Public Health Cost of Imported Measles
Public Health Cost of Imported Measles
By Carol A. Kemper, MD, FACP
This article originally appeared in the October 2006 issue of Infectious Disease Alert. It was edited by Stan Deresinski, MD, FACP, and peer reviewed by Connie Price, MD.
Synopsis: When a young woman arrived in Indiana from Romania in 2005, she initiated several waves of measles among a largely unvaccinated community, at a cost of approximately $5000 per infected patient.
Sources: Parker AA, et al. Implications of a 2005 Measles Outbreak in Indiana for Sustained Elimination of Measles in the United States. N Engl J Med. 2006;355:447-455. Erratum in: N Engl J Med. 2006;355:1184.
Parker and colleagues describe the public health effort required to contain the largest outbreak of measles occurring in the United States in the past 10 years. The outbreak, which occurred in Indiana in 2005, began when a 17-year-old girl who was incubating measles arrived from Romania. The following day she attended a church gathering with ~500 people. Within days, a 6-year-old girl attending the event was hospitalized. The outbreak quickly spread in this highly unvaccinated community — largely because of the presence of unvaccinated children of parents who were concerned about the safety of measles vaccination.
Over the next 6 weeks, 3 waves of measles infection occurred. Sixty-six persons were suspected to have measles; 34 persons were confirmed. Fifty individuals lacked immunity to measles (~10% of the gathering), and evidence of vaccine failures occurred in 2 infected individuals. Three patients required hospitalization, including a hospital phlebotomist who developed pneumonia, requiring ventilatory support for 6 days.
Virus isolated from 4 of the patients was identical, and all were genotype D4, which is endemic to Eastern Europe, as well as the Middle East and India.
Parker et al estimate that containment of the outbreak involved 3 different public health departments, 29 public health employees, 3650 person hours, and 4800 telephone calls; an estimated cost of $168,000 (~$5000 per infected patient). A total of 465 doses of MMR and 210 doses of prophylactic immune globulin were administered.
Importation of measles infection remains the single most important source of measles in the United States. Individuals in their 30s and 40s may be more vulnerable than previously suspected, possibly due to waning immunity. No nation currently requires measles vaccination for entry, including the United States. While this report was in press, a second, smaller outbreak occurred in Boston in May, 2006, when a young female computer programmer was recruited from India to work at the John Hancock Tower (where ~2000 people work). A total of 14 cases of measles occurred, including 12 employees in the building and 2 other Boston residents. Health care facilities should be alert to the possibility of measles infection in any immigrant or traveler with a febrile exanthem, and promptly alert public health authorities.
Parker and colleagues describe the public health effort required to contain the largest outbreak of measles occurring in the United States in the past 10 years. The outbreak, which occurred in Indiana in 2005, began when a 17-year-old girl who was incubating measles arrived from Romania.Subscribe Now for Access
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