The Minnesota Department of Health (MDH) announced on Tuesday that the measles outbreak has now spread to a fourth county in the south of the state and the number of cases has increased to 60.

Fifty-one cases have been diagnosed in Hennepin County, and three have been diagnosed in Ramsey County, both of which are in metropolitan Minneapolis-St. Paul. Four cases have been diagnosed in Crow Wing County in the northern part of the state. Now two cases have been diagnosed in Le Sueur County in the south of the state.

Fifty of the sixty cases “are Somali Minnesotan.”

Fifty-seven are “in children (ages 0-17 years).” Three “cases are in adults.”

Fifty-seven are “confirmed to be unvaccinated. 1 had 1 dose of MMR. 2 had 2 doses of MMR,” MDH reported.

“When it began last month, public health officials knew this outbreak could be large and ongoing, because many Somali-Americans have been refusing the measles, mumps, and rubella (MMR) vaccine for years over unfounded rumors that the childhood immunization, whose first dose is routinely given to babies at 12 to 15 months, causes autism,” the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) reported.

“This is not an access question,” said Kristen Ehresmann, RN, MPH, director for infectious diseases at the Minnesota Department of Health (MDH). “It’s an issue of being misinformed about the risk. Doing community outreach and engagement is much more labor intensive, because it’s not about just offering more clinics and opportunities to get the vaccine.” Ehresmann said that staffing costs for the current measles outbreak, which includes the communication office, are an extra $207,096 for the state per 21-day period. But Ehresmann said the $200,000 number is just the “tip of the iceberg.” “We’re already into the second month of this outbreak, and we haven’t plateaued yet,” she said. Ehresmann said the costs incur from several different departments: $165,000 for staffing infectious disease and communication departments; $9,600 for having staff on call 24/7; $14,000 for materials, testing supplies, translations, and shipping.

Last week, Health Commissioner Dr. Ed Ehlinger requested that the Minnesota State Legislature “create a public health response contingency fund of $5 million to ensure sufficient resources are available for immediate, life-saving actions to protect Minnesotans from infectious disease outbreaks.” The request specifically focused on measles, tuberculosis and syphilis, as well as “other unanticipated public health threats.”

“Governor Dayton has given me his support for this proposal, and we will advocate for its inclusion in any final legislative budget agreement,” Ehlinger added.

The costs of treating the current measels outbreak are expected to continue to grow as it spreads further throughout the state.

“We’re projecting another 3 months out at this point; it’s going to be expensive,” MDH’s director of infectious diseases Ehresmann told CIDRAP:

“If the measles outbreak lasts 3 months,” said Kate Awsumb, MA, MPH, “the back-of-the-envelope costs are approaching $1 million.” She is the assistant director of communications with the MDH. And those are just the MDH costs. Hennepin County, the epicenter of the outbreak, has to date incurred $79,000 on the outbreak, according to Lori Imsdahl, a communications specialist with the county. But that cost does not include staffing and payroll, information that won’t be calculated until May 19, Imsdahl said. On that date, the county will be able to estimate an average weekly cost for the outbreak.

The 60 cases of measles that have been diagnosed in Minnesota since the first case was detected on April 11 are the most in the state in more than 20 years.