Measles Outbreak Associated with an Infectious Traveler - Colorado, May-June 2025

Measles is a highly contagious vaccine-preventable viral disease. Successful vaccination programs resulted in limited measles transmission in the United States in 2000, but U.S. cases have been increasing since early 2025. On May 20, 2025, CDC notified the Colorado Department of Public Health and Environment of a measles case in an unvaccinated, non-Colorado resident who had arrived in Denver, Colorado, on an international flight and traveled through the Denver International Airport while infectious. The patient acquired measles in the United States before travelling internationally. Nine secondary measles cases and one tertiary case associated with this traveler were confirmed among Colorado residents; seven additional cases were reported by other jurisdictions. Four of the nine secondary Colorado cases occurred among persons who had received 2 doses of measles, mumps, and rubella vaccine before exposure. Two of these vaccinated persons received negative measles reverse transcription-polymerase chain reaction (RT-PCR) test results from nasopharyngeal swab specimens and positive results from urine specimens. A third patient, with unknown measles vaccination status, received a positive urine RT-PCR test result 24 days after rash onset. Three unvaccinated patients and one with unknown vaccination status were hospitalized, and all recovered. All patients reported having a rash, but vaccinated patients reported fewer and milder symptoms overall. This outbreak highlights the importance of staying up to date with recommended vaccinations, especially before traveling. Routinely collecting urine specimens for measles testing could improve identification of cases and increase detection sensitivity, especially among previously vaccinated persons.