Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak

Abstract

After 20 years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children’s Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country’s costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM’s economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education.

Measles outbreak investigation process in low- and middle-income countries: a systematic review of the methods and costs of contact tracing

“…From the 17 studies included in this review, four articles were from China (Jin et al, 2011 ; Ma et al, 2016 ; Ma et al, 2017 ; Zhang et al, 2015 ), three from Senegal (Cisse et al, 1999 ; Garenne & Aaby, 1990 ; Whittle et al, 1999 ), two from the Federated States of Micronesia (Hales et al, 2016 ; Pike et al, 2017 ), and one each from India (Rathi et al, 2017 ), Bolivia (Quiroga et al, 2003 ), Brazil (Lemos & Franco, 2017 ), Venezuela (Sarmiento et al, 2011 ), Republic of Marshall Islands (Marin et al, 2006 ), Romania (Njau et al, 2019 ), Tanzania(Goodson et al, 2010 ), and Ethiopia (Wallace et al, 2014 ). Eleven of the studies involved both male and female participants and the remaining six had no data on sex distribution of subjects (Garenne & Aaby, 1990 ; Marin et al, 2006 ; Pike et al, 2017 ; Quiroga et al, 2003 ; Sarmiento et al, 2011 ; Wallace et al, 2014 ). Most (88.2%) of the studies included both children and adults, but two studies included children (Whittle et al, 1999 ) and young adults (Jin et al, 2011 ) only.…”

Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies

“…Finally, we conducted a brief scoping review of the literature from January 2017 to May 2020 and found several articles that may have been eligible for inclusion post-2016. Particularly, we found two studies assessing the cost of measles in the Federated States of Micronesia [49] and the cost of measles and rubella in Romania [50] -a first for measles and rubella in LMIC. Other studies examined further the cost of GE [51][52][53][54][55][56][57][58][59], pneumonia [51,52,[59][60][61][62][63], and influenza [64,65].…”

The economic burden of measles in children under five in Bangladesh

“…However, with declining stockpiles (yellow fever), the discovery of gaps in immunity in young adults (rubella) [8] and a sharp recrudescence of cases (measles), strategies to sustain and improve the coverage of these existing vaccines are at the forefront, potentially delaying the introduction of vaccines against other diseases. To our knowledge, there is no other empirical cost-of-illness study for measles in lowincome settings: only a few were done in lower-and uppermiddle-income countries [9][10][11].…”