NYC: Measles outbreak in Orthodox Williamsburg stems from unvaccinated children

Some Ultra-Orthodox Jews Refuse to Immunize

October 18, 2018 By Mary Frost Brooklyn Daily Eagle

The number of confirmed measles cases rose this week to 359. Photo courtesy of CDC

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New York City Health Department officials met with rabbis and elected officials in Williamsburg on Thursday after six children in the ultra-Orthodox Jewish community were diagnosed with measles.

The highly contagious disease, which causes fever and a rash from head to toe, has been nearly eradicated in the U.S. but still exists in other countries. Young children, the immunocompromised and non-immune pregnant women are at highest risk for severe complications, including pneumonia, brain damage, deafness or even death.

The initial Brooklyn case was acquired by a child on a visit to Israel, where a large outbreak is currently taking place.

The infected children range in age from 11 months to 4 years. Five of them were unvaccinated; the sixth child had received one dose of the vaccine prior to exposure but was not yet immune. One of the children was hospitalized with pneumonia and another child developed an ear infection.

Many parents in the Orthodox Jewish community resist vaccinating their children. Besides meeting with religious and community leaders, the Health Department will be placing ads about the importance of vaccination in local newspapers and distributing posters to health care providers.

“Although measles is preventable, too many families are choosing to not vaccinate or delay vaccination, putting their children and other children at risk,” Acting Health Commissioner Dr. Oxiris Barbot said in a statement. He asked families who suspect their kids have measles to keep them home from school or day care and to contact their doctors.

There are also at least seven confirmed individuals with measles among a related Orthodox community in Rockland County. Five acquired measles during travel to Israel, and two were infected after an exposure to a person with measles.

The New York City Health Department recommends the measles, mumps and rubella (MMR) vaccine for children at age 12 months, with a second dose at 4 to 6 years old.

Extremely Infectious

According to the Health Department, if one person catches measles, 90 percent of that person’s non-immunized close contacts will also become infected. It typically spreads through coughing and sneezing, and the virus can live for up to two hours in the air.

While not as deadly as now-eradicated smallpox, which looks similar to measles in its early stage, many do not realize how serious measles can be. In the pre-vaccine era, roughly 6,000 measles deaths were reported in the U.S. each year, according to the Centers for Disease Control (CDC).

The vaccine was introduced in 1963, and measles was declared eliminated from the United States in 2000. But as vaccination rates have dropped, the disease has experienced a comeback, particularly in Orthodox and other ultra-religious communities, such as the Amish.

The number of parents against mandatory vaccines, known as anti-vaxxers, has also increased, especially in the western states. The LA Times estimates that 10 percent of children in private and religious schools in California go without protection from childhood diseases.

As of September 8, 137 cases of measles have been confirmed in 24 states and the District of Columbia, the CDC says.

A study by Dr. Jennifer B. Rosen published in the academic journal JAMA Pediatrics in August found that the 2013 New York measles outbreak, with 58 cases, also broke out among unvaccinated children within Orthodox Jewish communities in Williamsburg and Borough Park.

Of the 58 confirmed Brooklyn cases, 45 (78 percent) were unvaccinated because of parental refusal or intentional delay, and 12 (21 percent) were too young for routine measles vaccination.

Who Should Pay for Families Refusing to Vaccinate?

The outbreak’s investigation and response, which ultimately identified more than 3,000 confirmed contacts, involved 87 staff members from the NYC Health Department, who spent more than 10,000 hours working to control the outbreak at a direct cost of almost $400,000 and additional, uncompensated costs, according to Rosen.

Dr. Jason L. Schwartz, in an opinion piece in JAMA’s September issue, argues that this is a lot of time and money to spend on a preventable disease.

In all states except for California, Mississippi and West Virginia, parents may opt out of required vaccines for their children on religious grounds or personal beliefs.

“These policies facilitate the emergence of clusters of unvaccinated individuals and the corresponding increase in the likelihood of disease outbreaks in those communities,” Schwartz writes.

He suggests that those who refuse to comply and thereby spread vaccine-preventable diseases should bear financial responsibility for the consequences of their choices.

“One potential response to this long-standing inequity in U.S. vaccination policy would be to require families who obtain nonmedical exemptions to pay a fee. These fees would directly support vaccination activities such as educational efforts, information systems, and outbreak response,” he writes.