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Estimating the impact: How much does a measles outbreak cost?

John Heys
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A measles outbreak in Columbus, Ohio, that began in November had grown to 77 cases as of Dec. 15, according to the city’s public health department, with nearly 70% of the cases among children 1 to 5 years old. Twenty-nine of the cases had been hospitalized so far.

Measles outbreaks can incur substantial costs for public health departments and communities. How much cost? The authors of a 2020 review in Clinical Infectious Diseases looked at the question and calculated cost estimates based on 10 studies of 11 previous U.S. measles outbreaks:

  • Median total cost per outbreak: $152,308 (range, $9,862-$1,063,936);
  • Median cost per case: $32,805 (range, $7,396-$76,154);
  • Median cost per contact: $223 (range, $81-$746);
  • Approximate cost per day of investigation: $4,000.

But as the authors noted, there were limited data available on direct and indirect costs associated with measles in the studies they reviewed. “Because none of these estimates captured costs from a societal perspective, these estimates are likely an underestimate of all costs incurred during measles outbreaks,” they wrote in their review.

A 2021 study in Pediatrics by two of the same authors, along with additional co-authors, focused on costs from the societal perspective resulting from an outbreak of measles in Clark County in Washington State. The outbreak included 72 confirmed measles cases from December 2018 to April 2019.

Estimating the impact using this more comprehensive lens included costs for the public health response (labor, material and contractor costs) direct medical costs (third party or patient out-of-pocket treatment costs for infected individuals) and productivity losses (lost productivity due to illness, home isolation, quarantine or informal caregiving).

The overall societal cost of the outbreak, the authors estimated, was about $3.4 million ($47,479 per case or $814 per contact). The majority of the costs, approximately $2.3 million, were incurred by the public health response followed by productivity losses (about $1.0 million) and direct medical costs (about $76,000).

The estimates “indicate that undervaccination can carry a substantial cost for individuals, communities and public health institutions and underscore the value of vaccination,” the study authors wrote in their conclusion.

In the current outbreak in Ohio, 72 of the measles cases have been unvaccinated, meaning they had received no doses of the measles, mumps and rubella vaccine, according to Columbus Public Health. This included cases who may not have been eligible for any doses of the vaccine because of age. Four of the cases were partially vaccinated. No cases have been reported so far in anyone who was fully vaccinated, although the vaccination status for one case is unknown.

Globally, nearly 40 million children — a record high — missed a measles vaccine dose in 2021, according to a recent report from the World Health Organization and the Centers for Disease Control and Prevention. The statistic is part of a steady decline in measles vaccination coverage since the COVID-19 pandemic began.


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