Can adults acquire measles (rubeola)?

Can Adults Get Measles?

Yes, adults can absolutely acquire measles (rubeola), and the disease can be more severe in adults than in children, with higher rates of complications including pneumonia, encephalitis, hospitalization, and death. 1, 2

Who Is at Risk

Adults are susceptible to measles infection if they lack immunity, which is defined as:

• Adults born in 1957 or later without documentation of at least one dose of MMR vaccine, laboratory evidence of immunity, or physician-diagnosed measles are considered susceptible 3
• Adults born before 1957 were historically presumed immune due to natural infection during childhood, but this assumption is increasingly problematic—up to 9.3% of healthcare workers born before 1957 may actually be susceptible 4, 5
• Women of childbearing age without documented rubella immunity are at particular risk, as measles during pregnancy increases rates of spontaneous abortion, preterm delivery, and low birth weight 1, 6

Clinical Presentation in Adults

Adults with measles present with:

• Prodromal fever followed by a characteristic diffuse erythematous maculopapular rash that spreads in a centrifugal (head-to-toe) pattern 7
• The disease follows a more complicated course in adults compared to children, with higher complication rates 2, 6
• Encephalitis or death occurs in approximately 1 in 1,000 measles cases, with the risk being higher in adults and infants 1
• Fatal measles pneumonia can occur even in previously healthy adults, though most fatal cases involve some degree of immune compromise 8

Recent Outbreak Data

The threat is not theoretical—recent U.S. outbreaks demonstrate ongoing adult susceptibility:

• 2065 measles cases were reported in the United States in 2025, representing a significant resurgence 9
• In a 2025 Colorado outbreak, 4 of 9 secondary cases occurred in adults who had received 2 doses of MMR vaccine, though vaccinated patients experienced milder symptoms 10
• Between 1989-1990, adults ≥20 years represented 22% of measles cases, with 67% not appropriately vaccinated and 25% requiring hospitalization 1
• Between 1985-1990, 96.3% of all measles cases occurred in persons born in 1957 or later 1

High-Risk Adult Populations

Certain adult groups face elevated exposure risk and require special attention:

• Healthcare workers have documented susceptibility regardless of birth year, with 29% of healthcare workers who developed measles between 1985-1989 born before 1957 1, 5
• International travelers face increased exposure in countries with endemic measles 3
• College students and post-secondary institution attendees are at higher risk due to close living quarters 3
• Pregnant women cannot receive live measles vaccine and face increased risks of pregnancy complications 4, 6

Transmission Dynamics

Measles is extremely contagious and spreads via airborne transmission:

• Patients remain infectious from 4 days before through 4 days after rash onset 4
• The virus requires airborne precautions with N95 respirators—standard surgical masks are inadequate 4
• Hospital outbreaks demonstrate the significant potential for spread in healthcare settings, even among staff born before 1957 5

Common Pitfall to Avoid

Do not assume adults born before 1957 are immune, particularly healthcare workers—screening of 456 hospital employees found a 5% incidence of susceptibility among those born between 1950-1956 5. During outbreaks, vaccination of healthcare workers born before 1957 should be strongly considered 1.