Health officer: Measles case response cost more than $15K

The Monongalia County Health Department responded to a measles case in April of this year. (Monongalia County Health Department photo)

The local health department that responded to a single measles case in April spent more than $15,000 on the effort, the head of the agency said. 

Fifteen staff members of the Monongalia County Health Department spent a collective 250 hours to coordinate the contact tracing for the case. Approximately 160 people were potentially exposed to the measles virus after a case of the illness was confirmed on April 22, said Dr. Lee Smith, health officer for the health department. 

Dr. Lee Smith, health officer for the Monongalia County Health Department

“That’s unbudgeted,” Smith said. “That’s just doing public health work.”

The case — West Virginia’s first confirmed measle case since 2009 — was reported April 22. 

According to the Monongalia County Health Department and the state Department of Health, the adult patient developed measles symptoms and sought treatment at an outpatient clinic of WVU Hospitals. Lab work confirmed the case days later. The patient did not require hospitalization and recovered at home. 

The patient most likely contracted the virus during international travel, Smith said. They had received one dose of the vaccination’s two-dose series. Smith said the patient went to an urgent care clinic with symptoms of measles.

“The person had the typical type of facial rash… runny nose, cough and fever that anyone beyond the age of 53 can say ‘that looks like measles to me,’” Smith said. The urgent care clinic contacted a local emergency department, which opened an infectious disease room and allowed the patient to bypass the waiting room so that other patients were not exposed. 

Smith said during the investigation, officials learned that the patient had been to a scheduled clinic appointment prior to developing symptoms. Measles patients can spread the virus up to four days before they develop a rash. Learning about the clinic visit, “our exposure list went to 160 people,” Smith said. 

“So now we [were] busy trying to contact those people, and it’s not just a one time thing” Smith said. “You have to contact them daily for two weeks because that’s the amount of time that they have to express the illness themselves.”

The health department coordinated with other local health departments for residents of other states and counties. According to the Department of Health, the list of those exposed to the measles included 128 West Virginia residents from 30 counties and four states.

With 84 employees, the Monongalia County Health Department is among the largest health departments in the state. While the task was arduous, Smith said the department was fortunate to have the staff members to pull together for the response. He said the county’s high level of trust in medical establishments worked in the department’s favor.

“You get into some of these smaller counties’ [health departments], and they don’t have 15 people to draw into a response,” Smith said. “They may not have 15 employees total. And so we were fortunate… even though it was arduous and a difficult task for us to accomplish.”

Of the 160 people potentially exposed to measles, MCHD tested eight people who had symptoms of the virus. 

Measles is highly contagious. The virus spreads through the air when an infected person sneezes or coughs. A person can get measles by being in the room where someone who has it has been, up to two hours after the infected person has left, according to the Centers for Disease Control and Prevention. 

The disease was declared eliminated in the United States in 2000. Since the COVID-19 pandemic, vaccination coverage rates among kindergartens nationally has declined below the target rate of 95%, according to the CDC. 

The virus can cause death or complications like pneumonia and swelling of the brain and is especially dangerous for young children, adults over age 20, pregnant people and those with weakened immune systems. 

Smith credited herd immunity as the reason the virus did not spread to anyone else. 

“So even though an individual who contracted the illness and brought it back in here, it didn’t spread because there were no individuals vulnerable,” Smith said. 

By comparison, in March, a measles case was confirmed in a 1-year-old staying at a migrant shelter in Chicago, resulting in 57 cases of people staying at the shelter or having contact with people staying there as of May 13, according to the Centers for Disease Control and Prevention. 

“I’m telling you that we spent over $15,000, 250 man hours, 15 people on a single case,” he said. “I can’t imagine, I would have lost my mind had we [had] a third, fourth [measles case],” Smith said. 

States do not track measles vaccination rates for adults. According to the state Department of Health, people born before 1957 and those who have laboratory evidence of immunity are considered to have presumptive immunity to the disease. For the 2022-2023 school year, 95.6% of the state’s kindergarten students were vaccinated for measles, a rate that state health leaders have attributed to strong vaccination laws. 

All states have mandates that school children be vaccinated against certain diseases. West Virginia is one of five states in the country that does not allow religious or philosophical exemptions to those requirements. West Virginia schools allow exemptions for medical purposes only.

Earlier this year the Legislature passed legislation that would have allowed the state’s private and parochial schools to establish their own vaccination policies. At the urging of many in the state’s medical community, Gov. Jim Justice vetoed the bill. 

“God bless the governor,” Smith said of the veto. 

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