Measles sickened 644 people in 27 states last year and struck another 102 people across 14 states last month. Last week, five infants at an Illinois daycare center were diagnosed with the disease and a 1-year-old in New Jersey was confirmed to have it as well.
Worse still, the outbreak may not be over.
In late January, the California Department of Public Health warned the disease could spread further.
Along with being a terrible disease for sufferers and their families, measles is also a nightmare for public health officials to contain. According to the Centers for Disease Control and Prevention (CDC), if one person has the disease, 90 percent of the people close to that person who are not immune will also become infected. The virus is airborne and can linger in public spaces hours after the carrier has left a room. Sufferers can be contagious for days before they experience symptoms.
These features of measles add up to lots of work and steep costs for public health officials to contain even a small outbreak. Studies based on prior outbreaks show that costs easily run to more than $10,000 per case. That’s not enough to dent the U.S. economy, but it poses risks for specific communities if they are subject to a large and prolonged outbreak. For example, a 2008 outbreak in San Diego, California, that began with an unvaccinated boy and led to 11 cases, cost $124,517 to contain, according to a 2010 study published in the journal Pediatrics.
The public sector costs of treating each case each was $10,376, including the 1,745 person hours spent on “investigation and containment efforts,” according to the study. Direct medical costs totaled $1,347 and expenses related to quarantining 48 children who were too young to be vaccinated equaled $775 per patient.
A CDC study published in the journal Vaccine noted that there were 16 measles outbreaks in 2011 that resulted in 107 cases and cost public health departments between $2.7 million and $5.3 million to combat. "Beyond the impact on local and state public health departments, responses to measles outbreaks also affect hospitals, clinics, as well as non-health public departments such as schools, universities and occasionally local police departments enforcing quarantines," authors of the CDC study note.
Those figures don’t include costs incurred by the patients, which are considerable as well. Measles sufferers often require hospitalization. They can get complications like pneumonia and encephalitis (swelling of the brain) that can be deadly.
A Los Angeles hospital charged around $9,264 per patient during a resurgence of the infection in the 1990s, according to a 2004 report in the Journal of Infectious Diseases. That figure has no doubt risen in the intervening years.
One reason the disease is still a risk is because the high costs of treatment and containment make it hard for developing countries to eradicate. “In many countries, resources are not available to treat measles cases or for adequate hospital care for patients with complications,” notes a report in the Journal of Infectious Diseases.
The U.S. is the largest country to have outbreaks of the disease. “Measles is the greatest vaccine-preventable killer of children in the world today and the eighth leading cause of death among persons of all ages,” according to the Journal of Infectious Diseases.
In the U.S., the measles vaccine is widely available and 99 percent effective. But a growing trend of parents choosing not to vaccinate their children is making the U.S. more susceptible to outbreaks, despite its relative wealth.
The case outlined in the Pediatrics article highlights the risk. An unvaccinated 7-year-old, who caught the disease while traveling in Europe, exposed 839 people to the virus and caused 11 measles cases in children who also lacked protection against the highly contagious disease. Among those who caught the disease were the carrier’s brother and sister.
The Pediatrics study found that the parents who hadn’t vaccinated their children tended to be college-educated, white and adherents to what they consider to be a “natural lifestyle.” Moreover, they also believed in the debunked notion of a link between autism and vaccines. These issues have also come up during the current outbreak and have been the subject of some political debate.
“As long as there have been vaccines, there have been people opposed to them,” said Dr. Daniel Salmon, deputy director of Johns Hopkins’ Institute for Vaccine Safety, in an interview. “We have to do a better job with communication.”
Not surprisingly, it’s far more cost effective to prevent the disease in the first place than to contain outbreaks. Data from the CDC pegs the cost of the MMR vaccine, which also protects against mumps and rubella, at $19 per dose for the public sector, and $60 per dose in the private sector.
“Insurance and federal government programs cover the costs of vaccines for most kids, so the only cost to parents is the cost of taking their kid to the doctor and any co-pay,” writes Kimberly Thompson, the head of Kid Risk, a non-profit that focuses on vaccine research, in an email to The Fiscal Times.
For families, that is a small price to pay to keep their children healthy. For public health officials, it may seem an even smaller price to avoid the nightmare and extra costs of controlling a large outbreak.
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