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Disease — Measles Expensive



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Disease — Measles Expensive

Measles outbreaks cost a lot of money.


Mnookin 15 — Seth Mnookin, 7-14-2015 ("» The financial implications of the US measles outbreaks," No Publication, 7-14-2015, Available Online at http://blogs.plos.org/thepanicvirus/2011/05/25/the-financial-implications-of-the-us-measles-outbreaks/, Accessed 7-14-2015)

Earlier today, the CDC released a report about the measles outbreaks that have been occurring across the country since the beginning of the year. (Hat tip to USA Today‘s Liz Szabo for this story.) I wrote a fair amount about measles in my book, and one reason measles outbreaks are so scary (and so difficult to contain) is that measles is the most infectious microbe known to man–it’s transmission rate is around 90 percent. It has also killed more children than any other disease in history.

If you’re skeptical about the correlation between measles vaccination rates and the spread of the disease, or about the danger deliberately unvaccinated members of the population pose to infants, you should check out the CDC’s figures. They’re pretty stunning:

* There have been 118 reported measles cases in the first nineteen weeks of the year — which is the highest number of infections for that period since 1996. That’s particularly noteworthy because, as the CDC points out, “as a result of high vaccination coverage, measles elimination (i.e., the absence of endemic transmission) was achieved in the United States in the late 1990s and likely in the rest of the Americas since the early 2000s.”

* Eighty-nine percent of all reported cases have been in people who’ve been unvaccinated. Almost 20 percent of that figure is made up of children who were less than a year old. That means they were too young to have received the first dose of the measles-mumps-rubella (MMR) vaccine, which is given once between the ages of twelve and fifteen months and again when a child is between four and six years old. Another twenty percent of the total number of reported infections were in children between the ages of one and four.

* Forty percent of the infections recorded so far this year have resulted in hospitalization — and 98 percent of the people who were hospitalized were unvaccinated. In its typically understated manner, the CDC noted that “nine [of the hospitalized patients] had pneumonia, but none had encephalitis and none died”– which is another way of saying that encephalitis and death are potential complications of serious cases of pneumonia.



The most significant factor in the spread of measles in the United States is the increase of pockets of the country where vaccination rates have declined below the level needed to maintain herd immunity`– and, similar to what occurred in the UK in the early part of the last decade, that decline can be traced back to the press-fueled panic sparked by anti-vaccine messiah Andrew Wakefield’s discredited, retracted, and possibly fraudulent twelve-child case study linking the MMR vaccine to autism.

Indeed, it’s striking just how many of the infections are clustered around Minnesota, where anti-vaccine activists have been for years targeting an immigrant Somali community…and where Wakefield has made multiple trips over the past several months:

Reported measles cases in US, Jan 1-May 20 2011

Anyone curious about how quickly a series of small measles conflagrations can spread horribly out of control should check out the situation currently unfolding in France, which is in the third year of a nation-wide outbreak.^ In 2007, the number of reported cases in France was around forty. The next year, they jumped to six hundred…and they’ve been rising ever since. So far in 2011, there have been more than 6,400 infections in the country. Translated to a population the size of the US’s, that would represent a jump from 188 cases to more than 28,000.

The toll that would take on the nation’s health-care infrastructure is mind-boggling. Consider this: In 2008, a deliberately unvaccinated patient of “Dr. Bob” Sears caught measles while on vacation in Switzerland. That single infection ultimately resulted in a total of 12 cases…and the total cost of containing the outbreak topped $150,000.

FOOTNOTES

` The beginning of this sentence had previously read, “The most significant factor in the spread of measles in the United States is declining vaccination rates.” As some readers have pointed out, the overall vaccination rates in the country have more or less stayed the same; the issue is the increase in individual communities where vaccine refusal has grown.

^ France also illustrates how the result of vaccine panics can be similar even when the roots causes are completely unrelated: A recent British Medical Journal story titled “Outbreak of measles in France shows no signs of abating” points out that “the publication in the Lancet in 1998 of the research article by Andrew Wakefield purporting to show a link between the MMR vaccine and autism had no significant effect on uptake of the MMR vaccine in France. The main vaccine controversy in France has centred on that against hepatitis B, and this has taken its toll on immunisation campaigns as a whole.”



