Measles Outbreaks Cause Financial, Public Health Burden in US

Outbreaks of measles have been seeing an uptick in 2025, which, according to a new review,¹ leads to financial and public health strain in the US. Researchers recommend widespread use of measles vaccinations to avoid this increase in burden due to the rise in the number of cases.

Measles is an incredibly contagious virus that can lead to a fever, cough, conjunctivitis, maculopapular rash, and pathognomonic enanthema.² Although the measles virus can lead to complications on its own, secondary bacterial infections can lead to even worse complications and outcomes, including death, specifically in infants and children younger than 5 years, those with weakened immune systems, pregnant women, and adults aged 21 years or older. The US had previously declared that measles was eliminated in the country in 2000, but outbreaks have been appearing due to a decrease in vaccination rates. The year 2025 saw the highest number of cases since the virus was declared eliminated.¹ This systematic review aimed to assess the cost of measles outbreaks in the past 25 years, including how to scale them to the size of the outbreak.

The researchers used PubMed to search for studies published between January 1, 2000, and October 7, 2025. Studies written in English that contained data on measles cases in the 50 states, outbreak response, and cost were considered. Publicly available government records were examined separately.

Year of outbreak, number of cases, total costs, number of contacts, cost per case, cost perspective, and cost per contact were extracted from the studies included. All costs were adjusted for inflation by converting them to 2024 USD.

There were 18 studies covering 18 states that were included in the review. A total of 51 additional data points, of which 42 were from 2025, were also included from gray literature. A total of 1563 measles cases had been reported through October 7, 2025, in 41 states, with all but Connecticut, Delaware, Maine, Massachusetts, Mississippi, Nevada, North Carolina, New Hampshire, and West Virginia reporting a case of measles.

Texas had the largest outbreak of 802 cases. They also had incurred an estimated $10 million in costs for their measles cases. Total cost per measles case varied, with a single case in Iowa in 2004 costing $243,614.79, whereas the New York City outbreak of 2018 to 2019 had an estimated cost of $16,355 per case, totaling $10.6 million at 649 cases. The Clark County outbreak in Washington state had an estimated cost per case of $59,994, totaling $4.3 million at 71 cases.

The mean cost per case was estimated at $43,203.65 (range, $6,973.10-$243,614.79). However, the mean cost per contact was significantly lower at $443.46 (range, $98.46-$1028.57). Productivity loss was only estimated in 1 study, where the estimated productivity loss in Clark County totaled $1,300,716.21, or $18,065.61 per case and $309.58 per contact.

Estimating costs of direct medical treatment and quarantine protocols from a public health perspective showed an estimated total cost of $766,013.80, or $9,430.90 per case. Costs incurred by health care providers and outbreak response were estimated at a mean of $556,583.01, or a cost per case of $33,415.75.

There were some limitations to the study, including heterogeneous reporting of costs, which prevented strong conclusions from being drawn about indirect costs scaling with outbreak size. Cost breakdowns did not have sufficient details in studies. Public reports that were included show significantly less data on costs incurred. Societal costs of measles outbreaks are still understudied, with only 1 study in this review including the measure. The reported cases for measles may be preliminary for 2025, as the year is still ongoing.

The researchers concluded that measles outbreaks pose significant costs on the government, society, and health care providers, with the burden driven by incremental costs that scale with the number of cases as well as high fixed costs.

“Having better data on how these costs are incurred and by whom can substantially improve outbreak response budgetary planning and demonstrate the financial and economic impact that outbreaks have on health care systems,” the authors wrote.

References

1. Sriudomporn S, Patenaude. Quantifying the cost of measles outbreaks in the U.S. and how costs scale with outbreak size. medRxiv. Published online October 26, 2025. doi:10.1101/2025.10.24.25338724

2. Health Care Providers. Clinical overview of measles. CDC. May 23, 2025. Accessed October 30, 2025. https://www.cdc.gov/measles/hcp/clinical-overview/index.html