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March 26, 2025

Expanding measles outbreak in the U.S. and guidance for the upcoming travel season

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➜ This health advisory is also available in PDF format (163 KB).

Be aware of two recently confirmed measles cases in Washington state and an expanding measles outbreak in the South Plains region of Texas and nearby New Mexico.

Consider measles as a diagnosis in anyone with fever (≥101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently traveled internationally, or domestically to a region with a known measles outbreak, or has other known or suspected exposure to measles:

Ensure all patients without evidence of immunity are up to date on MMR vaccine per routine ACIP recommendations, especially for international travelers (regardless of the destination) or domestic travelers to outbreak areas:

  • Children are routinely recommended to receive 2 doses of MMR, the first at 12–15 months of age and the second at 4–6 years of age before school entry.
  • Adults not at high risk of exposure are recommended to have at least 1 documented dose of MMR in their lifetime, or other evidence of immunity (e.g., positive measles immunoglobulin G (IgG)). 
    • Adults at high exposure risk, including students at post-secondary institutions, healthcare workers, and international travelers, should receive 2 doses.
  • For any international travel: also recommend infants 6-11 months of age get an early dose of MMR at least 2 weeks prior to departure. 
    • An early dose of MMR before the first birthday does not count as part of the routine 2-dose series. MMR is not licensed for children <6 months of age.
  • For any domestic travel to outbreak areas, consider the same approach as for international travelers prior to departure:
    • An early MMR dose for infants 6-11 months of age 
    • A second MMR dose for anyone eligible who is 12 months of age or older (2 doses at least 28 days apart)

Background

Two cases of measles have been identified locally, a King County resident likely exposed during international travel and a Snohomish County resident likely exposed to the King County case at a public location where the previous case had visited while contagious.

The CDC recently issued a Health Alert Network (HAN) Health Advisory about an ongoing measles outbreak in Texas and New Mexico, along with 2 deaths. More U.S. cases are expected as this outbreak in the southwest continues to expand rapidly.

With spring and summer travel season approaching in the U.S., CDC emphasizes the important role that clinicians and public health officials play in preventing the spread of measles. They should be vigilant for cases of febrile rash illness that are consistent with measles and share effective measles prevention strategies, including vaccination guidance for international travelers.

Additional information is available from CDC on recommendations for management of persons exposed to measles, and supportive care for persons with measles.

MMR vaccination remains the most important tool for preventing measles infections and spread from imported cases. Two doses of MMR vaccine provide 97% protection against measles while one dose provides 93% protection.

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