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    Area of Science:

    • Public Health
    • Infectious Diseases
    • Epidemiology

    Background:

    • Measles transmission in the U.S. has increased since 2025, despite successful vaccination programs.
    • A measles case in an unvaccinated traveler led to a significant outbreak in Colorado.

    Purpose of the Study:

    • To report on a measles outbreak linked to an international traveler in Colorado.
    • To assess measles transmission dynamics and diagnostic challenges, including in vaccinated individuals.

    Main Methods:

    • Case investigation and contact tracing were performed.
    • Reverse transcription-polymerase chain reaction (RT-PCR) testing was utilized, including nasopharyngeal swabs and urine specimens.
    • Clinical data and vaccination status were collected for all identified cases.

    Main Results:

    • The initial traveler resulted in nine secondary and one tertiary measles cases in Colorado.
    • Four secondary cases occurred in individuals vaccinated with two doses of the measles, mumps, and rubella (MMR) vaccine.
    • Urine RT-PCR testing showed positive results in some vaccinated individuals and in one patient 24 days post-rash onset, suggesting potential for prolonged viral shedding or alternative detection methods.

    Conclusions:

    • Staying up-to-date with measles vaccinations is crucial, particularly before international travel.
    • Urine specimen testing may enhance measles case identification and detection sensitivity, especially in previously vaccinated populations.
    • This outbreak highlights the continued threat of measles and the importance of robust public health surveillance and vaccination efforts.