Tag: post-exposure prophylaxis

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”

Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.
Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”

The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”

When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”

What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”

Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

More on Measles in Pregnancy

What Should You Do If Your Child Might Have Measles

As you hear more and more about measles outbreaks, eventually you might think that your child has measles.

Why?

Until a child develops the classic measles rash, the symptoms of measles can mimic many other more common viral illnesses, as they include fever, cough, coryza, red eyes, and irritability.

What Should You Do If Your Child Might Have Measles

And while many other viruses can cause a fever and rash, it is really only measles that causes the classic pattern of 3 or 4 days of high fever, followed by the appearance of a rash with continued fever.

Unfortunately, by the time your child has developed the rash, you may have already have gone to the doctor or ER a few times, exposing a lot of people to measles.

If your child has measles, don’t give it to anyone else.

That’s why it’s important to try and recognize measles as early as possible, so that you don’t expose anyone else and get them sick too.

It is especially important to think about measles if your child:

  • traveled out of the country in the past 7 to 21 days, the incubation period for measles
  • recently traveled to or lives in an area that is experiencing measles outbreaks
  • is not yet fully vaccinated, with two doses of MMR, keeping in mind that a small minority of people can get measles even if they are fully vaccinated

So what do you do if your child might have measles?

Ideally, you would call your health care provider, clinic, or emergency room ahead of time and let them know that you are concerned about measles. That allows them to take steps to minimize the risk that your child will expose others to measles.

While the child is isolated, health care professionals can then decide if it is necessary to do further testing for measles. If they do suspect measles, they may even call the local health department for further help.

If necessary, post-exposure prophylaxis might also be provided for the child’s contacts.

What if you aren’t sure if your child has measles? Put a mask on them anyway if there is any doubt! Don’t take a chance on causing a big outbreak.

During some outbreaks, communities have even had to implement universal masking of all patients and all family members to help get their outbreak under control.

And remember that the best way to stop these outbreaks is for everyone to get fully vaccinated on time and on schedule.

More on Measles Exposure Prevention Measures

How to Avoid Getting Caught up in a Measles Outbreak

By now, you have likely heard the news that we are on track for record-breaking numbers of measles cases this year, both in the United States and around the world.

You may also have heard that some of the folks getting caught up in these outbreaks weren’t actually anti-vaccine, but were people who thought they already had measles or thought they were already vaccinated and protected.

How to Avoid Getting Caught up in a Measles Outbreak

Are you and your family protected against measles?

Six ways to avoid measles.

You might be thinking, “of course we are, we get all of our vaccines!”

But you still might want to double check, keeping in mind that:

  • only people born before 1957 are thought to have natural immunity to measles, because measles was very common in the pre-vaccine era
  • the original measles vaccine that was used between 1963 and 1967 was not thought to be effective, so if that’s the only dose you had, it should be repeated
  • a recommendation for a second dose of MMR didn’t come until 1990, so many people born before that time have only had one dose, especially since there was never a catch-up program to make sure older people had two doses. Even now, adults don’t necessarily need two doses of MMR unless they are in a high-risk group (foreign travel, healthcare workers, living with someone who has a compromised immune system, people with HIV, and students).
  • children don’t routinely get their first dose of MMR until they are 12 to 15 months old (one dose is 93% effective at preventing measles), with a second dose at age 4 to 6 years (two doses are 97% effective)
  • a third dose of MMR isn’t typically recommended for measles protection

Still think you and your family are protected?

In addition to routine recommendations, to avoid measles in a more high risk setting (traveling out of the country or during an outbreak), you should:

  • get infants an early MMR, giving them their first dose any time between 6 and 11 months of age (repeating this dose at age 12 to 15 months)
  • get toddlers and preschoolers an early second dose of MMR, giving them their second dose at least 28 days after the routine first dose that they received when they were 12 to 15 months old, instead of waiting until they are 4 to 6 years
  • get older children and adults two doses of MMR if they haven’t already had both doses

What if your baby is exposed to measles before you have a chance to get him vaccinated?

Younger infants who are less than six months old can get a dose of immunoglobulin within 6 days if they are exposed to measles. Older infants, children, and adults can get a dose of MMR within 72 hours if they are not vaccinated and are exposed to someone with measles.

