Costs of a Measles Outbreak

Breaking News – The 2019 measles outbreak in Clark County, Washington cost at least $3.4 million to contain. (see below)

The endemic spread of measles was eliminated in the United States in 2000, but unfortunately, that hasn’t stopped us from having outbreaks of measles each year.

Since reaching a record low of just 37 cases of measles in 2004, other milestones in the measles timeline we should all know about include that there were:

• 220 measles cases in 2011, a 15-year record and the highest number of cases since 1996 at least until 2014, when we had at least 667 cases
• 58 cases in the 2013 New York City measles outbreak and for a short time, the largest outbreak since the endemic spread of measles was eliminated in the United States
• 382 cases in the 2014 measles outbreak in Ohio and was the largest outbreak since the endemic spread of measles was eliminated in the United States (until 2019)
• 170 measles cases in the first few months of 2015, including a large outbreak in California that was linked to Disneyland.
• 188 cases and a measles death in 2015
• an outbreak in Rockland County, New York that had been going on since September 2018, making it the longest outbreak since the endemic spread of measles was eliminated in the United States
• a 2019 outbreak in Brooklyn, New York, which at 654 cases, became the largest outbreak since 1992
• 1282 cases of measles in the United States in 2019!

That’s still far below where we used to be though, especially when you consider that before the first measles vaccine was licensed, there was an average of about 549,000 measles cases and 495 measles deaths in the United States each year.

Containing a Measles Outbreak

Several factors help to limit the measles outbreaks that we continue to see in the United States. Most important is that fact that despite the talk of personal belief vaccine exemptions and vaccine-hesitant parents not getting their kids vaccinated, we still have high population immunity.

In the United States, 90.8% of children get at least one dose of the MMR vaccine by the time they are 35 months old and 91.1% of teens have two doses. While not perfect, that is still far higher than the 81% immunization rates the UK saw from 2002 to 2004, when Andrew Wakefield started the scare about the MMR vaccine. Instead of overall low immunization rates, in the U.S., we have “clusters of intentionally under-vaccinated children.”

It also helps that the measles vaccine is highly effective. One dose of a measles vaccine provides about 95% protection against measles infection. A second, “booster” dose helps to improve the effectiveness of the measles vaccine to over 99%.

To further help limit the spread of measles, there are a lot of immediate control measures that go into effect once a case of measles has been suspected, from initiating contact investigations and identifying the source of the measles infection to offering postexposure prophylaxis or quarantining close contacts.

That’s an awful lot of work.

A 2013 measles outbreak in Texas required 1,122 staff hours and 222 volunteer hours from the local health department to contain.

Cost of Containing a Measles Outbreak

A study reviewing the impact of 16 outbreaks in the United States in 2011 concluded that “investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.”

In addition to requiring a lot of work, containing a measles outbreak is expensive.

We still don’t know what it cost to contain many big outbreaks, like the one in Ohio, but we do know that it cost:

• over $6 million to contain the 2018-19 measles outbreak in Brooklyn, with more than 500 staff dedicated to the response
• at least $3.4 million to control the 2019 measles outbreak in Clark County, Washington
• over $2.3 million to contain the 2017 outbreak in Minnesota – 75 people got measles, 71 were unvaccinated, and more than 500 people were quarantined over a 5 month period
• up to an estimated $3.91 million (but likely much more) to contain the 2015 outbreaks in California
• $394,448 and 10,054 personnel hours in total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene responding to and controlling the 2013 outbreak in NYC
• two unrelated cases in Colorado in 2016 cost $49,769 and $18,423, respectively to investigate
• $50,758.93 to contain an outbreak at a megachurch in Texas
• $150,000 to contain (13 cases) an outbreak in Cook County, Illinois
• $223,223 to contain (5 cases, almost all unvaccinated) to contain another outbreak in Clallam County, Washington, an outbreak that was linked to the death of an immunocompromised woman.
• more than $190,000 of personnel costs in Alameda County, with 6 cases and >700 contacts, it is estimated that over 56 staff spent at least 3,770 hours working to contain the outbreak
• $5,655 to respond to all of the people who were exposed when a 13-year-old with measles was seen in an ambulatory pediatric clinic in 2013
• $130,000 to contain a 2011 measles outbreak in Utah
• $24,569 to contain a 2010 measles outbreak in Kentucky
• $800,000 to contain (14 cases, all unvaccinated) a 2008 measles outbreak at two hospitals in Tuscon, Arizona
• $176,980 to contain a 2008 measles outbreak in California
• $167,685 to contain a 2005 measles outbreak in Indiana – unvaccinated 17-year-old catches measles on church mission trip to Romania, leading to 34 people getting sick, including an under-vaccinated hospital worker who ends up on a ventilator for 6 days
• $181,679 (state and local health department costs) to contain a 2004 measles outbreak in Iowa triggered by a unvaccinated college student’s trip to India

