This week, a team with the Centers for Disease Control and Prevention (CDC) arrived in Chicago to assist in the response to the measles outbreak. According to the Chicago Department of Public Health, eight cases have been reported in the city in the past week. It’s the first time measles have been detected locally in Chicago since 2019. The outbreak in Chicago comes after an outbreak occurred last month, which has since been contained, in south Florida.
At the same time, in California, at least 300 people have been exposed after a child went to the University of California Davis Medical Center hospital for treatment recently. Michigan also recently confirmed its first case of measles. As the Atlantic reported, measles are making a comeback in the United States, confirming warnings from earlier this year in which health officials predicted we'd see more measles outbreaksin 2024.
“We're turning back the clock 30 years, 40 years, and exposing our children unnecessarily to a really nasty virus, one that we had eliminated from the United States,” Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center, told Salon. “Leaving pockets of unvaccinated children here in our own country, which once led the world in eliminating measles, seems to us in infectious diseases and public health a great tragedy — and great frustration, frankly.”
It's frustrating, in part, because measles is preventable. The measles vaccine is extremely effective. After two doses, nearly 99 percent of people will be shielded against infection. But in order to control the spread of measles in a population, a community needs a vaccination rate of around 95 percent. If it drops below that — even by a single percentage point — it can lead to localized outbreaks, like the U.S. is experiencing.
As experts have previously emphasized to Salon, measles isn’t just a fever and a rash as some try to casually portray online. An estimated one in four infected patients will be hospitalized. In severe cases, there can be complications like pneumonia and encephalitis — a swelling in the brain that can trigger seizures, deafness and mental disability. Before the measles vaccine was widely available in the U.S., nearly 400 to 500 children would die from measles and its complications each year.
In addition to being concerned about the health of unvaccinated children, infectious disease and public health experts tell Salon that the cost, both monetary and emotional, of even one single measles is high for all of those involved, requiring a lot of resources from the healthcare system. Similar to how COVID-19 placed tremendous strain on the U.S. healthcare system, measles outbreaks can do the same.
“Whenever a measles case is identified in a community, it sets off a whole cascade of events,” Dr. Sean O’Leary, who is the chair of the committee on infectious diseases at the American Academy of Pediatrics, told Salon, elaborating when it comes to measles an “outbreak” is defined by one single case. “Public health authorities spring into action when that happens and that can involve a number of individuals,” he said.
And “time is money,” O’Leary emphasized.
At the Children’s Hospital in Colorado, where O’Leary works, if there’s a measles exposure, a whole team in the hospital works to figure out who has been exposed, which can be a lengthy process that involves tracking everyone down.
“It's a big deal and that's just the single exposure of a kid coming into the emergency room,” O’Leary said. “Beyond that, the local public health and state public health track down everywhere that person has been, and that takes a lot of time and effort.”
After that, for people who were unvaccinated and exposed, officials have to track down their potential exposures as well. Again, this is for one single case. If there’s more than one confirmed case, the resources continue to multiply.
“The costs can quickly skyrocket,” O’Leary said. “And what's so frustrating, from the perspective of people like myself who work in the world of vaccines, is that these are essentially entirely preventable with a very simple low-cost vaccine.”
There have been a few studies published trying to quantify the cost of a measles outbreak. Authors of a paper published in Clinical Infectious Diseases found the median cost for an outbreak was $152,308 — but that’s just an average estimate. An outbreak in Tucson, Arizona, involving 14 cases in 2008 was estimated to cost $799,136. Researchers estimated that an outbreak of 72 cases in Clark County in the state of Washington came with a societal cost of $3.4 million.
The toll a measles outbreak takes extends beyond public health resources. When it comes to treating measles, O’Leary said there aren’t any “effective antivirals” and that doctors usually have to manage the symptoms. This can be costly for the patient.
“Pneumonia is a common complication of measles, and so they may need oxygen,” O’Leary said. “Some of the kids might end up on a ventilator, so that can be considered part of treatment, but again there’s nothing specific that we can use to stop the course of disease.”
Schaffner added there are costs to the clinical side as well. Frequently, there are diagnostic delays because there are two generations of doctors who aren’t thinking about measles right away when a patient comes in with symptoms, which could mean frequent doctors visits. A child infected with measles also has to stay home from school for a couple of weeks. The CDC also recommends that unvaccinated students stay home from school for three weeks after exposure.
“On the personal, family and individual side, there are a lot of disruptions, there are medical costs,” Schaffner said. “There's nothing good to be said about measles.”
Schaffner emphasized measles is a “public health emergency” and the response to one is serious.
“There's a terrific expenditure of resources and monies in response to even a single case,” Schaffner said .”It’s thousands of dollars, and a diversion of public health resources from the routine to responding to this outbreak.”
