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The 3 Cs of Measles

Dr. Melissa O’Meara, MD | Primary Care
April 29, 2025

Recent news reports on measles outbreaks have brought the once-dormant disease to the forefront of many people’s minds. As cases pop up across the country and now in Colorado, it’s important to understand this infectious disease and what steps we, as a community, can take to limit the spread and protect our children. 
 

The Top Three Things to Know

The most important points about measles to understand include:
  • Children: Children are most susceptible to measles. If your child is older than four years old and has not yet received two doses of the measles, mumps and rubella (MMR) vaccine, please have them vaccinated at your local pharmacy or call Colorado Mountain Medical to schedule an appointment for vaccination.
  • Adults: Adults who were born between 1963-1968 and who have not received two MMR vaccines in their lifetime should receive one booster through their local pharmacy.
  • Exposure: If you believe you have been exposed to measles and you have a fever, cough and rash, then you should isolate at home wearing an N95 mask and call the Health Department Colorado Department of Public Health & Environment (CDPHE) at (303) 692-2700 or Colorado Mountain Medical to arrange for testing. 
 

Symptoms & Risk

Measles is a viral disease characterized by the ‘3 Cs’ of cough, coryza (runny nose) and conjunctivitis (red, watery eyes). According to the CDC, 7-10 days after exposure, the first symptoms appear as the 3 Cs, as well as a high fever. A rash is likely to appear 3-5 days after symptoms begin. One of the hallmarks of the measles rash is that it typically starts on the face and then spreads down to the torso, arms and legs. Measles is spread through airborne particles and is highly contagious, much more so than COVID or the flu. The measles virus can live in air particles for up to two hours. The chart below illustrates the comparative infectiousness of measles. As illustrated here, it is about six times more infectious than COVID-19. 
 

Why the Resurgence?

Globally, the incidence of measles has decreased substantially since the introduction of the measles vaccine in 1963. Between 2000 and 2017, the global annual incidence of reported measles cases declined by 83%, from 145 to 25 cases per million population.[1] However, recent years have seen a resurgence in measles cases. For instance, from 2021 to 2022, estimated measles cases increased by 18%, from 7.8 million to 9.2 million, and the number of countries experiencing large or disruptive outbreaks increased from 22 to 37.[2]

Vaccination coverage is critical for controlling measles. The following figure illustrates the trend in measles cases in the United States from 1960 to 2019, highlighting the impact of vaccination and the recent resurgence in cases. 
 

Why Vaccinate?

It is much more effective to prevent the measles than to try to treat it after infection. Complications of measles infection include pneumonia, permanent blindness, permanent hearing loss, swelling of the brain (encephalitis) and even death. Measles is best prevented with the MMR vaccine, which is 97% effective after two doses. The MMR vaccine is typically received in childhood. For children, the MMR vaccine should be given at one year and four years of age (4-6 years). Early vaccination can be given if a child is traveling internationally or to a place with active spread. In this situation, they can receive their first MMR as young as six months of age. If they get a vaccine before the age of one, they will still need the standard two doses at one and four years old.   

Many children in our community may be unvaccinated or under-vaccinated due to interruptions in care during the COVID-19 pandemic. Now is a great time to check your records to make sure your children have received two doses of the MMR vaccine. If they have not, then catch-up vaccines are available at local pharmacies and at Colorado Mountain Medical. 

Most adults are either immune to measles or have been fully vaccinated. People born before 1957 lived in a time when measles was so prevalent that all children had it at some point. People born before 1957 are immune to measles. Those born between 1964-1968 are likely to have only received one dose in childhood. All adults should have received two doses of the measles vaccines. Those who know that they have not previously received two doses of the MMR should also be vaccinated. This is often the case if a person was born between 1964-1968, grew up outside the United States or did not regularly interact with healthcare as a child. Adults can be vaccinated at their local pharmacy. 

It is possible to test for immunity with a blood test called a titer. Titers check for antibodies to the measles vaccine in the blood. Antibodies would be present either if you previously had the measles or if you were successfully vaccinated. This laboratory testing is available through your primary care provider. It typically costs around $150-$200 and is usually not covered by insurance. Given this cost, we generally don’t recommend titers for everyone. Receiving the two-dose series is highly effective and provides immunity for a very long period of time. 
 

What Do I Do If I Symptoms?

If you do develop a fever, cough and rash after traveling to an endemic area, then you should isolate at home with an N95 mask and call either the Colorado Department of Health & Environment (CDPHE) at (303) 692-2700 (after-hours: (303) 370-9395) or Colorado Mountain Medical at (970) 926-6340 to arrange testing. If you have concerns that you might have measles, please call rather than coming to urgent care or the waiting room. 

While measles is back, the good news is that most of our population is protected against it. We can work together as a community to help protect our children from measles with a safe, highly effective vaccine. 
 

Sources

  1. Measles. Strebel PM, Orenstein WA. The New England Journal of Medicine. 019;381(4):349-357. doi:10.1056/NEJMcp1905181.
  2. Progress Toward Measles Elimination - Worldwide, 2000-2022. Minta AA, Ferrari M, Antoni S, et al. MMWR. Morbidity and Mortality Weekly Report. 2023;72(46):1262-1268. doi:10.15585/mmwr.mm7246a3.
  3. Progress Toward Measles Elimination - Worldwide, 2000-2023. Minta AA, Ferrari M, Antoni S, et al. MMWR. Morbidity and Mortality Weekly Report. 2024;73(45):1036-1042. doi:10.15585/mmwr.mm7345a4.
  
 

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