Measles and Public Health: An Integrative Approach

Measles and Public Health: An Integrative Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Measles and Public Health: An Integrative Approach Francesco Branda, Marta Giovanetti, Nicola Petrosillo, Mohamed Mustaf Ahmed, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7301790/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Oct, 2025 Read the published version in Biology Direct → Version 1 posted 7 You are reading this latest preprint version Abstract Background. Measles, once considered under control in many high-income countries, has experienced a notable resurgence in recent years due to declining vaccination rates, increased vaccine hesitancy, and gaps in public health preparedness. This study provides an overview of the current measles outbreaks in two socio-culturally distinct realities, both facing a challenging epidemiological situation, i.e., the Region of the Americas and Italy, the European country most impacted after Romania. The aim is to understand transmission dynamics and identify factors contributing to outbreak severity. Results. Epidemiological data show that Canada experienced an unprecedented increase in measles incidence, particularly in Ontario and Alberta, where spatial modelling revealed relative risks greater than 30 in high burden areas. In Mexico, the epidemic was highly localised, with over 90% of cases and all but one death concentrated in the state of Chihuahua. In the United States, 89% of cases were linked to epidemic outbreaks, with Texas showing significant spatial clustering and daily growth rates of over 4% in high-risk counties. In Italy, the 2024 outbreak marked a significant increase in measles cases compared to previous years, primarily affecting unvaccinated individuals. Over 50% of those affected required hospitalization, and major urban regions such as Lazio and Lombardy experienced sustained transmission. An initial phase of exponential growth (66% monthly) was followed by a plateau, with no significant decline observed, underlining delays in containment and persistent immune deficiencies. From genetic point of view, the study revealed the predominance of genotype D8, known for sustained global circulation, suggesting a single transmission chain behind the recent outbreaks. Phylogenetic analysis showed no significant intra-genotypic diversification, suggesting that the outbreak likely originated from a single introduction event followed by rapid, localized transmission. This limited genetic variation is consistent with a short transmission window and the absence of strong evolutionary pressure. Conclusions. The outbreaks in the United States and Italy, despite differences in healthcare systems and sociopolitical contexts, reveal common underlying issues. In the U.S., the epidemic was characterized by clusters of unvaccinated individuals in certain communities, while Italy faced challenges due to gaps in routine immunization programs and delays in responding to the outbreak. Both outbreaks illustrate the devastating impact of under-vaccination, inadequate surveillance, and the spread of misinformation on public health. Our results contribute to a deeper understanding of the dynamics of measles recurrence, providing a solid basis for science-based prevention and control measures. Furthermore, the study emphasises the importance of continuous and integrated surveillance to detect emerging or divergent strains at an early stage. Measles Outbreak dynamics Spatial modeling Public health response Genomic surveillance Phylogenomic analysis genetics Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Oct, 2025 Read the published version in Biology Direct → Version 1 posted Editorial decision: Revision requested 31 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviewers agreed at journal 13 Aug, 2025 Reviewers invited by journal 08 Aug, 2025 Editor assigned by journal 08 Aug, 2025 Submission checks completed at journal 07 Aug, 2025 First submitted to journal 05 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7301790","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497682093,"identity":"f77dfa8f-bdb1-4edd-9329-d1bbde61d41e","order_by":0,"name":"Francesco 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This study provides an overview of the current measles outbreaks in two socio-culturally distinct realities, both facing a challenging epidemiological situation, i.e., the Region of the Americas and Italy, the European country most impacted after Romania. The aim is to understand transmission dynamics and identify factors contributing to outbreak severity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003e Epidemiological data show that Canada experienced an unprecedented increase in measles incidence, particularly in Ontario and Alberta, where spatial modelling revealed relative risks greater than 30 in high burden areas. In Mexico, the epidemic was highly localised, with over 90% of cases and all but one death concentrated in the state of Chihuahua. In the United States, 89% of cases were linked to epidemic outbreaks, with Texas showing significant spatial clustering and daily growth rates of over 4% in high-risk counties. In Italy, the 2024 outbreak marked a significant increase in measles cases compared to previous years, primarily affecting unvaccinated individuals. Over 50% of those affected required hospitalization, and major urban regions such as Lazio and Lombardy experienced sustained transmission. \u0026nbsp;An initial phase of exponential growth (66% monthly) was followed by a plateau, with no significant decline observed, underlining delays in containment and persistent immune deficiencies. From genetic point of view, the study revealed the predominance of genotype D8, known for sustained global circulation, suggesting a single transmission chain behind the recent outbreaks. Phylogenetic analysis showed no significant intra-genotypic diversification, suggesting that the outbreak likely originated from a single introduction event followed by rapid, localized transmission. 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