And the very best way to avoid measles is to keep up herd immunity levels of protection in our communities. If everyone is vaccinated and protected, then we won’t have outbreaks and our kids won’t get exposed to measles!

More on Avoiding Measles

Where Are the Latest Chickenpox Outbreaks?

Breaking News – 32 cases at a school in Northern Kentucky (see below)

Chicken pox is a now vaccine-preventable disease thanks to the chicken pox vaccine that was first licensed in 1995.

Despite being added to the childhood immunization schedule in 1996, and the addition of a booster dose in 2007, we do continue to see occasional outbreaks of chicken pox.

Chicken Pox

Although chicken pox is said to have been a rite of passage for kids, it was never something that any of us looked forward to.

At best, you had five to seven days of fever and an itchy rash that covered your body.

“My life changed forever on June 30, 1988, when I had to stand by helplessly as an infectious disease claimed the life of my oldest child, Christopher Aaron Chinnes, at the age of 12.”

Rebecca Cole on Chickenpox Claimed the Life of My Son Christopher

But of course, some people had much more severe cases of chicken pox and some people died.

Chicken Pox Outbreaks

In the pre-vaccine era, before the mid-1990s, most kids got chicken pox.

And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.

Why are we still seeing clusters of chicken pox in schools when a safe and effective vaccine is readily available?
Why are we still seeing clusters of chicken pox in schools when a safe and effective vaccine is readily available?

These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.

  • 32 cases at the Our Lady of the Sacred Heart and Assumption Academy in Walton, Kentucky leading to the quarantine of all unvaccinated students (March 2019)
  • 7 new cases in the outbreak associated with the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 41 in that outbreak, including 4 cases in the community as the outbreak continues to spread (Nov 2018)
  • 6 new cases at the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 34 in that outbreak (Nov 2018)
  • several students at Hoquiam High School in Hoquiam, Washington (Nov 2018)
  • at least 28 cases at Asheville Waldorf School in West Asheville, North Carolina (Nov 2018)
  • at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
  • at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
  • a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
  • at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)

These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.

Cognitive dissonance helps explain how these folks try to explain that chicken pox isn't dangerous.
Cognitive dissonance helps explain how these folks try to explain that chicken pox isn’t dangerous.

Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.

Getting Chicken Pox

How do you get chicken pox?

Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).

Of course, if they vaccinated and protected, then they probably won’t, although mild, breakthrough chicken pox infections are still possible in vaccinated kids.

Their risk is higher if they:

  • are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
  • are partially vaccinated, with only one dose of the chicken pox vaccine
  • have a problem with their immune system, including kids getting chemotherapy

In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.

Avoiding Chicken Pox

Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?

Get your kids vaccinated.

That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.

More on Chicken Pox Outbreaks

Updated on March 14, 2019

Believe It or Not, Chicken Pox Parties Are Still a Thing

Do you remember having chicken pox?

Oh boy, I sure do!

I was about six or seven years old and it was bad. Still, I’m not sure if I remember because I had such a bad case or because it made me miss Halloween that year.

It was almost certainly both, as I remember being covered in spots from head to toe.

What I don’t recall is having many visitors. Why didn’t my mom throw me a chicken pox party!

I also don’t remember going to a chicken pox party to get sick.

Believe It or Not, Chicken Pox Parties Are Still a Thing

Whether or not chicken pox parties were ever that popular, the approval of the chicken pox vaccine in 1995 should have put an end to the practice.

After all, why intentionally expose your child to a potentially life-threatening disease, when a safe and effective vaccine is readily available?

“Chickenpox (varicella) is generally a much milder illness in children than in adults, with considerably lower rates of severe disease and death. Varicella is also virtually universal in many populations, meaning that very few individuals escape infection over a lifetime. Thus, a sound logic underlies the idea of chickenpox parties, at which susceptible children can acquire the contagious causative pathogen, varicella zoster virus (VZV), from their peers. However, chickenpox is not without risks, even for children of this age; severe, complicated, and occasionally fatal varicella occur in previously healthy children, as well as the immunocompromised (who are at very considerable risk).”

Hambleton et al on Chickenpox Party or Varicella Vaccine?

