Emerging and re-emerging infections continue to challenge public health disease control programs. The United States’ measles elimination status is currently at risk of revocation. In 2025, the U.S. had 2,288 cases of measles, compared to 191 in 2015. Local public health must reexamine internal processes and employ more sustainable approaches to time-intensive communicable disease investigations.
Methods
The Denver Department of Public Health & Environment (DDPHE) Epidemiology and Disease Control team has 9 staff tasked with responding to communicable diseases, including measles. DDPHE’s nursing and emergency preparedness programs are also intimately involved in response efforts, as well as colleagues from jurisdictions across the region and The Colorado Department of Public Health & Environment (CDPHE).
Results
Two hundred and fifty contacts were identified in response to a single Denver County infant measles case in 2025. Three additional Denver cases were identified between April and August 2025, totaling 4 cases for the year. Additionally, DDPHE further responded to 520 measles contacts in 2025 and coordinated post-exposure prophylaxis for numerous residents. In response to out-of-jurisdiction cases identified in 2026, DDPHE has already investigated 35 contacts (as of May 2026).
To accommodate increased workloads while maintaining core services, DDPHE has had to thoughtfully adjust investigation methods.
Strategies have included:
* Use of current epidemiologic data to adjust measles testing and assessment criteria * Use of mHealth surveys and press releases * Partnership with The Public Health Institute at Denver Health * Use of CDPHE’s Team EDIT for support * Prioritization of moderate/high-risk contacts for direct follow-up * Virtual delivery of quarantine and isolation orders * Early coordination with neighboring jurisdictions
Implications
Strained budgets and the threat of new and re-emerging diseases continue to stress public health capacity. Methods to create sustainable and practical response strategies are imperative to balance staff burnout and disease prevention in our communities.
