In a report published Monday in JAMA Pediatrics, researchers describe the human and financial costs associated with a single measles outbreak that swept through two Brooklyn neighborhoods in 2013, infecting 58 people, mostly children.
Responding to and containing the four-month-long outbreak ended up costing New York City’s health department almost $400,000 and more than 10,000 personnel hours, the report says.
It also cost the life of a baby, whose infected mother miscarried during her 38th week of pregnancy.
All but one of the people (an adult) who developed measles during the Brooklyn outbreak were unvaccinated, primarily because parents had refused or intentionally delayed the administration of the vaccine to their children, the report says.
The findings from the report, which was written by officials from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention, underscore the importance of getting every child vaccinated in a timely manner, says Jason Schwartz, an assistant professor of public health policy at Yale University, in an accompanying editorial.
“Decisions to delay or decline vaccination result in potentially serious health risks to those individuals and their communities as well as significant burdens and costs to health department and the health care system,” he adds.
The source of the outbreak
The first case in the Brooklyn outbreak was reported on March 13, 2013, in an unvaccinated teenager who had just returned from London. (Measles have been endemic in the United Kingdom since 2008, thanks to a precipitous drop in immunizations, which was triggered by a totally discredited medical paper linking vaccines to autism.) The last case in the Brooklyn outbreak was reported almost four months later, on June 9.
The 58 patients who became ill ranged in age from infancy to 32 years, although half were age 3 or younger. Forty-five (78 percent) were at least 12 months old, and therefore would have been vaccinated if their parents had not refused or delayed the procedure. Twelve (21 percent) of the patients were under a year old and thus too young to have received the vaccine. One person was an adult who reported receiving the vaccine as a child.
The most common way the 58 people contracted the measles was through a relative. Indeed, most of the patients were members of eight extended families. But people also became infected by living in the same building as someone who was ill or by being their friend or playmate. The illness was also spread at health care facilities and at a community gathering. In some cases, health officials were unable to trace where the infection had been transmitted.
Of those who became ill, two developed complications. One child came down with pneumonia and an unvaccinated pregnant woman, as already noted, miscarried.
Thousands of hours
During the four months of the outbreak, 87 health officials spent 10,054 personnel hours doing such activities as interviewing patients and then tracing down individuals with whom they had been in contact and immunizing them if needed. A total of 3,351 contacts were identified.
The officials also spent time collecting and coordinating lab test specimens, issuing health advisories and doing other tasks aimed at stopping the spread of the disease.
The outbreak cost New York City’s health department $394,448, according to the report. Most of that money went to staff salaries, but the total also included $30,000 for advertising, $17,590 for vaccines, $9,316 for lab supplies and testing and $4,886 for courier expenses.
Those costs are conservative estimates, the author’s of the report add. They don’t include unpaid hours or time spent on the outbreak by staff from other agencies.
A controversial proposal
As Schwartz points out in his editorial, even the conservative numbers reported by the study “underscore the resource-intensive nature of public health responses to vaccine-preventable disease outbreaks.”
“States and local health departments already face substantial budgetary pressures and difficult choices on where to invest limited funds and personnel,” he writes. “The prospect of having to rapidly redirect resources on the scale required during the 2013 New York City measles outbreak is surely daunting to public health officials, few of whom have in their departments resources comparable with those of the New York City [health department].”
Schwartz says this economic burden “is another lamentable consequence of individual decisions to reject evidence-based vaccination recommendations by delaying or declining vaccines for one’s self or one’s children.”
It’s in the public good for communities to have high vaccination rates, “regardless of one’s personal decision to vaccinate,” he stresses.
Furthermore, “those who voluntarily choose to forego vaccination are thus free-riders, benefiting from this public good without contributing to it,” he says.
In the editorial, Schwartz makes the controversial proposal that families who get nonmedical exemptions should be required to pay a fee that would directly support vaccination activities, such as educational efforts and outbreak response. He describes the fee as analogous to the alternative service required of conscientious objectors when service in the armed forces is compulsory — “a means by which all contribute to a collective, mutually beneficial efforts in a manner consistent with their personal values.”
“Such a fee would reflect the shared benefits among a community that result from a well-functioning vaccination system and the corresponding shared responsibility for contributing to and sustaining those benefits,” Schwartz says.
Not a benign disease
Measles is a highly infectious viral disease that is transmitted through the air by coughing and sneezing. Although most people who become infected with measles recover fully, it is not a benign illness, particularly for children under the age of 5 and adults over the age of 20. Measles can lead to severe complications, including pneumonia and encephalitis (swelling of the brain), and even death. The disease can also leave children susceptible to other infectious illnesses, and, in rare cases, to a neurological condition that can “hide” in the nervous system and show up years later.
Measles can be prevented with the measles, mumps and rubella (MMR) vaccine. Health officials recommend two doses of MMR — the first when a child is 12 to 15 months old and the second when the child is four to six years old.
The single dose is about 93 percent effective at preventing measles, and both doses are about 97 percent effective, according to the CDC.
FMI: You’ll find abstracts of the study and the editorial on the JAMA Pediatrics website, but the full papers are behind a paywall.