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Single measles case places high economic burden on public health agencies
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Separate investigations of two unrelated measles cases that occurred in the Denver area in July 2016 and January 2017 placed a considerable economic burden on public health agencies, costing approximately $68,000, according to a recent MMWR.
Both patients contracted measles while traveling outside the country and exposed hundreds of people in the United States to the virus, according to Grace E. Marx, MD, an Epidemic Intelligence Service officer at the CDC, and colleagues.
The first case was a 14-month-old child who returned from India on June 30. He was seen by a pediatrician for pretravel counseling but did not receive the measles-mumps-rubella (MMR) vaccine. After the trip, the child was seen by a pediatrician on July 12 for a fever, cough, coryza, conjunctivitis and a diffuse macular rash that spread from the head to the torso and legs. The pediatrician initially diagnosed the child with hand-foot-and-mouth disease because of an ulcer in the oropharynx. The child was seen again on July 14. He was then admitted to a pediatric hospital for suspected measles infection. However, there was a 5-hour delay before the child was moved to an airborne isolation room.
TCHD was notified of the case the following day. The health department launched a coordinated response to identify potential contacts and administer post-exposure prophylaxis (PEP) when appropriate. The investigation involved multiple public health investigators, hospital infection prevention specialists and personnel from other state and local health agencies.
Investigators determined that measles exposure occurred at eight settings, including three health care facilities, an apartment building, a children’s math and reading center, a supermarket, a large retail store and a fast-food restaurant. More than 310 possible contacts were evaluated. Among them, 32 were susceptible to measles, and all but one received PEP.
A second, unrelated investigation was launched in January 2017 after a 33-year-old man who recently traveled to Thailand also contracted measles. The patient developed a fever on Dec. 20, 2016, and a macular rash on Dec. 25. He was hospitalized on Dec. 29 and tested for measles on Jan. 1, 2017. His infection was confirmed on Jan. 6, and the investigation began the following day on Jan. 7.
Measles exposure occurred at 17 businesses and two health care facilities. More than 230 people were potentially exposed. Three were susceptible to measles but did not receive PEP because more than 6 days had passed since they were exposed to the disease.
During the first investigation, 756 hours of personnel time were spent at a cost of $49,769, according to Marx and colleagues. For the second investigation, 435 personnel hours were spent at a cost of $18,423. No secondary cases of measles occurred during either investigation.
“This report highlights the high cost of public health response to measles introduction in local communities,” the researchers wrote. “Failure of clinicians to recognize measles early in the course of illness in these two cases serves as a reminder that health care providers might not be familiar with clinical measles or aware of the risk for measles transmission during international travel. Health care providers need to recommend MMR vaccination before travel when appropriate and maintain a high index of suspicion for measles in patients with a febrile rash illness, particularly unvaccinated returning international travelers.” – by Stephanie Viguers
Disclosures: The authors report no relevant financial disclosures.
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