{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T16:10:01Z","timestamp":1758730201970,"version":"3.44.0"},"reference-count":11,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Sustaining measles elimination in the US requires high population-level vaccination coverage. Postelimination outbreaks expose persistent immunity gaps, especially in underimmunized communities. Understanding vaccination trends after such outbreaks is critical for public health responses and preparedness.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate changes in measles-mumps-rubella (MMR) vaccination coverage after a large postelimination measles outbreak in a major US pediatric primary care population.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This repeated, surveillance cross-sectional study was conducted at an extensive central Ohio pediatric primary care network that served approximately 150\u202f000 children at the following 3 time points: outbreak onset (October 8, 2022), 12 months (October 8, 2023), and 20 months (June 8, 2024). Children younger than 15 years with 1 well-child visit or more in the prior 24 months were analyzed. Children of Somali descent were analyzed as a prespecified subgroup.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Receipt of valid MMR vaccine doses per Centers for Disease Control and Prevention guidelines.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Primary outcomes were (1) timely MMR vaccine 1 receipt by 16 months of age, (2) timely MMR vaccine 2 receipt 28 days or more after MMR vaccine 1 and by 84 months of age, and (3) receipt of 1 valid MMR dose or more by 84 months of age. Coverage was assessed at each time point. Risk differences were estimated using binomial generalized linear models with an identity link. The secondary outcome was MMR coverage stratified by Somali descent.<\/jats:p><\/jats:sec>Results<\/jats:title>At 20 months after measles onset, the cohort included 149\u202f092 children (median [IQR] age, 7.96 [4.23-11.50] years; 76 469 [51.3%] male; 12 880 [8.6%] Somali descent and 136 212 [91.4%] non-Somali descent). Timely MMR vaccine dose 1 coverage remained unchanged (66\u202f143 of 123\u202f490 [53.6%] at 0 months and 74\u202f157 of 138\u202f301 [53.6%] at 20 months; risk difference, 0.1 percentage points; 95% CI, \u20130.3 to 0.4 percentage points; P<\/jats:italic>\u2009=\u2009.76). Timely MMR vaccine dose 2 coverage increased modestly (44\u202f210 of 76\u202f410 [57.9%] at 0 months and 50\u202f875 of 84\u202f576 [60.2%] at 20 months; risk difference, 2.3 percentage points; 95% CI, 1.7-2.8 percentage points; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Receipt of at least 1 MMR dose by 84 months of age increased from 59\u202f049 of 76\u202f410 (77.3%) at 0 months to 65\u202f891 of 84\u202f576 (77.9%) at 20 months (risk difference, 0.6 percentage points; 95% CI, 0.2-1.0 percentage points; P<\/jats:italic>\u2009=\u2009.003). Children of Somali descent had significantly lower timely MMR vaccine dose 1 coverage at all time points (overall risk difference at baseline, \u201319.7 percentage points; 95% CI, \u201320.7 to \u201318.8 percentage points; P<\/jats:italic> &amp;lt; .001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this repeated cross-sectional study of 149\u202f092 children in a large central Ohio primary care network during the 20 months after outbreak onset, all measures of MMR coverage remained well below the 93% herd immunity threshold. These persistent, population-wide immunity gaps suggest the need for sustained, equity-focused public health strategies to maintain measles elimination.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.33732","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T15:31:14Z","timestamp":1758727874000},"page":"e2533732","source":"Crossref","is-referenced-by-count":0,"title":["Measles Vaccination Coverage After a Postelimination Outbreak"],"prefix":"10.1001","volume":"8","author":[{"given":"Rosemary A.","family":"Martoma","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of General Pediatrics, Boston Children\u2019s Hospital, Boston"},{"name":"KidsMates Inc, Boca Raton, Florida"},{"name":"Florida Atlantic University, Schmidt College of Medicine, Boca Raton"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua C.","family":"Martoma","sequence":"additional","affiliation":[{"name":"KidsMates Inc, Boca Raton, Florida"},{"name":"College of Computing, Data Science, and Society, University of California, Berkeley"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maimuna S.","family":"Majumder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"},{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"issue":"12","key":"zoi250947r1","doi-asserted-by":"publisher","first-page":"S420","DOI":"10.1093\/infdis\/jiaa793","article-title":"Measles in the 21st century: progress toward achieving and sustaining elimination.","volume":"224","author":"Gasta\u00f1aduy","year":"2021","journal-title":"J Infect Dis"},{"key":"zoi250947r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100533","article-title":"Modeling vaccination coverage during the 2022 central Ohio measles outbreak: a cross-sectional study.","volume":"23","author":"Martoma","year":"2023","journal-title":"Lancet Reg Health Am"},{"issue":"3","key":"zoi250947r4","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1093\/cid\/ciab979","article-title":"Maintenance of measles elimination status in the United States for 20 years despite increasing challenges.","volume":"75","author":"Mathis","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"41","key":"zoi250947r5","doi-asserted-by":"publisher","first-page":"925","DOI":"10.15585\/mmwr.mm7341a3","article-title":"Coverage with selected vaccines and exemption rates among children in kindergarten\u2014United States, 2023\u201324 school year.","volume":"73","author":"Seither","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"8","key":"zoi250947r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.29696","article-title":"Epidemiologic analysis of a postelimination measles outbreak in central Ohio, 2022-2023.","volume":"7","author":"Martoma","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi250947r7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1001\/jama.2022.23241","article-title":"Amid Ohio measles outbreak, new global report warns of decreased vaccination during COVID-19 pandemic.","volume":"329","author":"Abbasi","year":"2023","journal-title":"JAMA"},{"issue":"45","key":"zoi250947r11","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.15585\/mmwr.mm7345a4","article-title":"Progress toward measles elimination\u2014worldwide, 2000\u20132023.","volume":"73","author":"Minta","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"zoi250947r2","unstructured":"Centers for Disease Control and Prevention. Measles vaccination. Updated January 4, 2024. Accessed July 21, 2025. https:\/\/www.cdc.gov\/measles\/vaccines\/index.html"},{"key":"zoi250947r8","unstructured":"Centers for Disease Control and Prevention. Measles cases and outbreaks. Updated July 16, 2025. Accessed July 21, 2025. https:\/\/www.cdc.gov\/measles\/data-research\/index.html"},{"key":"zoi250947r9","unstructured":"Sun? LH. US measles cases reach 33-year high as outbreaks spread. The Washington Post. Published July 7, 2025. Accessed July 21, 2025. https:\/\/www.washingtonpost.com\/health\/2025\/07\/07\/measles-cases-hit-record"},{"key":"zoi250947r10","unstructured":"Corum? J, Rosenbluth? T. Tracking US measles outbreaks. New York Times. Published April 15, 2025. Accessed April 16, 2025. https:\/\/www.nytimes.com\/interactive\/2025\/health\/measles-outbreak-map.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2839282\/martoma_2025_oi_250947_1758058610.22135.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T15:31:16Z","timestamp":1758727876000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2839282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":11,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.33732","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]}}}