LB-31. Financial Impact of an Imported Measles Outbreak on Public and Private Sectors
Session: Oral Abstract Session: Late Breaker Oral Abstracts
Saturday, October 22, 2011: 5:30 PM
Room: 156ABC
Background: Although measles is no longer endemic in the United States due to high vaccination rate (97%), imported cases occur, leading to extensive efforts to limit spread.  We investigated the public health and financial impact of an outbreak in Salt Lake County, Utah.

Method: Cases were confirmed by laboratory testing at CDC, clinical case definition, and/or epi-link. Case information was extracted from Utah’s National Electronic Disease Surveillance System.   Utah Department of Health, Salt Lake Valley Health Department, and Primary Children’s Medical Center (PCMC) calculated the direct cost of staff time, post-exposure vaccinations, measles antibody testing, and immunoglobulin prophylaxis. Costs for two additional hospitals, a temporary emergency department closure and a school system are not included.

Result: From April to May 2011, nine cases of measles were confirmed in Salt Lake County. The index case was an unvaccinated high school student who traveled to Europe. Cases ranged from 2 to 22 years (median 16); six (67%) were unimmunized due to personal exemption. Public health authorities investigated 49 confirmed or suspect cases, quarantined 184 individuals, and notified approximately 12,000 contacts. Of these, 193 (including 31 healthcare workers) were identified through PCMC.  No hospital-associated transmission was documented at PCMC, where mandatory proof of immunity for all employees had been recently implemented. Direct cost of physician and staff time was estimated to be $233,000 for public health and $17,000 at PCMC.  Vaccines, immunoglobulin, and serologies cost approximately $37,000 for public health and $4,700 for PCMC.  Direct costs for controlling this outbreak conservatively totaled nearly $300,000.

Conclusion:Personal exemptions for vaccination played a significant role in this outbreak. Mandatory documentation of measles immunity at PCMC facilitated control in the health care setting.  Contact investigation and isolation of infectious and potentially infectious persons required coordinated efforts on the part of state and local public health authorities and hospital infection control teams.  Although the outbreak was small, the direct costs to public health and the healthcare system were substantial.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Karyn Leniek, MD, MPH1, Dagmar Vitek, MD, MPH2, Ilene Risk, MPA2, Mary Hill, MPH3, Valoree Vernon, MPH4, Rouett Abouzelof, RN, MSN, CIC5, Carrie L. Byington, MD6, Krow Ampofo, MD7 and Andrew Pavia, MD, FIDSA6, (1)Utah Department of Health, Salt Lake City, UT, (2)Salt Lake Valley Health Department, Salt Lake City, UT, (3)Salt Lake Valley Health Dept., Salt Lake City, UT, (4)Utah Department of Health, Salt Lake City, UT, Afghanistan, (5)Primary Children’s Medical Center, Salt Lake City, UT, (6)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (7)University of Utah, Salt Lake City, UT

Disclosures:

K. Leniek, None

D. Vitek, None

I. Risk, None

M. Hill, None

V. Vernon, None

R. Abouzelof, None

C. L. Byington, Idaho Technology, Inc.: Grant Investigator, Research grant and intellectual property rights

K. Ampofo, None

A. Pavia, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.