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

ABSTRACT: After 20years 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.

SUBMITTER: Pike J

PROVIDER: S-EPMC5831405 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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

Pike Jamison J Tippins Ashley A Nyaku Mawuli M Eckert Maribeth M Helgenberger Louisa L Underwood J Michael JM

Vaccine 20170905 43

After 20years 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 ...[more]

PMID: 28886945

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Project description:BackgroundVaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs).ObjectiveTo assess vaccination timeliness in the Federated States of Micronesia (FSM), and the projected impact of suboptimal vaccination in the event of an outbreak.MethodsTimeliness of the 4th dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) and 1st dose of measles, mumps, and rubella vaccine (MMR) among children 24-35 months was assessed in FSM. Both doses are defined as on time if administered from 361 through 395 days in age. Timeliness was calculated by one-way frequency analysis, and dose delays, measured in months after recommended age, were described using inverse Kaplan-Meier analysis. A time-series susceptible-exposed-infected-recovery (TSEIR) model simulated measles outbreaks in populations with on time and late vaccination.ResultsTotal coverage for the 4th dose of DTaP ranged from 36.6% to 98.8%, and for the 1st dose of MMR ranged from 80.9% to 100.0% across FSM states. On time coverage for the 4th dose of DTaP ranged from 3.2% to 52.3%, and for the 1st dose of MMR ranged from 21.1% to 66.9%. Maximum and median dose delays beyond the recommended age varied by state. TSEIR models predicted 10.8-13.7% increases in measles cases during an outbreak based on these delays.ConclusionsIn each of the FSM states, a substantial proportion of children received DTaP and MMR doses outside the recommended timeframe. Children who receive vaccinations later than recommended remain susceptible to VPDs during the period they remain unvaccinated, which may have a substantial impact on health systems during an outbreak. Immunization programs should consider vaccination timeliness in addition to coverage as a measure of susceptibility to VPDs in young children.

Project description:BackgroundThe burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia.MethodsWe used data from the cross-sectional World Health Organization's STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25-64 years).ResultsIn general, we found that higher education (?13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29-0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34-0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29-4.43, p < 0.001). Among women, paid employment nearly doubled the odds of daily tobacco use (OR: 1.72, CI: 1.08-2.73, p = 0.006) than unemployment. For all participants, income >?$10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43-3.51, p = 0.003), versus lower-income (<$5,000). Men had over twice the odds of high BP (OR: 2.01, CI: 1.43-2.83, p < 0.001) than women. Paid employment nearly doubled the odds of central obesity with the magnitude of association increasing by more than 20% adjusted for sex and age. Men reporting paid employment had three times the odds of central obesity (OR: 3.00, CI: 1.56-5.78, p < 0.001) than those unemployed.ConclusionOur analysis revealed associations between socioeconomic position and selected CVD risk factors, which varied by risk-factor, sex and age characteristics, and direction of association. The 2002 Pohnpei dataset provides country-level baseline information; further population health surveillance might define trends. Stronger country-level data might help decision-makers tailor population-based prevention strategies.

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

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

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