Don’t think that this year’s measles outbreaks will break any records?
Which Measles Records Will We Break This Year?
Unfortunately, as measles cases rise, we keep breaking new records.
The Rockland County, New York measles outbreak, which has been going on since September 2018, has the record for being the longest outbreak since the endemic spread of measles was eliminated in the United States.
What other records will we break?
What other records are there?
37 cases – the record low for the number of measles cases in a year, set in 2004
667 cases – the recent record high set in 2014 and the most cases since 1994, when there were 963 cases.
383 cases – the largest single outbreak since the endemic spread of measles was eliminated, set in Ohio in 2014
an outbreak in Rockland County, New York that has been going on since September 2018, making it the longest outbreak since the endemic spread of measles was eliminated in the United States
an outbreak in Brooklyn, New York, which at 654 cases, became the largest outbreak since 1992
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.
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.
Costs of a Measles Outbreak
In addition to requiring a lot of work, containing a measles outbreak is expensive.
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.”
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
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.