title: Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia.
abstract: Background On August 24, 2011, 31 US-bound refugees from Kuala Lumpur, Malaysia (KL) arrived in Los Angeles. One of them was diagnosed with measles post-arrival. He exposed others during a flight, and persons in the community while disembarking and seeking medical care. As a result, 9 cases of measles were identified. Methods We estimated costs of response to this outbreak and conducted a comparative cost analysis examining what might have happened had all US-bound refugees been vaccinated before leaving Malaysia. Results State-by-state costs differed and variously included vaccination, hospitalization, medical visits, and contact tracing with costs ranging from $621 to $35,115. The total of domestic and IOM Malaysia reported costs for US-bound refugees were $137,505 [range: $134,531 - $142,777 from a sensitivity analysis]. Had all US-bound refugees been vaccinated while in Malaysia, it would have cost approximately $19,646 and could have prevented 8 measles cases. Conclusion A vaccination program for US-bound refugees, supporting a complete vaccination for US-bound refugees, could improve refugees' health, reduce importations of vaccine-preventable diseases in the United States, and avert measles response activities and costs.
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Coleman
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Burke
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Welstead
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Tarissa
authors.initials: T
authors.lastname: Mitchell
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Eboni M
authors.initials: EM
authors.lastname: Taylor
authors.affiliation: b International Organization for Migration , Kuala Lumpur , Malaysia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Shapovalov
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Maskery
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Heesoo
authors.initials: H
authors.lastname: Joo
authors.affiliation: a Division of Global Migration and Quarantine , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Weinberg
mesh_terms: D000293:Adolescent; D064870:Air Travel; D059028:Airports; D000076263:Communicable Diseases, Imported / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003365:Costs and Cost Analysis; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D015141:Los Angeles / Q000453:epidemiology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008457:Measles / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D008458:Measles Vaccine / Q000191:economics; D012036:Refugees; D000076082:Travel-Related Illness; D014481:United States; D014611:Vaccination / Q000191:economics; D055815:Young Adult
chemical_list: D008458:Measles Vaccine
keywords: cost; measles; outbreak; refugee; vaccination