{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:53:55Z","timestamp":1792785235253,"version":"4.5.0"},"reference-count":57,"publisher":"National Academy of Sciences","issue":"17","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018818","name":"National Research, Development and Innovation Office","doi-asserted-by":"publisher","award":["2024-1.2.3-HU-RIZONT-2024-0003"],"award-info":[{"award-number":["2024-1.2.3-HU-RIZONT-2024-0003"]}],"id":[{"id":"10.13039\/501100018818","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["ALLRP 576914-22"],"award-info":[{"award-number":["ALLRP 576914-22"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ontario Fund for Research Excellent","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:p>\n                    The resurgence of measles in the United States, driven by declining childhood vaccination coverage, poses a substantial public health and economic threat. Using county-level Measles\u2013Mumps\u2013Rubella (MMR) vaccine coverage data and spatial incidence models, we quantified the economic burden of measles in 2025 and projected the impact of continued declines in vaccine uptake. In 2025, the estimated cost per measles case was $104,629 [50% high-density interval (HDI): $100,729 to $110,140], yielding a national burden of $244.2 million (50% HDI: $69.9 to $872.5 million). The cost per case varied widely across counties and was inversely correlated with local population immunity levels (Spearman correlation = \u22120.75,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001). We modeled a scenario in which coverage among children aged 0 to 6 y declined by 1% per year, reaching a 5% absolute reduction by year 5 relative to baseline. Under this scenario, we projected a nonlinear surge in cases, hospitalizations, and annual expenditures arising from outbreak response, direct medical costs, and productivity losses. This scenario produced 17,232 (50% HDI: 9,177 to 26,428), 4,085 (50% HDI: 2,184 to 6,210) hospitalizations, 36 (50% HDI: 19 to 54) deaths, and $1.50 (50% HDI: $0.90 to $2.85) billion in annual costs in 2030, with a cumulative cost of $7.77 billion (50% HDI: $5.56 to $11.58 billion) over 5 y. These findings demonstrate that even marginal reductions in MMR vaccine uptake can result in disproportionately large health and economic burdens.\n                  <\/jats:p>","DOI":"10.1073\/pnas.2605971123","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T18:02:37Z","timestamp":1776189757000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":5,"title":["The health and economic repercussions of declining MMR coverage in the United States"],"prefix":"10.1073","volume":"123","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1370-8350","authenticated-orcid":false,"given":"Chad R.","family":"Wells","sequence":"first","affiliation":[{"name":"Center for Infectious Disease Modeling and Analysis, Yale School of Public Health","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4578-7487","authenticated-orcid":false,"given":"Abhishek","family":"Pandey","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Modeling and Analysis, Yale School of Public Health","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Ye","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Modeling and Analysis, Yale School of Public Health","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Bawden","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Modeling and Analysis, Yale School of Public Health","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Giglio","sequence":"additional","affiliation":[{"name":"The Common Health Coalition","place":["New York"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene","family":"Wong","sequence":"additional","affiliation":[{"name":"The Common Health Coalition","place":["New York"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Velda","family":"Wang","sequence":"additional","affiliation":[{"name":"The Common Health Coalition","place":["New York"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Cipriano","sequence":"additional","affiliation":[{"name":"The Common Health Coalition","place":["New York"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamia","family":"Ayaz","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Modeling and Analysis, Yale School of Public Health","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gergely","family":"R\u00f6st","sequence":"additional","affiliation":[{"name":"National Laboratory for Health Security, University of Szeged","place":["Szeged, Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4414-0227","authenticated-orcid":false,"given":"Seyed M.","family":"Moghadas","sequence":"additional","affiliation":[{"name":"Agent-Based Modelling Laboratory, York University","place":["Toronto, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-2668","authenticated-orcid":false,"given":"Meagan C.","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5295-5971","authenticated-orcid":false,"given":"Burton H.","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Emerging Pathogens Institute, University of Florida","place":["Gainesville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2059-6716","authenticated-orcid":false,"given":"Alison P.","family":"Galvani","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Modeling and Analysis, Yale School of Public Health","place":["New Haven"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"e_1_3_4_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00850-X"},{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.3290"},{"key":"e_1_3_4_3_2","unstructured":"E. Williams Trump administration drops medicaid vaccine reporting requirements. KFF (2026). https:\/\/www.kff.org\/medicaid\/trump-administration-drops-medicaid-vaccine-reporting-requirements\/. Accessed 29 January 2026."