Costly 2013 NYC Measles Outbreak Highlights Problem of Vaccine Refusal

Researchers from the New York City Department of Health and Mental Hygiene (DOHMH) recently studied the impact of the city’s 2013 measles outbreak, finding that vaccine refusals and delays led to a costly response effort.

According to the Centers for Disease Control and Prevention (CDC), an intentionally unvaccinated 17-year-old infected with measles while traveling in London, United Kingdom returned to New York City on March 13, 2013. The case led to what was at the time, the largest outbreak of measles in the United States since 1996, and the largest in New York City since 1992.

In total, the outbreak included 58 cases mostly impacting the Jewish Orthodox community in 2 Brooklyn neighborhoods. There were 28 infected individuals in the Borough Park neighborhood, with a median age of 10 years, and 30 infected individuals in the Williamsburg neighborhood, with a median age of 19 months. Of 2 pregnant women hospitalized for measles illness, 1 miscarried. In both neighborhoods, health officials noted high rates of measles vaccination refusal in those infected.

Vaccine hesitancy has been linked with a fourfold increase in measles cases in Europe in 2017, and with the growing rate of individuals opting for nonmedical exemptions from vaccination in the United States, researchers have identified several hotspots around the country now at risk for measles outbreaks. In a new study published in the journal JAMA Pediatrics, researchers investigated the public health burden of New York City’s 2013 measles outbreak.

In an epidemiologic assessment and cost analysis conducted between August 15, 2013, and August 5, 2014, the researchers examined all outbreak-associated cases of measles among New York City residents in 2013. Of those infected in the outbreak, only 28 individuals (48%) visited a medical health care professional who suspected measles and reported the case to the DOHMH upon initial diagnosis. In addition, there were exposures in 11 health care facilities after many of those infected were not placed in airborne isolation, and health officials identified a total of 3,351 exposed contacts. The overall direct cost for New York City’s DOHMH was $394 448, along with 10,054 hours spent in response efforts to control the outbreak.

“Vaccine refusals and delays appeared to have propagated a large outbreak following importation of measles into the United States,” conclude the authors. “Prompt recognition of measles along with the 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.”

In an editorial response to the study, Jason L. Schwartz, PhD, writes that the 2013 New York City outbreak underscores the resource-intensive nature of public health responses to outbreaks of vaccine-preventable diseases.

“Vaccine hesitancy poses a growing threat to the success of vaccination efforts worldwide,” Dr Schwartz writes, noting that overall national vaccination rates in the United States remain strong. “However, national vaccination coverage data mask the presence of clusters of large numbers of unvaccinated children in specific communities, which understates the risks of vaccine-preventable diseases for these individuals and those around them, as well as the magnitude of the challenge that public health officials face when outbreaks occur in these areas.”