title: The economic burden of sixteen measles outbreaks on United States public health departments in 2011.
abstract: BACKGROUND
  Despite vaccination efforts and documentation of elimination of indigenous measles in 2000, the United States (US) experienced a marked increase in imported cases and outbreaks of measles in 2011. Due to the high infectiousness and potential severity of measles, these outbreaks require a vigorous response from public health institutions. The effort and resources required to respond to these outbreaks are likely to impose a significant economic burden on these institutions.
  
  
  OBJECTIVE
  To estimate the economic burden of measles outbreaks (defined as ≥ 3 epidemiologically linked cases) on the local and state public health institutions in the US in 2011.
  
  
  METHODS
  From the perspective of local and state public health institutions, we estimated personnel time and resources allocated to measles outbreak response in local and state public health departments, and estimated the corresponding costs associated with these outbreaks in the US in 2011. We used cost and resource utilization data from previous studies on measles outbreaks in the US and, relying on outbreak size classification based on a case-day index, we estimated costs incurred by local and state public health institutions.
  
  
  RESULTS
  In 2011, the US experienced 16 outbreaks with 107 confirmed cases. The average duration of an outbreak was 22 days (range: 5-68). The total estimated number of identified contacts to measles cases ranged from 8936 to 17,450, requiring from 42,635 to 83,133 personnel hours. Overall, the total economic burden on local and state public health institutions that dealt with measles outbreaks during 2011 ranged from an estimated $2.7 million to $5.3 million US dollars.
  
  
  CONCLUSIONS
  Investigating and responding to measles outbreaks imposes a significant economic burden on local and state health institutions. Such impact is compounded by the duration of the outbreak and the number of potentially susceptible contacts.
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, Ne MS-A-34, Atlanta, GA 30333, USA. Electronic address: IOrtegaSanchez@cdc.gov.
authors.forename: Ismael R
authors.initials: IR
authors.lastname: Ortega-Sanchez
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, Ne MS-A-34, Atlanta, GA 30333, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Vijayaraghavan
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, Ne MS-A-34, Atlanta, GA 30333, USA.
authors.forename: Albert E
authors.initials: AE
authors.lastname: Barskey
authors.affiliation: Centers for Disease Control and Prevention (CDC), National Center for Immunization and Respiratory Diseases, 1600 Clifton Road, Ne MS-A-34, Atlanta, GA 30333, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Wallace
mesh_terms: D017281:Cost of Illness; D004196:Disease Outbreaks / Q000191:economics*; D006077:Government Agencies / Q000191:economics; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006296:Health Services / Q000191:economics; D006801:Humans; D008457:Measles / Q000191:economics*; D014481:United States
keywords: Costs; Measles outbreak; Public health