Year: 2026
Type: preprint
Abstract: US measles elimination is in question, and the protective doses are already committed; which schools receive them first is unresolved. Of 36,031 US schools, 12,196 hold enough susceptible children to sustain transmission once a case arrives. One 77,292-dose budget would clear 2,497 of them under a lightly hedged rule against 1,511 under the lowest-coverage-first rule now in use, leaving 112,733 fewer children where a chain can persist at no additional dose. The gain comes from finishing schools near the herd-immunity threshold rather than starting schools far below it. Allocation theory’s point-optimal form of that rule assumes every school is equally likely to see a case; pre-outbreak records from a 2025-26 South Carolina outbreak show exposed schools over-represented 5.0-fold in susceptible headcount, unlike enrollment. Under non-uniform risk, whose strength one outbreak cannot identify, that optimum is the least robust of seven rules, while the hedge holds roughly 90% of attainable benefit.
Source: medRxiv
Language: English
Topic: Virology and Viral Diseases
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204125260