},{"key":"e_1_3_4_4_2","unstructured":"Fact sheet: CDC childhood immunization recommendations. US Department of Health and Human Services (2026). https:\/\/www.hhs.gov\/press-room\/fact-sheet-cdc-childhood-immunization-recommendations.html. Accessed 2 February 2026."},{"key":"e_1_3_4_5_2","unstructured":"CDC acts on presidential memorandum to update childhood immunization schedule. US Department of Health and Human Services (2026). https:\/\/www.hhs.gov\/press-room\/cdc-acts-presidential-memorandum-update-childhood-immunization-schedule.html. Accessed 2 February 2026."},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.6495"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.1695"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2018.1474310"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30044-X"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/ANNALS-25-01611"},{"key":"e_1_3_4_11_2","unstructured":"Public Health Agency of Canada Statement from the Public Health Agency of Canada on Canada\u2019s measles elimination status. Government of Canada (2025). https:\/\/www.canada.ca\/en\/public-health\/news\/2025\/11\/statement-from-the-public-health-agency-of-canada-on-canadas-measles-elimination-status.html. Accessed 18 November 2025."},{"key":"e_1_3_4_12_2","unstructured":"J. Steenhuysen US builds case to retain measles elimination status as infections mount. Reuters (2026). https:\/\/www.reuters.com\/legal\/litigation\/us-builds-case-retain-measles-elimination-status-infections-mount-2026-01-06\/. Accessed 2 February 2026."},{"key":"e_1_3_4_13_2","unstructured":"CDC Measles symptoms and complications. Measles (Rubeola) (2025). https:\/\/www.cdc.gov\/measles\/signs-symptoms\/index.html. Accessed 6 January 2026."},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae470"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1086\/377712"},{"key":"e_1_3_4_16_2","first-page":"577","volume-title":"Handbook of Clinical Neurology","author":"Griffin D. E.","year":"2014","unstructured":"D. E. Griffin, \u201cMeasles virus and the nervous system\u201d in Handbook of Clinical Neurology, A. C. Tselis, J. Booss, Eds. (Elsevier, 2014), vol. 123, pp. 577\u2013590."},{"key":"e_1_3_4_17_2","unstructured":"CDC Measles cases and outbreaks. Measles (Rubeola) (2025). https:\/\/www.cdc.gov\/measles\/data-research\/index.html. Accessed 24 November 2025."},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1086\/378565"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815000631"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-027037"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2013.10.012"},{"key":"e_1_3_4_22_2","doi-asserted-by":"crossref","unstructured":"S. Sriudomporn B. Patenaude Quantifying the cost of measles outbreak in the U.S. and how costs scale with outbreak size. medRxiv [Preprint] (2025). https:\/\/doi.org\/10.1101\/2025.10.24.25338724. Accessed 7 January 2026.","DOI":"10.1101\/2025.10.24.25338724"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2023.01.015"},{"key":"e_1_3_4_24_2","unstructured":"Johns Hopkins University Measles Tracking Team U.S. measles tracker: Tracking measles cases in the U.S. John Hopkins International Vaccine Access Center. https:\/\/publichealth.jhu.edu\/ivac\/resources\/us-measles-tracker. Accessed 2 January 2026."},{"key":"e_1_3_4_25_2","unstructured":"Measles cases in the United States. Our World in Data. https:\/\/ourworldindata.org\/grapher\/number-of-measles-cases. Accessed 25 November 2025."},{"key":"e_1_3_4_26_2","doi-asserted-by":"crossref","unstructured":"N. Jones Measles makes a comeback: Four charts show where and how. Nature Publishing Group UK (2025). https:\/\/dx.doi.org\/10.1038\/d41586-025-03769-z. Accessed 25 November 2025.","DOI":"10.1038\/d41586-025-03769-z"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2025.127830"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/ej\/ueac078"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpubeco.2021.104441"},{"key":"e_1_3_4_30_2","doi-asserted-by":"crossref","unstructured":"E. A. Hanushek L. Woessmann \u201cThe economic impacts of learning losses\u201d (OECD Education Working Papers No. 225 2020). https:\/\/dx.doi.org\/10.1787\/21908d74-en. Accessed 9 January 2026.","DOI":"10.1787\/21908d74-en"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix302"},{"key":"e_1_3_4_32_2","first-page":"257","article-title":"Economic benefits of a routine second dose of combined measles, mumps and rubella vaccine in Canada","volume":"8","author":"Rivi\u00e8re M.","year":"1997","unstructured":"M. Rivi\u00e8re, R. Tretiak, C. Levinton, C. Fitzsimon, C. Leclerc, Economic benefits of a routine second dose of combined measles, mumps and rubella vaccine in Canada. Can. J. Infect. Dis. 8, 257\u2013264 (1997).","journal-title":"Can. J. Infect. Dis."