pavia, A. T.; Nolen, L. D.; Komatsu, K.; Oakeson, K.; Keegan, L. T.

2026-07-15 infectious diseases
10.64898/2026.07.09.26357695 medRxiv
Show abstract

Declining childhood vaccination rates have fueled a resurgence of measles in the United States. Surveillance systems may not accurately measure the true extent of outbreaks. As of May 2026, the largest ongoing measles outbreak in the United States originated along the Utah-Arizona border in a community with high vaccine exemption rates and limited engagement with healthcare systems, leading to incomplete testing and reporting. To quantify the true outbreak size, we used two independent approaches with complementary data sources: a phylodynamic analysis and an agent-based model. Both methods found significant underreporting, estimating the true outbreak size to be 3.1- to 4.8-fold larger than reported, with confirmed cases representing only 20.96%-32.5% total infections. These findings suggest that substantial underreporting of measles occurs, especially in tight knit communities. The use of complementary analytical approaches to evaluate completeness of reporting can reveal the extent of measles transmission and aid control efforts.

Matching journals

The top 2 journals account for 50% of the predicted probability mass.

1
Nature Communications
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39.8%
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2
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3
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9
Science Advances
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10
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11
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12
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13
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14
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0.9%
16
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18
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20
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"Similar papers" are the closest papers from that journal in the model's embedding space. They show what the match is built on, but the ranking comes mostly from a classifier over the whole training set, not from these examples alone.