It is important to keep in mind that these costs are often only for the direct public health costs to the county health department, including staff hours and the value of volunteer hours, etc. Additional costs that come with a measles outbreak can also include direct medical charges to care for sick ($14,000 to $16,000) and exposed people, direct and indirect costs for quarantined families (up to $775 per child), and outbreak–response costs to schools and hospitals, etc.

We should also consider what happens when our state and local health departments have to divert so much time and resources to deal with these types of vaccine-preventable diseases instead of other public health matters in the community. Do other public health matters take a back seat as they spend a few months responding to a measles outbreak?

There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, “the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

In contrast, it will costs about $77 to $102 to get a dose of the MMR vaccine if you don’t have insurance. So not only do vaccines work, they are also cost effective.

What to Know About the Costs of a Measles Outbreak

Containing a measles outbreak is expensive – far more expensive than simply getting vaccinated and protected.

More on the Cost of Containing a Measles Outbreak

• What to Do If Your Child Is Exposed to Measles
• Who Is at Risk If You Don’t Vaccinate Your Kids?
• The Myth That Measles Isn’t Deadly
• Are the Measles Outbreaks in New York a Hoax?
• Why Are You Still Worried About the MMR Vaccine?
• Everything You Need to Know About the Measles Vaccine
• Was the Measles Outbreak in Michigan Caused by Vaccine-Strain Measles?
• Fun and Games with Measles?
• When Was the Last Measles Death in the United States?
• Mayor de Blasio, Health Officials Declare End of Measles Outbreak in New York City
• CDC – Measles Cases and Outbreaks
• Anti-Vaccine Movement Causes Worst Measles Epidemic In 20 Years
• Over Half Of Measles Cases In U.S. Outbreaks Are Often Intentionally Unvaccinated
• Pre-Vaccine Declines in Measles Mortality
• CDC – Top 4 Things Parents Need to Know about Measles
• The measles vaccine protects against more than just the measles
• Measles vaccination has saved an estimated 17.1 million lives since 2000
• Comparing risks – Measles vs MMR
• Measles Outbreak in Dollars and Cents: It Costs Taxpayers Bigtime
• The cost of measles: A CDC review
• 2014-2015 California Measles Outbreak: It’s a Small World After All
• CDC – Public Health Economic Burden Associated with Two Single Measles Case Investigations — Colorado, 2016–2017
• MN Health Dept. Spent $2.3M During 5-Month Measles Outbreak
• Societal Costs of a Measles Outbreak
• Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated
• The economic burden of sixteen measles outbreaks on United States public health departments in 2011.
• Measles mortality reduction contributes substantially to reduction of all cause mortality among children less than five years of age, 1990-2008.
• The average cost of measles cases and adverse events following vaccination in industrialised countries
• Health care-associated measles outbreak in the United States after an importation: challenges and economic impact.
• Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States.
• Cost of measles containment in an ambulatory pediatric clinic.
• Public Health Consequences of a 2013 Measles Outbreak in New York City
• Here’s How Much America’s 2019 Measles Outbreak Is Costing Us