Measles are really expensive


Haelle 15 — Tara Haelle, I am a freelance science journalist and photojournalist who specializes in reporting on vaccines, pediatric and maternal health, parenting, nutrition, obesity, mental health, medical research, environmental health and the social sciences. My work has appeared in Scientific American, the Washington Post, Politico, Slate, NOVA, Wired, Science and Pacific Standard, and I write regularly for HealthDay, Frontline Medical Communications and my science and health mom blog Red Wine & Apple Sauce. I was the health editor at Double X Science and am currently co-authoring an evidence-based parenting book due in late 2015. I received my master's in journalism at the University of Texas at Austin (also my undergrad alma mater), and I teach journalism at Bradley University in Peoria, Ill. I previously taught high school and often think of my journalism as a form of teaching, by helping others understand science and medical research and by debunking misinformation about vaccines, chemicals and other misunderstood topics, 2-11-2015 ("Measles Outbreak in Dollars and Cents: It Costs Taxpayers Bigtime," Forbes, 2-11-2015, Available Online at http://www.forbes.com/sites/tarahaelle/2015/02/11/measles-outbreak-in-dollars-and-cents-it-costs-taxpayers-bigtime/, Accessed 7-14-2015)

The official measles count is up to 121 cases in 17 states, the CDC reported on Monday, and 85 percent of those resulted from the outbreak stemming from the Disneyland exposure. That’s more cases than were seen in all of 2012 – and it’s only February.

Much virtual ink has been spilled in the past several weeks about what an awful disease measles can be, about the impact of irresponsible doctors’ advice, and about the ramifications of not vaccinating on those unable to be vaccinated.

But only a handful of folks have talked about costs. Measles is expensive. Really expensive. And even if you live in a highly vaccinated area with no outbreaks, a measles case in your state – that’s a third of the U.S. right now – still means health department tax dollars diverted from other programs to deal with a disease that was eliminated from the U.S. in 2000.

“These outbreaks have economic costs. They are disruptive,” said Gregory Poland, head of the Mayo Clinic's Vaccine Research Group. “The smaller ones have cost a couple hundred dollars in public resources, and one cost nearly a million dollars. It’s on the lesser side – health is more important – but it consumes public health resources that could be applied to the other pressing problems we face.”

In 2011, the cost of 107 cases spread across 16 outbreaks cost local and state health departments an estimated $2.7 million to $5.3 million. Because measles is so contagious, infecting 90 percent of susceptible individuals and remaining airborne up to two hours after an infectious person has left the area, the number of contacts a single case can generate grows exponentially once an outbreak begins. The cases in 2011 involved contacting somewhere between 8,900 and 17,450 individuals, which required 42,000 to 83,000 personnel hours.

The outbreak tied to Disneyland is responsible for approximately 85% of the cases to date. Photo from the CDC.

The outbreak tied to Disneyland is responsible for approximately 85% of the cases to date. Photo from the CDC.

During another outbreak in 2008, during which an intentionally unvaccinated 7-year-old boy returned from Switzerland with the virus, San Diego grappled with 11 additional cases, costing taxpayers $10,376 per case. That outbreak involved more than 800 exposed individuals, including 48 children too young to be vaccinated who had to be quarantined at a family cost of $775 per child.

Among the ten measles cases in Illinois, eight are infants too young to be vaccinated, which means it’s highly likely that other infants in those classrooms were exposed and may need to be quarantined for up to three weeks. If so, the costs will very likely be higher than they were in 2008.

Then there are the family costs of an actual measles case, which lasts about seven to ten days, though those costs are a bit harder to measure, according to health economist Adam Powell, president of Payer+Provider Syndicate Healthcare Consulting.

“While this cost can be absorbed by many employees through the use of sick days, employees with lower incomes are the least likely to have sick leave,” Powell said. “The Economic Policy Institute reported that the median wage for people without sick days is $10 per hour. Assuming the person works five days a week, missing a week of work would cause a loss of $400. If the absence extended to eight days of work and two days of weekend as a result of a ten day illness, the loss would be $640.”

But that figure only accounts for an estimate of lost wages, not the any additional costs such as hospitalization. “After factoring in the cost of medical care, expenses could be even higher,” Powell said.

Contrast those numbers with the cost of the MMR (measles-mumps-rubella) vaccine, which prevents the measles in 95 percent of those who get one dose and 99 percent of those who get both doses. A provider under a CDC contract, such as those using the Vaccines for Children program, pays $19.91* for a single pediatric dose of MMR (or $37.04* for an adult dose), and the private sector price is $59.91*.

Even those costs are not ones that consumers would have to pay, however.

“Although there is a cost to the vaccine, it is not borne by insured patients,” Powell said. “The Affordable Care Act requires that the MMR vaccine be fully covered without patient cost sharing in its provisions requiring the coverage of preventive services.”

It’s long been clear that the risk-benefit calculation from a health and scientific perspective comes down heavily in favor of the vaccine. Measles kills approximately one in 1,000 to 3,000 cases, and it causes brain damage from encephalitis in one in 1,000 cases, not including the individuals who develop pneumonia or other complications. The vaccine, by contrast, most commonly causes a fever, joint pain or mild rash and can cause a fever-caused seizure in one of 3,000 doses, a low platelets count (that usually resolves on its own) in one of 30,000 doses, or, in extremely rare situations, a severe allergic reaction in one in a million doses.

The cost-benefit calculation in dollars and cents looks pretty similar.




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