Health and economic costs of an import-initiated measles outbreak in an international border area of Yunnan Province

ABSTRACT

Background

Measles outbreaks often require labor- and resource-intense response. A border-area measles outbreak occurred in Yunnan province that required outbreak response immunization for its containment. We report results of our investigation into the outbreak and the health sector costs of the response activities, with the goal of providing evidence for policy makers when considering the full value of vaccines and of measles elimination.

Methods

We conducted case investigations to determine sources of infection and routes of transmission. Costs of outbreak response activities incurred by health sector were determined through retrospective interviews and record reviews of staff.

Results

In total, 67 measles cases were confirmed, including 4 cases imported from Myanmar. Among the 33 cases aged between 8 months and 14 y old, 22 (66∙7%) had received 2 doses of MCV; 2 (6∙0%) had received 1 dose of MCV; 9 (27∙3%) had not received MCV. The first 4 cases had been infected in Myanmar, and we identified 8 transmission clusters with a total of 62 cases. Transmission among Yunnan province residents occurred in schools, family settings, and at gatherings. The overall cost to control the outbreak was $214,774, for a per-case cost of $3,206. The outbreak response vaccination campaign accounted for 64% of the total outbreak costs.

Conclusions

Despite high population immunity among Yunnan province children and adolescents, an import-related measles outbreak occurred among individuals who were not vaccinated or had vaccine failure in the across-border area. The economic cost of the outbreak was substantial. Investment in a sensitive measles surveillance system to detect outbreaks in a timely manner, maintaining high population immunity to measles, and reinforcing cross-border collaboration with neighboring countries support achieving and sustaining measles elimination in the border areas of China.

KEYWORDS:

• Measles
• outbreak
• importation
• economic costs

Acknowledgments

We thank staff in Lincang city CDC, Gengma county CDC for their efforts made in the field investigation. We thank Dr. Lance Rodewald for his suggestions and English polishing of our manuscript.

Disclosure of potential conflicts of interest

The authors report no potential conflicts of interest.