Outbreak economic analysis of six imported hemorrhagic fevers following detection at 24 hours

A ten-language search found no economic analysis of symptomatic hemorrhagic fever importation for Crimean Congo (CCHF), Hantavirus (HV), Lassa (LV), Marburg (MARV), Middle East Respiratory Syndrome (MERS) or Nipah (NV) into the USA/EU/UK. This study used available literature to calculate the cost of importation of the six selected fevers with each outbreak detected at 24 hours. A PRISMA search of Pubmed and grey literature was undertaken to uncover respective R0, case fatality ratios, average hospital stay, time to death, frontline casualty frequency and contact histories. A simulated breakout, t24 intervention, Borel distribution contact model, with R0 determined infection (0-1.59) and death rate (CFR: 0.01-0.5) was formed. Treatment inc. plasma therapy, and PPE best prices were determined. ICU median operational costs were factored with contact tracing. Indirect admin costs, based on national mean values, frontline replacement, GNI per capita productivity losses through isolation (21 days as standard), hospitalisation and death were factored. Mean patient discharge ranged 4.4 - 28 days (CCHF to MERS). Time to death ranged 2 - 15 days (HV, NV). The number infected at t48 ranged 1 - 9.59 (CCHF/HV to MARV). Contacts ranged 27 - 169 (CCHF to MARV/NV/MERS). Direct costs of outbreak care, labour, and tracing ranged €424707 - €2850083.07 (CCHF - MARV). Indirect costs, attributed to administrative burdens ranged €5264 -€32800.02 (CCHF to MARV). Productivity losses, attributed separately to the isolated, treated, and dead totaled €2042613 - €26198606 (CCHF - MARV). The total outbreak cost ranged €2488512.78 - €29081489.72 (EU, CCHF - MARV). Significant direct, indirect and productivity costs were attributed to the importation of a single case of six hemorrhagic fevers when detected at t24. The significant societal cost of MARV in particular highlights the importance of continued hemorrhagic fever research and preparedness to healthcare systems in protecting future budgets. KEY MESSAGES: • The importation of hemorrhagic fevers has significant direct and indirect budgetary, and productivity, impacts. • Besides human cost, financial costs demand public health enhanced surveillance and response plans for hemorrhagic fever importation.