Cost of a Measles Outbreak in an Urban Shelter.

Importance: Measles outbreaks are costly and challenging to control. A measles outbreak associated with a Chicago, Illinois, shelter, which primarily affected shelter residents, resulted in substantial public health response costs, direct medical costs, and productivity losses. Objective: To evaluate the societal burden of the 2024 Chicago measles outbreak in terms of resources used and costs. Design, Setting, and Participants: This economic evaluation analyzed the costs of a shelter-associated measles outbreak in Chicago between March 7 and April 30, 2024, in terms of measles cases, contacts (children, adult residents, shelter personnel), and relevant agencies involved in the outbreak response. Exposure: Measles virus. Main Outcomes and Measures: Three types of costs were estimated in this limited societal cost analysis: (1) total response costs (personnel time, vaccination, quarantine space, transportation, laboratory testing, and other materials) incurred by the Chicago Department of Public Health and partner agencies; (2) direct medical costs (case isolation in hospitals, emergency department visits, treatment, interfacility emergency transportation, and infrastructure modifications); and (3) productivity losses due to isolation, quarantine, or informal caregiving (including number of days children were excluded from school). Results: There were 57 measles cases (including 30 females [52.6%]; median [IQR] age, 3 [1-22] years) and 3569 contacts (including 1837 females [51.6%]; median [IQR] age, 17 [7-30] years) associated with the shelter outbreak. The associated societal cost was $8 700 258, or $152 636 per measles case. Response costs included $1 798 780 in personnel costs, $1 397 976 in vaccination costs, $200 489 in laboratory testing costs, $104 263 in transportation costs, and $63 023 in other material costs. Direct medical costs were $4 399 639, and estimated productivity losses were $683 895, with 17 113 school days among children lost due to the outbreak. Conclusions and Relevance: This economic evaluation of a measles outbreak in a congregate setting found complex response challenges that contributed to substantial costs. This outbreak response was one of the most expensive in the measles postelimination era due to the large costs associated with vaccination and isolation and quarantine in hospitals. Though the outbreak placed a considerable cost burden on both public health and health care systems, rapid disease identification and mass vaccination among shelter residents prevented a more costly and larger outbreak. Strategies to reduce disease transmission and costs during outbreaks among undervaccinated populations living in congregate settings may include funding non-health care isolation and quarantine spaces and vaccinating new shelter residents on arrival.