The Gazette Times article, "Man with measles may have exposed travelers, patients" (Saturday, June 2) leaves a large part of the story untold. While the inconvenience and costs to the ill traveler - and now to a secondary case - are fairly obvious, the threat to Oregon's inadequate public health system is a greater concern.

Failure to protect a child from a vaccine-

preventable infectious disease exposed not only the patient but also dozens of air travelers and hundreds of local hospital patients, employees and visitors to measles. That choice left taxpayers responsible for the costs of mandated communicable disease investigation and follow-up.

The Centers for Disease Control contacts

international airline passengers exposed to measles and assesses their immune status - just as it did recently for travelers aboard international flights carrying the passenger with extremely drug resistant tuberculosis (XDR TB. Yet it falls on state and local governments to notify contacts and assess the risk of infection for those people exposed on the domestic flights and in local hospitals.

Those who are not protected by previous measles disease or vaccination may require isolation or voluntarily quarantine to protect the public.

Expenses for communicable disease investigations like the one in Eugene could easily cost the county tens of thousands of dollars, depending on the number of exposures and secondary cases.

In 2003, a smaller measles outbreak in Corvallis involved only 155 contacts. That investigation occupied 13 health department staff and incurred additional costs of $15,000.

Nationwide investigations like this one (or E.coli in spinach), can run into the millions. Oregon and Benton County played a key role in quickly identifying E. coli in the spinach case.

Much attention is given to highly pathogenic avian influenza (flu) as it tries to establish a toehold in the human population. The travel-

related case of measles reminds us that, once established, avian flu or some other pandemic will be a global problem.

County health departments are responsible for planning and leading responses to avian flu, including mass dispensing, field hospitals and mass fatality morgues.

A strong public health infrastructure is necessary, if we are to reduce the harm caused by avian flu, tuberculosis and other emerging diseases in Benton County.

In Oregon, this occurs at a time when funds for local public health services are being reduced. Benton County Health Department cut $1.25 million per year and 14 full time positions as compared to its previous budget.

Private health systems also bear the brunt of communicable disease costs. As a result of this measles exposure, at least three hospital employees were required to stay away from work for three weeks.

Their salaries must be paid, provider revenue will be lost, and some patients may not be seen during this time.

Hospital costs will remain, and the financial shortfall can only be passed on to insured patients through higher medical bills.

Oregon contributes 58 cents a year per person toward public health to protect us from disease outbreaks. Counties and federal funds pay the rest.

The governor's recommended budget proposed a $5 million increase in support to local public health departments. That initiative was not reflected in the co-chairs' budget. We hope the Legislature will again consider the governor's recommendation before the legislative session ends.

A more sustainable and protective approach would be to rethink how Oregon funds the public's health security.

Tom Eversole is the administrator of the Benton County Health Department.