# Social Determinants and Outbreak Dynamics of the 2025 Measles Epidemic in Mexico: A Nationwide Analysis of Linked Surveillance Data

## TL;DR

The 2025 measles outbreak in Mexico was driven by social factors and low vaccination rates in marginalized communities, leading to severe outcomes among indigenous populations.

## Contribution

This study integrates nationwide surveillance data with social determinants to reveal how measles spreads through vulnerable populations and identifies actionable vaccination pathways.

## Key findings

- Measles cases were concentrated in Chihuahua, with 47 hot-spot municipalities accounting for 64.4% of cases.
- Molecular surveillance identified two virus strains, with the majority linked to the North American outbreak.
- Late outbreak phase and being under one year old were significant risk factors for complications.

## Abstract

Measles resurgence threatens elimination achievements in the Americas. We conducted a nationwide analysis of Mexico’s 2025–2026 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’s 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 6–14 years may have mediated the effect of very high marginalization on municipal case presence (OR 1.26; p < 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: 1.42–2.00), converging with an age of <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.