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JAMA Insights
Clinical Update
August 14, 2020

Vaccine Refusal and Measles Outbreaks in the US

Author Affiliations
  • 1Division of Infectious Diseases, Emory University School of Medicine, Emory University, Atlanta, Georgia
  • 2Department of Epidemiology, Emory University, Atlanta, Georgia
  • 3Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
  • 4Emory Vaccine Center, Emory University, Atlanta, Georgia
  • 5Yale Institute for Global Health, Yale University, New Haven, Connecticut
  • 6Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, Yale University, New Haven, Connecticut
  • 7Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
  • 8Yale School of Nursing, Orange, Connecticut
JAMA. 2020;324(13):1344-1345. doi:10.1001/jama.2020.14828

In the US, despite high rates of coverage (>90%) at the national level for at least 1 dose of measles, mumps, and rubella (MMR) vaccine, the size and number of measles outbreaks has increased.1 This rise in measles incidence has provoked a variety of policy changes aimed at improving vaccine coverage. Given this response, it is imperative for public health officials and policy makers to understand the contribution of vaccine refusal to the changing epidemiology of measles. In a previous review,2 we reported that unvaccinated individuals made up the majority (56.8%) of cases in measles outbreaks and that more than two-thirds (70.6%) of unvaccinated individuals who were age-eligible for vaccination had a nonmedical exemption to vaccination. In this article, we update the previous review and describe the added role of measles importation, which was not previously covered, to further characterize the association between vaccine refusal and measles epidemiology in the US.

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