CIENCIASMEDICASNEWS: Ahead of Print - Assessment of Economic Burden of Concurrent Measles and Rubella Outbreaks, Romania, 2011–2012 - Volume 25, Number 6—June 2019 - Emerging Infectious Diseases journal

Joseph Njau1, Denisa Janta, Aurora Stanescu, Sarah Pallas, Adriana Pistol, Nino Khetsuriani2, Susan Reef, Daniel Ciurea, Cassandra Butu, Aaron Wallace, and Laura Zimmerman

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J. Njau, S. Pallas, S. Reef, A. Wallace, L. Zimmerman); National Public Health Institute, Bucharest, Romania (D. Janta, A. Stancescu, A. Pistol); Centers for Disease Control and Prevention, Tbilisi, Georgia (N. Khetsuriani); Center for Health Policies and Services, Bucharest (D. Ciurea); World Health Organization Country Office, Bucharest (C. Butu)

Abstract

We estimated the economic impact of concurrent measles and rubella outbreaks in Romania during 2011–2012. We collected costs from surveys of 428 case-patients and caretakers, government records, and health staff interviews. We then estimated financial and opportunity costs. During the study period, 12,427 measles cases and 24,627 rubella cases were recorded; 27 infants had congenital rubella syndrome (CRS). The cost of the outbreaks was US $9.9 million. Cost per case was US $439 for measles, US $132 for rubella, and US $44,051 for CRS. Up to 36% of households needed to borrow money to pay for illness treatment. Approximately 17% of patients continued to work while ill to pay their treatment expenses. Our key study findings were that households incurred a high economic burden compared with their incomes, the health sector bore most costs, and CRS costs were substantial and relevant to include in rubella outbreak cost studies.

Outbreaks of measles and rubella constitute serious public health events and entail a vigorous response from public health agencies. A typical response could include a range of complex activities, including isolation of case-patients, case–contact tracing, assessment of disease or vaccination history of each case-patient, identification of potentially susceptible persons, and, if required, vaccination or quarantine (1). Economic impact studies of measles and rubella outbreaks in high-income countries illustrate a high cost of outbreaks and response activities (1–5). However, little information is available on the economic impact of measles and rubella outbreaks in a middle-income country, and in 2011, this impact was identified as a global research priority (6). Concurrent measles and rubella outbreaks in Romania provided an opportunity to estimate this economic impact.

In coordination with other World Health Organization European Region countries, Romania has a goal of measles and rubella elimination by 2020. During 2000–2003, coverage with a first dose of measles-containing vaccine in Romania was reported to be >95%; for 2004–2010, combined measles and rubella vaccine first dose coverage was >95% and second dose coverage was >88%. In spite of these high national coverage rates among recent birth cohorts, unvaccinated subpopulations exist among older age cohorts and subnationally, which create conditions for continued measles or rubella outbreaks.

During 2011–2012, Romania experienced concurrent outbreaks of measles and rubella. Measles cases were primarily reported among children from the northwest part of the country, and rubella cases were reported primarily among adolescents and adults throughout Romania. The outbreaks resulted in 12,427 measles cases and 24,627 rubella cases during 2011–2012 (the number of measles cases officially associated with the outbreak was subsequently revised to 12,234 after our analysis was conducted) (7). We estimated the economic cost of these outbreaks and response activities incurred by the health sector and households of persons with measles or rubella infection.