Adding to the frustration of the re-emergence of measles — a childhood vaccine-preventable disease — are the labor-intensive high cost investigations to track down all people exposed to a case that was not immediately identified and isolated.

How expensive? Two unrelated cases that occurred from July 2016 to January 2017 in Denver required public health expenditures in excess of $68,000, the CDC reported.

The costs spiraled because each case exposed hundreds of people, triggering a response by multiple public health agencies. Both patients had traveled to countries with endemic measles transmission.

“Increased awareness of the risk of travel-associated measles infection is needed,” the CDC recommended. “Prior to international travel, measles-mumps-rubella vaccination is recommended to prevent measles disease.”

No secondary cases of measles were identified in either investigation, the CDC reported. The first case required post-exposure prophylaxis (PEP) to 31 contacts, but no PEP was administered in the second case because of a delay in diagnosing measles.

“Public health costs of disease investigation in the first and second case were estimated at $49,769 and $18,423, respectively,” the CDC concluded. “Single measles cases prompted coordinated public health action and were costly and resource-intensive for local public health agencies.”

The first case was a 14-month-old infant diagnosed with measles who potentially exposed people in a number of settings, including three healthcare facilities, an apartment building, and a children’s math and reading center. The second unrelated measles case was an unvaccinated man who had traveled to Thailand. The man eventually was hospitalized, but during the infectious period he visited 17 businesses and two healthcare facilities. In total, the cases required follow-up on hundreds of people. The first case required 756 hours of public health labor, and the second 435 hours.

“Failure of clinicians to recognize measles early in the course of illness in these two cases serves as a reminder that healthcare providers might not be familiar with clinical measles or aware of the risk for measles transmission during international travel,” the CDC stated. “Healthcare 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.”

REFERENCE

1. CDC. Public Health Economic Burden Associated with Two Single Measles Case Investigations — Colorado, 2016–2017. MMWR 2017;66(46):1272–1275.