},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1057\/s41283-022-00094-x"},{"key":"e_1_3_4_34_2","unstructured":"HHS standard values for regulatory analysis. ASPE. https:\/\/aspe.hhs.gov\/reports\/standard-ria-values. Accessed 9 January 2026."},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa070"},{"key":"e_1_3_4_36_2","unstructured":"CDC Vaccination coverage and exemptions among kindergartners. SchoolVaxView (2025). https:\/\/www.cdc.gov\/schoolvaxview\/data\/index.html. Accessed 24 November 2025."},{"key":"e_1_3_4_37_2","unstructured":"CDC Vaccination coverage among young children (0\u201335 months). ChildVaxView (2024). https:\/\/www.cdc.gov\/childvaxview\/about\/interactive-reports.html. Accessed 24 November 2025."},{"key":"e_1_3_4_38_2","unstructured":"K. Arundel Florida seeks to eliminate vaccine mandates including for children. K-12 Dive (2025). https:\/\/www.k12dive.com\/news\/florida-seeks-to-eliminate-vaccine-requirements-schools\/759191\/. Accessed 1 December 2025."},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1017\/jme.2025.51"},{"key":"e_1_3_4_40_2","unstructured":"M. R. Smith Associated Press Laura Ungar Associated Press Anti-science bills hit statehouses attacking longstanding public health protections. PBS News (2025). https:\/\/www.pbs.org\/newshour\/health\/anti-science-bills-hit-statehouses-attacking-longstanding-public-health-protections. Accessed 1 December 2025."},{"key":"e_1_3_4_41_2","unstructured":"E. Yam How do Americans view childhood vaccines vaccine research and policy? Pew Research Center (2025). https:\/\/www.pewresearch.org\/science\/2025\/11\/18\/how-do-americans-view-childhood-vaccines-vaccine-research-and-policy\/. Accessed 1 December 2025."},{"key":"e_1_3_4_42_2","unstructured":"J. Bhattacharya M. Oz M. Makary Decision memo: DECISION REQUESTED\u2014Adopting revised childhood and adolescent immunization schedule. (US Department of Health and Human Services 2026). https:\/\/www.hhs.gov\/sites\/default\/files\/decision-memo-adopting-revised-childhood-adolescent-immunization-schedule.pdf. Accessed 2 February 2026."},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2025.102885"},{"key":"e_1_3_4_44_2","unstructured":"14 Nov Measles cases rise globally while the Americas Region regains measles elimination status. https:\/\/www.paho.org\/en\/news\/14-11-2024-measles-cases-rise-globally-while-americas-region-regains-measles-elimination. Accessed 25 November 2025."},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-016887"},{"key":"e_1_3_4_46_2","unstructured":"Emergency vaccine response has cut infectious disease deaths by nearly 60% since 2000 (2025). https:\/\/www.gavi.org\/news\/media-room\/emergency-vaccine-response-has-cut-infectious-disease-deaths-nearly-60-2000. Accessed 24 November 2025."},{"key":"e_1_3_4_47_2","doi-asserted-by":"crossref","unstructured":"Help save 2 million lives: Close the vaccine funding gap. Nature Publishing Group UK (2025). https:\/\/dx.doi.org\/10.1038\/d41586-025-02270-x. Accessed 24 November 2025.","DOI":"10.1038\/d41586-025-02270-x"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7314a1"},{"key":"e_1_3_4_49_2","volume-title":"Vaccine Funding Guidelines","author":"Gavi, The Vaccine Alliance","year":"2023","unstructured":"Gavi, The Vaccine Alliance, Vaccine Funding Guidelines (Gavi, The Vaccine Alliance, 2023)."},{"key":"e_1_3_4_50_2","unstructured":"Measles\u2014Annual epidemiological report for 2024. (European Centre for Disease Prevention and Control 2025). https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/MEAS-AER-2024-Report.pdf. Accessed 12 January 2026."},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7331a2"},{"key":"e_1_3_4_52_2","unstructured":"CDC Measles vaccination. Measles (Rubeola) (2025). https:\/\/www.cdc.gov\/measles\/vaccines\/index.html. Accessed 26 September 2025."},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/0304-4076(86)90002-3"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11538-010-9623-3"},{"key":"e_1_3_4_55_2","unstructured":"D. Mistry Inferring high-resolution human mixing patterns for disease modeling. https:\/\/doi.org\/https:\/\/zenodo.org\/badge\/latestdoi\/239899144. Deposited 23 November 2020."},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1002993"},{"key":"e_1_3_4_57_2","doi-asserted-by":"crossref","unstructured":"C. R. Wells The health and economic repercussions of declining MMR coverage in the United States. GitHub. https:\/\/github.com\/WellsRC\/Measles_USA. Deposited 2 February 2026.","DOI":"10.64898\/2026.02.19.26346619"}],"container-title":["Proceedings of the National Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pnas.org\/doi\/pdf\/10.1073\/pnas.2605971123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T18:02:40Z","timestamp":1776189760000},"score":1,"resource":{"primary":{"URL":"https:\/\/pnas.org\/doi\/10.1073\/pnas.2605971123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":57,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2026,4,28]]}},"alternative-id":["10.1073\/pnas.2605971123"],"URL":"https:\/\/doi.org\/10.1073\/pnas.2605971123","relation":{},"ISSN":["0027-8424","1091-6490"],"issn-type":[{"value":"0027-8424","type":"print"},{"value":"1091-6490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"assertion":[{"value":"2026-02-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2605971123"}}