In late June, the Multnomah County (Oregon, USA) Health Department confirmed that a case of measles was diagnosed in the Portland area (the area’s first measles case since 2014). The patient visited an emergency room and local healthcare facility while contagious, potentially exposing approximately 500 people to the virus. Forty of these individuals were determined to not have adequate immunity to measles. Since the diagnosis of the index case, 2 secondary cases have been diagnosed, one in Portland and the other across the Columbia River in Vancouver, Washington.

Unfortunately, this outbreak is not unique, and measles cases and outbreaks are on the rise in the United States. This includes sizeable outbreaks in Minnesota (2017), Arizona (2016), California (2014-15), and Ohio (2014) in the past 5 years alone. The year 2014 saw a record number of measles cases—667 in total from 27 different states. As of June 16, the CDC has reported 93 cases from 19 different states so far this year.

No matter how large or small the outbreak, public health response activities can be extremely resource intensive and costly. This week, Outbreak Observatory looks at measles outbreaks through an economic lens, exploring the costs of responding to these vaccine-preventable diseases.

How Much Does It Cost?

Measles is extremely contagious and can cause life-threatening complications, including pneumonia and encephalitis. Therefore, any outbreak—no matter how small—requires a robust public health response, which can include case isolation, quarantine, contact tracing, disease testing, vaccination, enhanced disease surveillance, and public communication. These activities can be extremely costly in terms of direct costs and personnel time, which is particularly challenging for public health departments that are often already operate under substantial resource constraints.

For example, a 2005 measles outbreak in Indiana, triggered by an unvaccinated 17-year-old returning from Romania, resulted in enormous expenditures. Thirty-four individuals in total contracted measles, and health officials identified an additional 500 contacts, ultimately costing an estimated $167,685 ($4,932 per confirmed case). Ninety-nine total personnel were involved in the response, and more than 3,500 person-hours were spent on response activities. Other associated costs included telephone calls, MMR vaccines, immunoglobulin, specimen collection kits and laboratory tests, and transportation. In 2008, an unvaccinated 7-year-old returning to San Diego, California from Switzerland sparked an outbreak that resulted in 11 additional cases and 839 potentially exposed persons. The cost of this outbreak was estimated at $124,517 ($10,376 per case), with approximately 1,745 person hours dedicated to the response.

Even small outbreaks can have significant cost impacts. For example, the response to a single case of measles in Kentucky in 2010 (44 contacts) cost approximately $25,000, including labor, medical care costs for the patient, vaccine and immunoglobulin, screening tests, and transportation. Similarly, a 2004 measles outbreak in Iowa cost an estimated $142,452 for a single case—and more than 1,000 potentially exposed contacts.

What is the Alternative?

Measles outbreaks are extremely cost and resource intensive, and they can easily be prevented through vaccination with the MMR vaccine. In fact, one study found that a “2-dose MMR vaccination program spends $78 to prevent 1 measles case.” As noted previously, the response to just one case of measles in Iowa cost more than $140,000. The dramatic difference between these two costs demonstrates the economic (not to mention health) benefits of proactive vaccination.

Unfortunately, parents who are voluntarily elect not to vaccinate their children due to concerns over the safety of vaccines, or any number of other reasons, place their children and others at increased risk of infection. Unvaccinated, or under-vaccinated, children are vulnerable to highly contagious diseases such as measles, and populations with low vaccine coverage are at increased risk for sustained community transmission. Enhanced outreach to these communities, as well as improving vaccine access for those who do wish to get vaccinated, could help improve vaccine coverage and reduce the number of cases and outbreaks. In doing so, thousands of dollars and person-hours could be allocated for other necessary public health activities.

 

Photo courtesy of CDC/Allison M. Maiuri, MPH, CHES

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.