Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia

Abstract

BackgroundOn 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.MethodsWe 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.ResultsState-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.ConclusionA 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.

Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review

“…Two studies published after the economic analysis systematic review was performed examined different costs associated with pre-departure vaccinations, one in the context of a response to an outbreak [ 55 ] and the second evaluating the US Vaccination Program for US-bound Refugees (VPR) [ 56 ]. The first study showed that pre-departure vaccination of all US bound refugees would not only improve health, reduce importations of VPD, but be cost saving when considering all the resources required for response to outbreak activities.…”

Measles outbreak from Hong Kong International Airport to the hospital due to secondary vaccine failure in healthcare workers

“…Previous outbreaks were confined to either transmission of measles at airports or at hospitals. 5,6,9,10 In nonendemic areas, air travel was considered as a risk factor for the introduction of measles in a highly vaccinated population. 19 The measles seropositive rates among all age groups from 2011 to 2017 in Hong Kong were >95%, 2 exceeding the cutoff of 93%-95% required to prevent sustained local transmission.…”

“…2 However, international travel facilitates intercontinental measles transmission, 3 which can affect the small number of unimmunized persons and those with primary or secondary vaccine failure. 4 Outbreaks of measles have been reported in international airports in the United Kingdom, The Netherlands, 5 the United States, [6][7][8] and Japan. 9 Nosocomial outbreaks of measles in emergency departments, triage wards, and waiting rooms of the hospitals have also been summarized.…”

Immigrant and Refugee Health

“…For example, international and domestic costs for just one of these outbreaks were estimated at $130,000, partly due to the high costs of travel cancellations and rebookings. 20 …”