Multistate Measles Outbreak Drives Up State Health Agency Costs and Points to Importance of Quality Immunization Communication
With the Disneyland measles outbreak up to 87 cases in seven states as of Jan. 26, state health departments are responding to the disease by educating primary care providers and the public about measles and conducting contact tracing.
Measles is airborne and one of the most contagious diseases in existence--it can linger in a room for up to two hours after the infected person has left. It also remains pervasive around the world and can easily be imported into other countries. Measles is a leading cause of death among young children, and about 30 percent of people who contract measles will develop complications. WHO reports that although measles deaths decreased by 73 percent worldwide between 2000 and 2013, measles still caused 145,700 deaths globally in 2013.
"Measles was declared eliminated in the United States in 2000. Sadly, this status is endangered," says Paul Jarris, MD, MBA, executive director of ASTHO. "Many parents and physicians have never seen a case of measles before. This outbreak demonstrates why we can never let our guard down against vaccine-preventable diseases."
Due to its highly infectious nature, health departments have to respond rapidly and thoroughly to contain outbreaks and save lives. If a measles patient has traveled to school, the grocery store, or any other public space, a large group of people may have been exposed to the disease. State health departments are responsible for ensuring that patients are isolated to prevent further spread. They then identify potential contacts, educate them about measles symptoms, advise them on when to go to the doctor, and encourage them to become immunized if they aren't already.
"At ASTHO, I'm proud of the work that the California Department of Public Health and other states are doing to protect our children by containing this outbreak, preventing future ones, and bringing us closer to maintaining full elimination status," Jarris says.
In addition to the time spent containing a measles outbreak, responding to them is expensive for state and local governments. A March 2014 study found that there were 16 measles outbreaks in 2011 that resulted in 107 cases, which cost local and state public health departments an estimated $2.7 million to $5.3 million. In early 2008, a 7-year-old boy contracted measles while visiting Switzerland. After returning home to San Diego, he attended school, where five of his fellow students were infected. In total, 11 people, including the boy's two siblings, contracted measles. The county and state health department responded to the outbreak and contained it, costing the local and state governments $176,980.
However, these outbreaks and their time and economic burdens are preventable. Every dollar spent on the child measles, mumps, and rubella vaccine saves $23.30, according to CDC.
"This is an important opportunity for public health to continue to articulate the benefits of immunization," says Kathy Talkington, ASTHO's senior director of immunization and infectious disease. "This measles outbreak illustrates that we live in a global world, and as long as these diseases exist in other countries, we must continue to protect ourselves in all communities through high immunization rates."
To help public health professionals communicate with the public and primary care providers about how vaccines can prevent outbreaks and save lives, the ASTHO Infectious Disease Department offers seven tips:
How to Communicate the Importance of Vaccines
- Parents want to do what's best for their children, so when you communicate about vaccines, focus on how they protect kids. ASTHO has created audience-tested campaign templates that public health institutions can use as examples.
- Many negative messages, such as showing pictures of children infected with vaccine-preventable diseases, are often not effective, and may even backfire.
- Don't spend too much time refuting vaccine refusers--it can give credence to long-discredited theories.
- The public sees that primary care providers, public health officials, and CDC are responsible sources of information, and want to be empowered with accurate, complete information. Refer family decisionmakers to trustworthy sources for vaccine information.
- Don't just focus on child immunization--you need to encourage adult vaccination, too. More than 60 percent of the people who contracted measles from the Disneyland outbreak are 20 years old and up. Most were unvaccinated, but some may have been born before 1989--when the measles booster become part of the immunization schedule-and missed out getting theirs.
- Talk to primary care providers about the importance of consistently communicating how vaccines protect our children.
- States can examine their school vaccination opt-out policies to determine if they are maximizing public health. For example, parents can be advised or required to speak with a well-informed primary care provider before submitting a school vaccination opt-out form.
For more information about innovative best practices to increase access to vaccines and rates of vaccination, visit the ASTHO Immunization Resource Guide.