Most folks understand that. They get their kids vaccinated and have helped get chicken pox under very good control, with outbreaks of chicken pox declining over 95%.

“Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States”

CDC on Monitoring the Impact of Varicella Vaccination

Apparently, not everyone has gotten the message though.

Remember when CPS had to investigate the mom who was having chicken pox parties in Plano, Texas a few years ago?

“On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.”

CBS 5 Investigates mail order diseases

Or when anti-vaccine folks were selling and mailing lollipops contaminated with chicken pox to folks so that they could skip the trouble of finding a chicken pox party?

And then there’s that time that a family served chicken pox contaminated punch at their chicken pox party. Oh wait, that was The Simpsons

Chicken pox party - The Simpsons did it.
Chicken pox party – The Simpsons did it in the Milhouse of Sand and Fog episode in Season 17.

So what are they up to now?

Folks are still advertising chicken pox parties in anti-vaccine Facebook groups.
Folks are still advertising chicken pox parties in anti-vaccine Facebook groups.

More of the same…

Does she know that the chicken pox vaccine likely decreases your risk of getting shingles later in life?
Does she know that the chicken pox vaccine likely decreases your risk of getting shingles later in life?

Apparently, there are still plenty of folks looking for chicken pox parties to infect their kids.

Why?

It is easy to see a lot of cognitive biases at play in the decision to host or bring a child to a chicken pox party, including ambiguity aversion (prefer what they think are the known risks of getting the disease), bandwagoning (they think everyone else is doing it, because in their echo chambers of anti-vaccine propaganda, everyone might), and optimism bias, etc.

There is also a very poor perception of risks, as the risks from a natural chicken pox infection are far, far greater than any risk from the vaccine.

Don't forget to tent!!!
Don’t forget to tent and share breath!!!

In bigger news, Facebook has groups who’s mission is “finding pox,” so that parents can get their kids sick!

The mission of PX Colorado is finding pox!
The mission of PX Colorado is finding pox!

How many other PoX type groups are there on Facebook?

How many other parents are intentionally not vaccinating their kids and intentionally exposing them to chicken pox?

Do any of them quarantine or isolate their kids for 10 to 21 days after the chicken pox party, so as to not expose anyone who is too young to be vaccinated, too young to be fully vaccinated, or has a true medical exemption to getting vaccinated, including those who are immunocompromised?

Do they understand the consequences of having these pox parties?

The latest chicken pox party hostess is apparently a nurse - at least for now...
The latest chicken pox party hostess is apparently a nurse – at least for now…

Of course, an investigation from CPS, the health department, or a medical board isn’t the most serious consequence that should discourage folks from hosting or attending a chicken pox party.

Chicken pox can be a serious, even life-threatening infection. Sure, many kids just get a mild case, but others get more serious cases and have bad complications, including skin infections, encephalitis, sepsis, or stroke.

And some people do still die from chicken pox, which is supposed to be a mild, childhood illness.

“This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years.”

Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009

Fortunately, these deaths have been nearly eliminated thanks to the chicken pox vaccine.

And that’s why parents who are on a mission for “finding pox” should rethink things and switch to a mission to get their kids vaccinated and protected.

More on Chicken Pox Parties

Can You Treat Tetanus Without a Tetanus Shot?

Why would anyone want to try and treat tetanus without a tetanus shot?

That’s a good question…

Misinformation about tetanus from the PIC.

Why would a doctor tell others that tetanus could be treated without a tetanus shot?

That might be a question for a state medical board…

Can You Treat Tetanus Without a Tetanus Shot?

As most people will notice, even looking at the ironically named Physicians for Informed Consent’s own post, you don’t treat tetanus without a tetanus shot.

“Tetanus is a medical emergency requiring hospitalization, immediate treatment with human tetanus immune globulin (TIG), agents to control muscle spasm, aggressive wound care, antibiotics, and a tetanus toxoid booster. If tetanus immune globulin is unavailable, Immune Globulin Intravenous (IGIV) can be used.”

CDC on Tetanus for Clinicians

Even in the study that they used as a reference clearly used both tetanus immune globulin and a tetanus shot.

