{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:45:19Z","timestamp":1792424719561,"version":"4.5.0"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"24","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,6,24]]},"abstract":"\n Importance<\/jats:title>\n Widespread childhood vaccination has eliminated many infectious diseases in the US. However, vaccination rates are declining, and there are ongoing policy debates to reduce the childhood vaccine schedule, which may risk reemergence of previously eliminated infectious diseases.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate the number of cases and complications in the US under scenarios of declining childhood vaccination for measles, rubella, poliomyelitis, and diphtheria.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A simulation model was used to assess the importation and dynamic spread of vaccine-preventable infectious diseases across 50 US states and the District of Columbia. The model was parameterized with data on area-specific estimates for demography, population immunity, and infectious disease importation risk. The model evaluated scenarios with different vaccination rates over a 25-year period. Inputs for current childhood vaccination rates were based on 2004-2023 data.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were estimated cases of measles, rubella, poliomyelitis, and diphtheria in the US. The secondary outcomes were estimated rates of infection-related complications (postmeasles neurological sequelae, congenital rubella syndrome, paralytic poliomyelitis, hospitalization, and death) and the probability and timing for an infection to reestablish endemicity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n At current state-level vaccination rates, the simulation model predicts measles may reestablish endemicity (83% of simulations; mean time of 20.9 years) with an estimated 851\u202f300 cases (95% uncertainty interval [UI], 381\u202f300 to 1.3 million cases) over 25 years. Under a scenario with a 10% decline in measles-mumps-rubella (MMR) vaccination, the model estimates 11.1 million (95% UI, 10.1-12.1 million) cases of measles over 25 years, whereas the model estimates only 5800 cases (95% UI, 3100-19\u202f400 cases) with a 5% increase in MMR vaccination. Other vaccine-preventable diseases are unlikely to reestablish endemicity under current levels of vaccination. If routine childhood vaccination declined by 50%, the model predicts 51.2 million (95% UI, 49.7-52.5 million) cases of measles over a 25-year period, 9.9 million (95% UI, 6.4-13.0 million) cases of rubella, 4.3 million cases (95% UI, 4 cases to 21.5 million cases) of poliomyelitis, and 197 cases (95% UI, 1-1000 cases) of diphtheria. Under this scenario, the model predicts 51\u202f200 cases (95% UI, 49\u202f600-52\u202f600 cases) with postmeasles neurological sequelae, 10\u202f700 cases (95% UI, 6700-14\u202f600 cases) of congenital rubella syndrome, 5400 cases (95% UI, 0-26\u202f300 cases) of paralytic poliomyelitis, 10.3 million hospitalizations (95% UI, 9.9-10.5 million hospitalizations), and 159\u202f200 deaths (95% UI, 151\u202f200-164\u202f700 deaths). In this scenario, measles became endemic at 4.9 years (95% UI, 4.3-5.6 years) and rubella became endemic at 18.1 years (95% UI, 17.0-19.6 years), whereas poliovirus returned to endemic levels in about half of simulations (56%) at an estimated 19.6 years (95% UI, 14.0-24.7 years). There was large variation across the US population.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Based on estimates from this modeling study, declining childhood vaccination rates will increase the frequency and size of outbreaks of previously eliminated vaccine-preventable infections, eventually leading to their return to endemic levels. The timing and critical threshold for returning to endemicity will differ substantially by disease, with measles likely to be the first to return to endemic levels and may occur even under current vaccination levels without improved vaccine coverage and public health response. These findings support the need to continue routine childhood vaccination at high coverage to prevent resurgence of vaccine-preventable infectious diseases in the US.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.6495","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T12:30:22Z","timestamp":1745497822000},"page":"2176","source":"Crossref","is-referenced-by-count":70,"title":["Modeling Reemergence of Vaccine-Eliminated Infectious Diseases Under Declining Vaccination in the US"],"prefix":"10.1001","volume":"333","author":[{"given":"Mathew V.","family":"Kiang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Population Health, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate M.","family":"Bubar","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, Stanford University, Stanford, California"},{"name":"Department of Pediatrics, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Hotez","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital Center for Vaccine Development, Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston"},{"name":"Department of Biology, Baylor University, Waco, Texas"},{"name":"James A. Baker III Institute of Public Policy, Rice University, Houston, Texas"},{"name":"Hagler Institute for Advanced Study and Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan C.","family":"Lo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"18","key":"joi250029r1","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1001\/jama.298.18.2155","article-title":"Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United 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