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Original Investigation
July 30, 2018

Public Health Consequences of a 2013 Measles Outbreak in New York City

Author Affiliations
  • 1New York City Department of Health and Mental Hygiene, New York
  • 2now with Brighter Bites, New York, New York
  • 3National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Pediatr. Published online July 30, 2018. doi:10.1001/jamapediatrics.2018.1024
Key Points

Question  What is the burden of a measles outbreak on public health?

Findings  This epidemiologic assessment and cost analysis of a 2013 measles outbreak in New York City, New York, found 58 cases of measles infection and 3351 exposed contacts, with 78% of the age-eligible cases unvaccinated owing to refusal or intentional delay. Total direct costs to the Department of Health and Mental Hygiene were $394 448, and 10 054 personnel hours were consumed responding to and controlling the outbreak.

Meaning  Measles vaccine refusals or delays can lead to large outbreaks following measles importations, with costly and resource intensive response and containment.

Abstract

Importance  Internationally imported cases of measles into the United States can lead to outbreaks requiring extensive and rapid control measures. Importation of measles from an unvaccinated adolescent in 2013 led to what has been the largest outbreak of measles in New York City, New York, since 1992.

Objective  To describe the epidemiology and public health burden in terms of resources and cost of the 2013 measles outbreak in New York City.

Design, Setting, and Participants  This epidemiologic assessment and cost analysis conducted between August 15, 2013, and August 5, 2014, examined all outbreak-associated cases of measles among persons residing in New York City in 2013.

Exposures  Measles virus.

Main Outcomes and Measures  Numbers of measles cases and contacts. Total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene (DOHMH), calculated as the sum of inputs (supplies and materials, equipment, and logistics) and personnel time (salary and fringe benefits).

Results  Between March 13, 2013, and June 9, 2013, 58 persons in New York City with a median age of 3 years (range, 0-32 years) were identified as having measles. Among these individuals, 45 (78%) were at least 12 months old and were unvaccinated owing to parental refusal or intentional delay. Only 28 individuals (48%) visited a medical health care professional who suspected measles and reported the case to the DOHMH at the initial clinical suspicion. Many case patients were not immediately placed into airborne isolation, resulting in exposures in 11 health care facilities. In total, 3351 exposed contacts were identified. Total direct costs to the New York City DOHMH were $394 448, and a total of 10 054 hours were consumed responding to and controlling the outbreak.

Conclusions and Relevance  Vaccine refusals and delays appeared to have propagated a large outbreak following importation of measles into the United States. Prompt recognition of measles along with rapid implementation of airborne isolation of individuals suspected of measles infection in health care facilities and timely reporting to public health agencies may avoid large numbers of exposures. The response and containment of measles outbreaks are resource intensive.

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