What might be confusing to some folks, is that tetanus toxoid, is synonymous (has the same meaning) as:

  • tetanus vaccine
  • tetanus shot
  • Td (tetanus toxoid + diphtheria toxoid)

So like most people with tetanus, this patient received both tetanus immune globulin and a tetanus vaccine, a fact I tried to point out so that visitors to Physicians for Informed Consent could get true informed consent about their vaccine choices.

The comment that got me banned from posting on Phyicians for Informed Consent.
As often happens on anti-vaccine sites, my comment was quickly deleted and I was banned from posting further messages.

And fortunately, the patient, who’s previous immunization history was unknown, got better!

Treating Tetanus With a Tetanus Shot

Why did he have tetanus?

The case they are talking about occurred in Japan, and again, it isn’t known if the patient had ever received a tetanus vaccine.

“In Japan, tetanus toxoid was introduced in 1968, so elderly adults who were born before 1968 have high risk of tetanus.”

Tomoda et al. on Tetanus without apparent history of trauma

He was born in 1950 and although he had no history of recent trauma, “he grew vegetables in a field as his hobby.”

As most people know, gardening is a risk factor for getting tetanus.

And with such a long incubation period, it is very likely that he had a minor wound or injury while gardening, was exposed to tetanus spores, and later developed tetanus symptoms.

Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.
Over 100 years ago, we did treat tetanus with just tetanus immunoglobulin, but that was before the tetanus vaccine was developed.

The long incubation period is also the reason that giving a tetanus vaccine works to prevent you from getting tetanus even after you have been exposed. Tetanus spores have to germinate, the bacteria have to grow and then produce exotoxins. And then the exotoxins have to travel to different sites in your nervous system, where they act as neurotoxins.

Hopefully, before they do, the dose of tetanus vaccine you got when you pricked your finger on a thorn, stepped on a nail, or cut your leg, etc., will have already induced you to start making antibodies against the exotoxins – antitoxin. Just in case they don’t, in a high risk case, you also would have gotten a dose of tetanus immune globulin for an immediate dose of antitoxin – antibodies against the exotoxins.

The same thing happens if you have already developed tetanus symptoms. A dose of tetanus immune globulin helps to neutralize neurotoxins that haven’t already started doing damage, and you get supportive care until you recover. Plus antibiotics to kill the bacteria so they won’t make more exotoxins and a tetanus shot.

Why not just give tetanus immune globulin, as the post from Physicians for Informed Consent implied you can do?

It is mostly because a tetanus infection doesn’t stimulate any natural immunity and the immunity you get from tetanus immune globulin is temporary, so won’t prevent a relapsing or recurrent case.

Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.
Before the use of tetanus vaccines became standard, it was well known that tetanus relapses were possible.

And because no one would substitute a treatment that is known to work well, a tetanus vaccine with tetanus immune globulin, and switch it out for one that might be riskier and have no extra benefits.

Using immune globulin alone was once the recommended treatment. That was before the tetanus vaccine was developed though. Back then, in the late 19th century and early 20th century, folks with suspected tetanus got treated with anti-tetanic serum that was made in horses. The main problem with this tetanus antitoxin was that it could sometimes trigger serum sickness.

Fortunately, a tetanus vaccine was soon developed and it’s use with tetanus immune globulin helped make deaths from tetanus very rare.

Of course, tetanus is still around. Although it is a vaccine-preventable disease, it will never be eradicated, like smallpox.

“This case had no apparent portal of entry; there was no history of trauma, and no site was found on physical examination. However, this is not uncommon; no obvious entry site was reported in approximately 26% of cases in Japan.”

Tomoda et al. on Tetanus without apparent history of trauma

And not specific to Japan, that you can get tetanus without a history of trauma should be what really concerns folks in this article that the Physicians for Informed Consent has decided to spotlight.

It is a great reminder that vaccines are necessary.

More on Treating Tetanus Without a Tetanus Shot

Costs of a Measles Outbreak

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 now the largest outbreak since the endemic spread of measles was eliminated in the United States
  • 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 has been going on since September 2018, making it the longest outbreak since the endemic spread of measles was eliminated in the United States

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.

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:

  • at least $1.6 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
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994. How much did these outbreaks cost to contain?

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 Costs of a Measles Outbreak

Updated April 10, 2019