{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:34:46Z","timestamp":1792445686547,"version":"4.5.0"},"reference-count":27,"publisher":"National Academy of Sciences","issue":"40","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["DMS-2330801"],"award-info":[{"award-number":["DMS-2330801"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:p>Florida\u2019s proposal to remove vaccine mandates in the state raises urgent questions about the state\u2019s vulnerability to measles resurgence. We develop and analyze an age-structured measles transmission model with heterogeneous contact patterns between children and adults, calibrated using data from the 2025 measles outbreak in Gaines County, Texas, and applied to Florida using state-specific demographic structure and measles\u2013mumps\u2013rubella (MMR) vaccination coverage. Using Florida-specific mixing patterns and demographic composition, we estimate the state\u2019s vaccine-induced herd immunity threshold and find that current MMR coverage already falls below the level required to prevent sustained measles transmission. Simulated declines in MMR vaccination coverage following removal of school-entry requirements further increase outbreak potential, producing epidemic sizes not seen since prevaccine eras and projecting a significant number of pediatric deaths within five years. Sensitivity analyses highlight that small reductions in child vaccination rates yield disproportionately large increases in outbreak magnitude, especially under strong assortative mixing among children. These findings indicate that Florida\u2019s vaccination policies are approaching a critical tipping point: Maintaining or improving MMR vaccination coverage is essential to prevent measles from reestablishing endemic circulation within the state and potentially spreading to the broader United States.<\/jats:p>","DOI":"10.1073\/pnas.2610455123","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:02:56Z","timestamp":1790622176000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":1,"title":["Projected effects of removing school-entry vaccination requirements on measles transmission in Florida"],"prefix":"10.1073","volume":"123","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1216-4510","authenticated-orcid":false,"given":"Alice","family":"Oveson","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/047s2c258","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Mathematics, University of Maryland","place":["College Park"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8413-1248","authenticated-orcid":false,"given":"Abba B.","family":"Gumel","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/047s2c258","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Mathematics, University of Maryland","place":["College Park"]},{"name":"Institute for Health Computing, University of Maryland","place":["North Bethesda"]},{"id":[{"id":"https:\/\/ror.org\/00g0p6g84","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Mathematics and Applied Mathematics, University of Pretoria","place":["Pretoria, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_3_4_1_2","unstructured":"CDC History of Measles (May 9th 2024). https:\/\/www.cdc.gov\/measles\/about\/history.html (Accessed 20 October 2025)."},{"key":"e_1_3_4_2_2","unstructured":"J. Zipprich et al. Measles outbreak \u2014 California December 2014\u2013February 2015 (2015). https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6406a5.htm#:~:text=As%20of%20February%2011%2C%20a )%20and%20Canada%20(10). (Accessed 20 October 2025)."},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1912514"},{"key":"e_1_3_4_4_2","unstructured":"TD of State Health Resources Measles Outbreak \u2013 August 12 2025 (2025). https:\/\/www.dshs.texas.gov\/news-alerts\/measles-outbreak-2025 (Accessed 20 October 2025)."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1137\/S0036144500371907"},{"key":"e_1_3_4_6_2","unstructured":"Centers for Disease Control and Prevention (CDC) About global Measles (2025). https:\/\/www.cdc.gov\/global-measles-vaccination\/about\/index.html. Accessed 12 November 2025."},{"key":"e_1_3_4_7_2","unstructured":"M. Matza Florida aims to ban vaccine mandates for schoolchildren (BBC) (2025). https:\/\/www.bbc.com\/news\/articles\/cvg0e485wwwo (Accessed 20 October 2025)."},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)00004-9"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.7063839"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30307-9"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1009098"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00285-021-01686-z"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050074"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.6495"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idm.2024.04.007"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.abc6810"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz058"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2015.0024"},{"key":"e_1_3_4_19_2","first-page":"41","article-title":"Mathematical analysis of an age-structured vaccination model for measles","volume":"33","author":"Garba S.","year":"2014","unstructured":"S. Garba, A. Gumel, N. Hussaini, Mathematical analysis of an age-structured vaccination model for measles. J. Niger. Math. Soc. 33, 41\u201376 (2014).","journal-title":"J. Niger. Math. Soc."},{"key":"e_1_3_4_20_2","unstructured":"CDC Vaccination coverage and exemptions among kindergartners (2025). https:\/\/www.cdc.gov\/schoolvaxview\/data\/index.html (Accessed 20 October 2025)."},{"key":"e_1_3_4_21_2","unstructured":"D. Commons Florida \u2014 data commons (2025). https:\/\/datacommons.org\/place\/geoId\/12?utm_medium=explore&mprop=count&popt=Person&hl=en (Accessed 23 October 2025)."},{"key":"e_1_3_4_22_2","unstructured":"C. Reporter Florida \u2014 profile data (acs 2023 1-year) (2023). https:\/\/censusreporter.org\/profiles\/04000US12-florida\/ (Accessed 23 October 2025)."},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-5564(02)00108-6"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00178324"},{"key":"e_1_3_4_25_2","unstructured":"A. Kearney Most parents nationally and in Florida want schools to require vaccines (2025). https:\/\/www.kff.org\/quick-insights\/most-parents-nationally-and-in-florida-want-schools-to-require-vaccines\/. Accessed 24 October 2025."},{"key":"e_1_3_4_26_2","unstructured":"F. Spooner S. Dattani S. Vanderslott M. Roser Measles cases (2022). https:\/\/ourworldindata.org\/grapher\/number-of-measles-cases. Data adapted from Public Health Reports US Census Bureau and CDC. Our World in Data. Accessed 24 October 2025."},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.3934\/mbe.2023009"}],"container-title":["Proceedings of the National Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pnas.org\/doi\/pdf\/10.1073\/pnas.2610455123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:03:19Z","timestamp":1790622199000},"score":1,"resource":{"primary":{"URL":"https:\/\/pnas.org\/doi\/10.1073\/pnas.2610455123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":27,"journal-issue":{"issue":"40","published-print":{"date-parts":[[2026,10,6]]}},"alternative-id":["10.1073\/pnas.2610455123"],"URL":"https:\/\/doi.org\/10.1073\/pnas.2610455123","relation":{},"ISSN":["0027-8424","1091-6490"],"issn-type":[{"value":"0027-8424","type":"print"},{"value":"1091-6490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-03-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2610455123"}}