{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:47:32Z","timestamp":1791478052416,"version":"4.3.4"},"reference-count":64,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Measles resurgence threatens elimination achievements in the Americas. We conducted a nationwide analysis of Mexico\u2019s 2025\u20132026 measles outbreak, integrating individual-level surveillance data from the Special Surveillance System for Febrile Exanthematous Diseases with municipal-level social determinants from eight national databases, complemented by molecular surveillance data. We analyzed 6892 confirmed cases using spatial autocorrelation (Moran\u2019s I and LISA), effective reproduction number estimation, logistic regression models for municipal case presence, and multivariable logistic regression for risk factors for complications. Cases concentrated in Chihuahua (65.2%), with 47 LISA hot-spot municipalities containing 64.4% of cases. Molecular surveillance confirmed two independent introductions: D8\/MVs\/Ontario.CAN\/47.24 (98.1%), linked to the North American outbreak, and B3 (1.9%) in Oaxaca. Transmission followed a three-stage pattern: introduction through seasonal agricultural worker networks, amplification in undervaccinated communities, and diffusion to marginalized indigenous populations. A dual-model analysis revealed that school non-attendance among children aged 6\u201314 years may have mediated the effect of very high marginalization on municipal case presence (OR 1.26; p &lt; 0.001), identifying a potentially actionable vaccination pathway. Vaccine effectiveness was 98.1%, confirming susceptible accumulation rather than vaccine failure. Wave-stratified analysis showed late outbreak phase as an independent risk factor for complications (aOR 1.68, 95% CI: 1.42\u20132.00), converging with an age of &lt;1 year (aOR 3.36), indigenous status (aOR 1.89), and unvaccinated status (aOR 1.96) in the most marginalized communities. Indigenous individuals comprised 29.1% of cases but 76% of the 25 deaths. This outbreak demonstrates that national vaccination thresholds are insufficient when municipal pockets of susceptibility remain systematically underserved.<\/jats:p>","DOI":"10.3390\/v18020219","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T09:41:02Z","timestamp":1770630062000},"page":"219","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Social Determinants and Outbreak Dynamics of the 2025 Measles Epidemic in Mexico: A Nationwide Analysis of Linked Surveillance Data"],"prefix":"10.3390","volume":"18","author":[{"given":"Judith Carolina","family":"De Arcos-Jim\u00e9nez","sequence":"first","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0505-6340","authenticated-orcid":false,"given":"Pedro","family":"Mart\u00ednez-Ayala","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4698-5063","authenticated-orcid":false,"given":"Oscar Francisco","family":"Fern\u00e1ndez-Diaz","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6153-3703","authenticated-orcid":false,"given":"Sergio","family":"S\u00e1nchez-Enr\u00edquez","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n de Ciencias Biomedicas, Centro Universitario de Los Altos, Universidad de Guadalajara, Tepatitl\u00e1n de Morelos 47600, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Noemi","family":"Vargas-Becerra","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"L\u00f3pez-Y\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3424-1382","authenticated-orcid":false,"given":"Roberto","family":"Damian-Negrete","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda","family":"Gutierrez-Perez","sequence":"additional","affiliation":[{"name":"Comisi\u00f3n Estatal de Derechos Humanos Jalisco, Guadalajara 44600, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1901-392X","authenticated-orcid":false,"given":"Jaime","family":"Briseno-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n Salud, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Zu\u00f1iga 45641, Mexico"},{"name":"Hospital Civil de Oriente, T\u00f3nala 45425, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1056\/NEJMra2504516","article-title":"Measles 2025","volume":"393","author":"Do","year":"2025","journal-title":"N. 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