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No evidence for critical slowing down before measles outbreaks in the US, 2006-2025

John M Drake1,2,3, Pejman Rohani1,2,4

  • 1Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA.

Future Microbiology
|February 20, 2026
PubMed
Abstract

Insights

Statistical early warning signals (EWS) did not reliably predict measles outbreaks in the United States. Further research is needed to assess EWS for vaccine-preventable diseases with complex outbreak dynamics.

Area of Science:

  • Epidemiology
  • Public Health
  • Statistical Modeling

Background:

  • Measles outbreaks have resurged in the US after elimination.
  • Anticipating disease resurgences is a critical public health goal.
  • Early warning signals (EWS) based on critical slowing down theory show promise for predicting epidemic thresholds.

Purpose of the Study:

  • To assess the reliability of statistical EWS for anticipating measles outbreaks in the United States.
  • To evaluate if increased variance and autocorrelation precede measles resurgence.
  • To analyze trends in outbreak characteristics over time.

Main Methods:

  • Analysis of weekly US measles case data from 2006-2025.
  • Harmonization of CDC surveillance data with a curated domestic case dataset.
  • Estimation of variance and lag-1 autocorrelation using the spaero R package in rolling windows.
  • Autocorrelation-adjusted Spearman correlations to test for trends.

Main Results:

  • No consistent increases in variance or autocorrelation were detected before or during major measles outbreaks.
  • No significant trends were observed in outbreak duration, size, or fade-out frequency.
  • Statistical EWS did not reliably anticipate the studied US measles outbreaks.

Conclusions:

  • Statistical EWS, as applied, were not effective in reliably predicting US measles outbreaks.
  • Further research is required to determine the applicability of EWS to vaccine-preventable disease resurgence.
  • Heterogeneous susceptibility and outbreak response strategies may influence EWS reliability.
Keywords:
Measlescritical slowing downearly warning signalsepidemiologyoutbreak predictionresurgence

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