title: Cost of measles containment in an ambulatory pediatric clinic.
abstract: BACKGROUND
  Measles is highly infectious; prompt containment of illnesses is necessary to prevent spread. In August 2013, a 13-year-old male with measles exposed patients and employees in a pediatric clinic. We studied containment costs to identify avoidable costs.
  
  
  METHODS
  Measles exposure was defined as in-person contact with or presence in the same room <2 hours after the measles patient. Costs were calculated retrospectively using published costs of measles-mumps-rubella vaccine, cost-to-charge ratios for inpatient care in urban Washington State and local emergency department charges for post-exposure immunoglobulin (IG). Personnel costs were calculated by multiplying hourly wages by time for employees who worked on the response; overhead was excluded.
  
  
  RESULTS
  Fifty-two patients, 60 caretakers and 10 employees were exposed. Personnel time cost $1961. Exposed patients had a mean age of 9.6 years (range: 2 months-19 years); 34 (65%) were fully vaccinated, and 18 (35%) were <12 months of age and too young to be vaccinated. Five patients (10%) were <6 months of age and required IG; 13 infants (25%) 6-11 months of age required measles-mumps-rubella vaccination. Caretakers followed up with their physicians for evidence of immunity. One employee had documented evidence of immunity; 9 required measles antibody testing or vaccination. Management of exposed persons cost $3694; overall clinic costs were $5655.
  
  
  CONCLUSIONS
  Responding to 1 measles case cost the pediatric clinic more than $5000, despite isolating the patient promptly after examination. Documentation of employee immunity, vaccination of eligible patients and strict infection control precautions might reduce ambulatory costs associated with measles containment.
authors.affiliation: From the *Communicable Disease Epidemiology & Immunization Section, Public Health-Seattle & King County, Seattle, WA; †Epidemic Intelligence Service, Centers for Disease Control and Prevention; ‡Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention; and §Council of State and Territorial Epidemiologists, Atlanta, GA.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Wendorf
authors.forename: Meagan
authors.initials: M
authors.lastname: Kay
authors.forename: Ismael R
authors.initials: IR
authors.lastname: Ortega-Sanchez
authors.forename: Meaghan
authors.initials: M
authors.lastname: Munn
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Duchin
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000191:economics; D007223:Infant; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage / Q000191:economics; D056990:Post-Exposure Prophylaxis / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D014861:Washington; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D008458:Measles Vaccine