When Kansas City found itself in the grips of not one but two measles outbreaks in March, Tiffany Wallin, a disease investigator for the Johnson County Health Department, was working on it nearly around the clock.
At an infectious disease conference last month, Wallin described being in almost constant contact with a specialist at Children’s Mercy Hospital who was providing recommendations on halting the spread of the highly contagious virus.
“I think we probably talked every hour on the hour, late into the night and on the weekend going, ‘Can you believe this is happening?’” Wallin said.
The strangely simultaneous outbreaks are both officially over, as of Monday, when there had been no new cases in 42 days, or two full incubation periods.
But the costs of containing them are just beginning to be calculated.
What is known at this point is that more than $170,000 in taxpayer resources was spent to hold the outbreaks to 35 total cases — 22 in Kansas and 13 in Missouri.
Some of the $170,000 is federal money, some of it came out of redirected state and local resources and none of it includes other costs that are difficult or even impossible to quantify.
The Kansas Department of Health and Environment said it spent about $46,000 on a bevy of lab testing, vaccines and staffing costs. But that’s a conservative estimate that doesn’t include baked-in costs to maintain the state’s disease surveillance software, EpiTrax, or salaries for support staff.
It does include salaries for some staffers who had to put off other work, even though they're mostly salaried and won't get overtime.
“The cost of epidemiology staff salaries and laboratory staff salaries are included because staff was diverted from normal work activities to response activities,” KDHE spokeswoman Theresa Freed said.
The Johnson County Health Department said it spent about $99,000 in staff costs alone on its response to the Kansas measles outbreak, enlisting disease investigators, epidemiologists, public spokesmen, directors, child care licensing staff, immunizations staff, lab staff and accounting staff.
Miami County health officials didn't respond to the Star's request for a cost estimate.
The Missouri Department of Health and Senior Services said it couldn’t provide an estimate of what the Missouri measles outbreak cost because much of it was wrapped into the state’s ongoing disease surveillance.
“We’d have a hard time putting together actual numbers,” said Kerri Tesreau, the director of the department’s Division of Community and Public Health.
But she provided a Centers for Disease Control cost study of previous measles outbreaks, including two in Utah in 2011 that combined for 13 cases and cost $330,000.
The Kansas City Health Department spent $21,273.50 in staff hours alone on the Missouri outbreak.
“This does not include additional resources like travel or mileage to conduct home visits to patients for surveillance interviews or operating costs,” department spokesman Bill Snook said. “There is also a cost delay for other projects which is not accounted for.
Due to the seriousness and infectiousness of measles, most everything else is paused except for the highest of priorities.”
Clay County didn’t have any actual cases among its residents, but spokeswoman Kaitlyn Wallace said its epidemiologists spent many hours coordinating with both states and other local health departments and calling potentially exposed individuals.
Wallace said it cost the Clay County Public Health Center about $6,000.
“This was a huge effort by various government entities and also local hospitals,” Wallace said.
Even with that effort, Kansas still experienced the most measles cases it has seen since 1990, and across the two outbreaks there were several hospitalizations and some common respiratory complications like pneumonia and croup.
But there have been no serious complications reported.
“This definitely could have been a lot worse than it was,” Wallin said at the Kansas Infectious Disease Symposium last month.
Officials hope for increased vaccination
Both measles outbreaks started when travelers brought the virus back to Kansas City from other countries where it's still prevalent.
The first outbreak began in a Johnson County daycare — a particularly dangerous spot because of the number of exposed kids who were too young to be vaccinated.
They picked it up and then carried it out into the community, where it spread to Miami County and Linn County. Then the Missouri outbreak started and spread in and around Liberty, mostly among a few unvaccinated families.
Suddenly health officials were tracking dozens of people who had carried the virus to dozens of places in at least a half-dozen counties across two states.
“Part of our challenge was many, many exposure sites,” Mary Anne Jackson of Children’s Mercy said at the symposium. “This included our daycare center, this included a megachurch, this included elementary and middle schools, this included multiple health care settings including Children’s Mercy and pediatricians’ offices in multiple different counties. So you can see how difficult it is to halt the spread of measles once it gets within your community.”
Someone involved in the Missouri outbreak also potentially exposed people in Iowa, Minnesota and Wisconsin on a road trip through those states, but officials in those states said no cases resulted from those exposures.
Health officials in Kansas and Missouri released several lists of public places where people might have been exposed, except in cases where they believed they could contact all of the people who had been to those places individually.
They also initiated state policies that require unvaccinated students to be held out of school for weeks if there is an exposure risk.
Open records requests filed by the Star showed that meant that 13 of the 791 students at South Valley Middle School had to be held out. Eleven of them had religious exemptions to vaccination requirements and two had medical exemptions.
Nine of 375 students at Nashua Elementary School had to be held out. Six had religious exemptions, two had medical exemptions and one was in the process of getting his or her measles-mumps-rubella, or MMR, vaccines.
With two doses, the MMR shot is estimated to be about 97 percent effective at preventing measles.
Wallace said Clay County hoped to use this outbreak “to emphasize the importance of vaccination and to learn to be even more prepared in the future.”
Jackson said that she thinks compliance with the regular CDC vaccine schedule is increasing among new parents after years of decline.
But families that are already against vaccinating their kids aren’t going to change their minds as the kids get older.
“The vaccine-refusing population — often affluent and college educated — are still resistant to immunization even after measles has occurred within their household,” Jackson said. “So it’s a huge challenge, and it’s a concern.”