Screening hospital employees for measles immunity is more cost effective than blind immunization

Objective: To examine alternative strategies in developing a cost-effective program to assure measles immunity among hospital employees. Design: Observational. Setting: Referral teaching hospital. Participants: Eighteen hundred "established" hospital employees with potential patient contact and 630 newly hired hospital employees. Interventions: Established employees born after 1 January 1957 and all newly hired employees were screened for serologic evidence of measles immunity and immunized if necessary. Measurements: Cost analysis. Results: The cost of screening and directed immunization of established employees was $3.98 per employee compared with a potential cost of $10.03 to $42.80 per employee if all employees were "blindly" immunized with monovalent measles vaccine or trivalent mumps-measles-rubella vaccine. The cost of the screening and directed immunization of new employees was $2.42 per employee compared with potential costs of $8.30 to $39.34 per employee for blind immunization. These analyses assumed that varying percentages of employees would be able to produce documentation of having received a previous dose of vaccine or of having had measles. Conclusions: In a large referral hospital, screening for measles immunity followed by directed immunization was considerably less expensive than immunizing all potentially susceptible employees.