Title : Measles resurgence in the United States: Epidemiological patterns and the impact of digital misinformation
Abstract:
Background: Measles elimination in the United States in 2000 was achieved through widespread vaccination and the adoption of the two-dose schedule. However, outbreaks since 2014 reveal how biomedical gains can be reversed when social and digital dynamics undermine vaccine uptake. This study reframes measles resurgence in the United States by highlighting the role of digital misinformation ecosystems rather than solely structural coverage gaps.
Methodology: This scoping review analyzed 44 studies published between 2000 and 2026, spanning epidemiology, vaccine hesitancy, misinformation, and policy responses.
Results: Evidence shows that imported cases repeatedly seeded outbreaks, including the 2014 Disneyland episode and the 2019 surge of over 1,200 cases. Misinformation on social media spread faster than corrective messaging, eroding trust in vaccines. Vaccine hesitancy was linked to cultural beliefs, institutional distrust, and misinformation, creating pockets of under-immunized communities. Policy interventions such as the two-dose schedule and school entry requirements were effective historically, but recent counter misinformation efforts struggled to match the speed and reach of digital platforms.
Conclusion: Measles resurgence in the U.S. reflects a shift from structural coverage gaps to socio-digital vulnerabilities. Safeguarding elimination requires integrating vaccination strategies with effective digital counter-misinformation, community trust building, and closing immunity gaps to prevent future outbreaks.
Keywords: measles elimination, measles resurgence, vaccine hesitancy, digital misinformation, social media and vaccines, United States.
