Measles outbreaks come with serious consequences

(Reuters Health) - Measles outbreaks can be very costly to communities, a new report suggests.

For example, the 2013 measles outbreak in New York City cost the city’s health department nearly $395,000 and more than 10,000 personnel hours, according to a report in JAMA Pediatrics. And there were other non-monetary costs, including the loss of a pregnancy, researchers reported.

The New York City outbreak started when an unvaccinated teen returned home from the UK on March 13, 2013 infected with the measles virus. By June 9, the city’s health department had identified 58 people as having measles, most of whom had been unvaccinated because of parental refusal or intentional delay.

Half of those infected with the virus were under age three, including 45 children who were at least a year old and 12 babies who were less than a year old, which meant they were too young to have been vaccinated.

The report underscores the importance of getting every child vaccinated on time, said study coauthor Dr. Jane R. Zucker, the assistant commissioner for the Bureau of Immunization at the New York City Department of Health and Hygiene. “Many cases could have been prevented if children were vaccinated at the recommended age, she said. “It also reminds us of how important high vaccine levels are.”

That’s because people who cannot get the vaccine - including infants and people with compromised immune systems - depend on what is known as “herd immunity” for protection: if the vast majority of the population is vaccinated, it’s unlikely that the vulnerable members will be exposed to the disease.

Because measles had been virtually wiped out in the U.S., “we forget that measles can be deadly,” Zucker said. “Before we had the vaccine, there were a quarter million cases every year and 500 deaths. It’s still a major killer in lower resource countries. Just this year alone, in Europe there have been have been several large outbreaks and 31 deaths.”

While death is the most serious consequence of a measles infection, the disease can also lead to pneumonia, diarrhea and ear infections, as well as the rare complication of brain inflammation, which can show up many years after the measles infection is over.

That’s why the health department treats any new case of measles as “an emergency,” Zucker said. “We ask them where they’ve been and whom they were with during the incubation period. And we identify the contacts and assess if they are immune or not. If they are not, we can vaccinate within 72 hours of contact if they are over six months old, or we can give them immune globulin within six days to prevent them from getting sick.”

Two of the 58 people infected in New York City experienced complications: one had a miscarriage and one developed pneumonia.

The new report highlights the growing number of measles cases in the U.S., said Anne Rimoin, an epidemiologist at the Fielding School of Public Health at the University of California, Los Angeles.

“It’s due to the fact that there are pockets of people in the U.S. who are unvaccinated,” Rimoin said. “People forget that there is a responsibility not only to their own children, but also to their community to have high levels of vaccination so outbreaks can be prevented. It’s particularly important for children with cancer or other immune suppressing conditions who have to depend on herd immunity. Measles is very contagious. Up to 90 percent of those exposed who don’t have immunity become infected.”

Beyond the obvious human price, there are other costs when a community is faced with a measles epidemic, Rimoin said. “The Disneyland outbreak in 2017, during which 125 people got measles and 500 were quarantined, cost $2.3 million,” she explained. “And something people forget is if we have our public health system dedicating their time to managing a measles outbreak, they are not doing other public health issues.”

SOURCE: JAMA Pediatrics, online July 30, 2018.