Vaccines will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 premature deaths during the lifetimes of children born during the two decades after the Vaccines for Children Program began in 1994, according to a report released April 24 by the Centers for Disease Control and Prevention.
In addition, vaccines will save an estimated $295 billion in direct costs and $1.38 trillion in societal costs, according to the analysis, published in the April 25 issue of Morbidity and Mortality Weekly Report (MMWR 2014;61:352-5). The Vaccines for Children (VFC) Program, which provides recommended vaccines to about half the children in the United States, was created in 1993 in response to a resurgence of measles during 1989-1991, caused mostly by a failure to vaccinate uninsured children at the recommended age of 12-15 months.
The VFC provides vaccines to children if they are eligible for Medicaid, are uninsured, or are American Indian or Alaskan native. Children who are underinsured and do not have vaccine coverage are also eligible. About half of the children in the United States receive vaccines through this program.
To estimate the program’s effect on health care costs and the health of all children born from 1994 to 2013, the Centers for Disease Control and Prevention (CDC) evaluated national data on immunization coverage, and used a cost-benefit model that estimated illnesses, hospitalizations, and premature deaths (not including influenza and hepatitis A).
Measles makes 2014 return
But a second MMWR report released April 24 described 58 confirmed measles cases in California during the first 4 months of this year, in children and adults from age 5 months to 60 years. That report illustrates some of the current vaccination challenges, particularly with cases related to people traveling to and from outside the United States.
California’s 58 measles cases were reported from January 2014 through April 16, 2014. It’s the highest number of cases reported for that calendar period in the state since 1995. The 129 cases reported in the United States during this period also were the largest number reported since 1996 (MMWR 2014;61:362-3). No deaths have been reported.
During a CDC media briefing on April 24, Dr. Anne Schuchat said that 34 of the 129 cases were imported cases, and occurred in residents traveling abroad or people traveling to the United States. Among those infected who were traveling to the United States, 17 people were from the Philippines, which is in the midst of a large measles outbreak – with about 20,000 confirmed or suspected cases, including 69 deaths, through February.
“Though not direct imports, most of the remaining cases are known to be linked to importation,” said Dr. Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, and one of the authors of the VFC study.
The 129 cases of measles nationwide have been reported in 13 states. Cities and states with the highest number of cases are California, with 58 cases; New York City, with 24 cases; and Washington state, with 13 cases.
“While the story of the 1989 measles resurgence was one of poor children missing out on vaccines because they didn’t have insurance, today’s measles outbreaks are too often the result of people opting out” of vaccination, she said, noting that 84% of the cases have been in people who were not vaccinated or did not know if they had been vaccinated. This included 68% with personal-belief exemptions.
The California report shows the risk of measles spreading in health care settings, Dr. Schuchat noted. Of the California cases, 11 were transmitted in health care settings, including 6 in health care personnel.
Most of the 58 measles cases in California this year were in people who were not vaccinated (43%) or could not document that they had been vaccinated (31%), according to the report. The 25 patients who were not vaccinated included 19 who had philosophical objections to vaccination, and 3 who were too young for the vaccine. But 19% – two children and nine adults – had received two or more doses of MMR vaccine.
Most cases – 54 (93%) – were associated with imported cases, and included 13 cases of U.S. residents who had traveled internationally, 8 to the Philippines.
Travelers should vaccinate
The increase in imported cases from the Philippines “and subsequent transmission in certain settings in the United States highlight the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level,” according to the report’s authors.
The researchers also recommend that all residents of the United States born after 1956 make sure they have received the MMR vaccine “or have serologic evidence of measles immunity.”
If individuals do not have serologic evidence of immunity and are traveling outside of North America or South America, the CDC recommends one dose of MMR vaccine for infants aged 6-11 months, and two doses of MMR vaccine at least 28 days apart in children aged 1 year and older, and in adults.
There were no author disclosures for either report.
Donna M. Wachowich, MD, FCFP 