Health officials have declared an end to the measles outbreak in Salt Lake County.
But there's still some cleanup to do as epidemiologists wind down their disease monitoring and accountants tally the final tab to be picked up by taxpayers. The outbreak the largest in Utah in more than a decade may also give rise to public health policy changes.
"Our position is there should be exemptions for those who have medical reasons," said Gary Edwards, executive director of the Salt Lake Valley Health Department. "But this outbreak brought to light the impact that exemptions for personal reasons can have on the entire community."
Edwards announced on Tuesday that the nine-person outbreak is over, with a 28-day quarantine concluded and no suspected cases on the horizon.
"We are still receiving reports of rash illnesses, and we'll follow up on these," he said. "But as far as a full-blown measles investigation, it significantly scales back."
County epidemiologists logged 3,000 hours interviewing more than 12,000 people identified as having come in contact with the virus. And they placed 184 residents in voluntary isolation or quarantine.
The agency's costs, to date: $130,246.
The outbreak started with the unimmunized children in one family who traveled to Poland to retrieve a missionary.
The ripple effects included quarantines at four public schools in the Granite School District, which spent $10,000 hiring substitutes to fill in for teachers who had no immediate proof of immunization. Dozens of students were sent home, missing assignments and exams along with sports games, proms and other events, said district spokesman Ben Horsley.
One infectious person was discovered to have attended two large community gatherings, prompting health officials to issue a warning to anyone who had gone to those events.
Lost wages, time off work and unforeseen medical expenses are among other costs to families whose lives were disrupted.
And beyond that is "the fear and anger of thousands of people who feel their rights have been compromised by a few," said Rep. Carol Spackman Moss, D-Holladay, who is weighing reforms to the state's immunization law.
To attend public school in Utah, children must show proof that they are up-to-date on their shots. But parents can seek exemptions for philosophical and religious reasons, or if a licensed physician determines that a specific vaccine would endanger a student's life or health.
"I'm not sure how much political capital I want to invest in something that's bound to stir up a hornet's nest," Moss said. "But at same time, there's a lot of interest in the community here."
Instead of an outright ban on personal exemptions, Moss is considering imposing a fee on families who choose to skip shots. The fee similar to taxes on other health nuisances, such as cigarettes could be used to fund outbreak containment efforts, she said.
Salt Lake County boasts a relatively high vaccination rate, which Edwards said was integral to stopping the highly infectious disease from spreading further. More than 97 percent of the county's school-age children are fully vaccinated against the measles.
While commendable, that leaves about 17,300 children unprotected not to mention the thousands of infants and people with compromised immune systems who are too young or sick to be vaccinated, Edwards said.
There is no treatment for measles, and Salt Lake County data underscore that vaccination remains the best defense.
A majority of the county's confirmed cases were at two schools, where nearly 23 percent of the unvaccinated kids caught the virus and only 0.1 percent of vaccinated children succumbed to it, said Edwards, noting that's in line with national statistics.
Widespread use of the measles, mumps and rubella vaccine led to the eradication of measles in the United States in 2000, according to the U.S. Centers for Disease Control and Prevention. Even people who aren't vaccinated benefit from what's known as herd immunity, which slows the spread of the virus.
Today's outbreaks are imported from areas where vaccines are less popular, such as Africa and Europe.
"Because there continues to be measles outbreaks in other parts of the world and across the country," said Edwards, "it is nearly impossible to definitively say that we will not see any more measles cases this year."
Utah's 2011 measles outbreak
9 confirmed cases
12,000 people exposed
184 people quarantined
Direct costs, to date
$107,812 staff time
$9,470 lab tests
Total • $130,246
Source • Salt Lake Valley Health Department