Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 1;172(9):811-817.
doi: 10.1001/jamapediatrics.2018.1024.

Public Health Consequences of a 2013 Measles Outbreak in New York City

Jennifer B Rosen  1 , Robert J Arciuolo  1 , Amina M Khawja  1   2 , Jie Fu  1 , Francesca R Giancotti  1 , Jane R Zucker  1   3
Affiliations

Public Health Consequences of a 2013 Measles Outbreak in New York City

Jennifer B Rosen et al. JAMA Pediatr. .

Abstract

Importance: Internationally imported cases of measles into the United States can lead to outbreaks requiring extensive and rapid control measures. Importation of measles from an unvaccinated adolescent in 2013 led to what has been the largest outbreak of measles in New York City, New York, since 1992.

Objective: To describe the epidemiology and public health burden in terms of resources and cost of the 2013 measles outbreak in New York City.

Design, setting, and participants: This epidemiologic assessment and cost analysis conducted between August 15, 2013, and August 5, 2014, examined all outbreak-associated cases of measles among persons residing in New York City in 2013.

Exposures: Measles virus.

Main outcomes and measures: Numbers of measles cases and contacts. Total personnel time and total direct cost to the New York City Department of Health and Mental Hygiene (DOHMH), calculated as the sum of inputs (supplies and materials, equipment, and logistics) and personnel time (salary and fringe benefits).

Results: Between March 13, 2013, and June 9, 2013, 58 persons in New York City with a median age of 3 years (range, 0-32 years) were identified as having measles. Among these individuals, 45 (78%) were at least 12 months old and were unvaccinated owing to parental refusal or intentional delay. Only 28 individuals (48%) visited a medical health care professional who suspected measles and reported the case to the DOHMH at the initial clinical suspicion. Many case patients were not immediately placed into airborne isolation, resulting in exposures in 11 health care facilities. In total, 3351 exposed contacts were identified. Total direct costs to the New York City DOHMH were $394 448, and a total of 10 054 hours were consumed responding to and controlling the outbreak.

Conclusions and relevance: Vaccine refusals and delays appeared to have propagated a large outbreak following importation of measles into the United States. Prompt recognition of measles along with 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. The response and containment of measles outbreaks are resource intensive.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Numbers of Case Patients With Measles Stratified by Rash Onset Date and Neighborhood of Brooklyn, New York, Between March 13 and June 30, 2013
The 58 case patients included 1 asymptomatic infant born with measles infection. The date of birth was used as a proxy for onset date in this infant because there was no rash.
See this image and copyright information in PMC

Comment in

References

    1. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; Centers for Disease Control and Prevention . Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1-34. - PubMed
    1. Katz SL, Hinman AR. Summary and conclusions: measles elimination meeting, 16-17 March 2000. J Infect Dis. 2004;189(suppl 1):S43-S47. doi: 10.1086/377696 - DOI - PubMed
    1. Hill HA, Elam-Evans LD, Yankey D, Singleton JA, Dietz V; CDC . Vaccination coverage among children aged 19-35 months—United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(39):1065-1071. doi: 10.15585/mmwr.mm6539a4 - DOI - PubMed
    1. Centers for Disease Control and Prevention (CDC) Measles—United States, January 1-August 24, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(36):741-743. - PMC - PubMed
    1. New York City Health Code §11.03; reportable diseases and conditions. http://www1.nyc.gov/assets/doh/downloads/pdf/about/healthcode/health-cod.... Accessed June 29, 2017.

Substances