Every once in a while, there’s news of a measles outbreak. On the surface, they don’t involve large numbers of cases — there’s one in Minneapolis right now that has racked up 21 cases so far — and so people seem to wonder why these outbreaks are such a big deal.

Here’s one reason why: Measles transmission within the US stopped in 2000 because of vaccination. Outbreaks here start with an importation from somewhere else where the disease still flourishes — but they gain a foothold because lack of vaccination, primarily from vaccine refusal, lets the disease get past what should be an impregnable barrier of herd immunity to attack those who are too young to be vaccinated or whose immunity has faded.

Here’s another reason: Stopping the measles virus before it can cause serious disease — and by “serious,” I mean deafness, pneumonia, encephalitis and miscarriage — is incredibly costly and labor-intensive. An account published overnight in the Journal of Infectious Diseases gives a glimpse at just how costly. To stop a 14-person outbreak that began with one unvaccinated tourist visiting a US emergency room, the Arizona Department of Health had to track down and interview 8,321 people; seven Tucson hospitals had to furlough staff members for a combined 15,120 work-hours; and two hospitals where patients were admitted spent $799,136 to contain the disease.

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