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The number of confirmed cases of measles in Brooklyn's Orthodox Jewish community increased to 42 this week, up from six cases in October, according to the NYC Department of Health (DOH).

The city has begun barring kids who haven't had the required measles-mumps-rubella (MMR) vaccine from attending school, which includes Jewish religious yeshivas.

The first Brooklyn child with measles acquired the infection on a visit to Israel, where a large outbreak is occurring, according to DOH. The highly-contagious disease has since spread among children (and a couple of adults) in Borough Park and Williamsburg.

Dr. Joseph Kaplovitz, pediatric specialist at NYU Langone Stepping Stones clinic in Borough Park, told the Brooklyn Eagle that he expects to see more measles cases.

"I do suspect it to go on for another month or two," he said. "The problem is, it's very contagious. There's a 90 percent chance you'll catch it if you're in a room with someone who has it and you're not immunized."

It can be contagious even before the rash shows up, he added, so if the office suspects a child has the disease they will be met outside the office, outside in the fresh air, so they don't bring the infection inside.

Two of his patients have been confirmed as having the disease and he suspects he saw two more cases this week.

While most of his Orthodox patients - roughly 95 percent, he estimated - have been immunized, there's "lots of misinformation" still being spread by anti-vaxxers.

"They may believe conspiracy theories, like [the vaccine] causes autism, even though that idea has been shot down. Mercury and preservatives are another reason - even though there's more mercury in a can of tuna fish," he said. "While they have some valid concerns, when we do a risk-benefit analysis we see that the side effects of the vaccine are exceedingly small compared to the bad the measles can do.

Since the city starting requiring the measles shots, "We've had patients come in, and that the only vaccine the child has. But now they can go to school."

Kaplovitz said the closeness of the Orthodox Jewish community contributed to the disease's spread.

"We're amongst each other," he said. "We spend a lot of time together. In a way, that's better; we don't spread it to anyone else." He said it was appropriate for the city to ban non-immunized children from schools. "It's prudent to have kids stay home if they don't have their two MMR shots."

To fight misconceptions, the city has reached out to the Orthodox community, and Kaplovitz' office hands out a 30-page pamphlet prepared by a rabbinical organization that explains the benefits of vaccination, how vaccines are made and tested, and other details.

Vaccination is required for all children 2 months to 18 years old who go to child care, public school or private school.
Started in Israel, Spread to New York
The 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. The initial Brooklyn case was acquired by a child on a visit to Israel, where a large outbreak was taking place.

Besides Borough Park and Williamsburg, the infection has been spreading in Hasidic villages in upstate New York - New Square and Muncie - and in the Orthodox community in Lakewood, New Jersey, Kaplovitz said. Other cases have broken out at a related Orthodox community in Rockland County.

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).

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 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 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.

The decline in vaccination rates across communities has led to the resurgence of diseases like measles and mumps, and recent outbreaks "have demonstrated the importance of an integrated infection prevention response," according to research presented in June at the 45th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

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Measles outbreak in Brooklyn's Orthodox Jewish areas continues to climb - Brooklyn Daily Eagle

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The number of confirmed cases of measles in Brooklyn's Orthodox Jewish community increased to 42 this week, up from six cases in October, according to the NYC Department of Health (DOH). The city has begun barring kids who haven't had the required measles-mumps-rubella (MMR) vaccine from attending school, which includes Jewish religious yeshivas.

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Why New York's Measles Outbreak Is the Worst in Decades

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There is a new measles outbreak in New York State, where 167 cases of the preventable infectious disease have been reported since September

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Measles Outbreak: Confirmed In 25 Other States As Well As NY

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Measles Outbreak: Confirmed In 25 Other States As Well As NY

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**Measles cases in other states but most are in Brooklyn. WHY?

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You may have been surprised by the measles outbreak in Rockland County and Brooklyn. Many considered measles a childhood disease that was all but wiped out by 2000 due to widespread vaccination - but it is making a comeback worldwide.

The U.S. Centers for Disease Control and Prevention said this week that 220 cases of measles have been confirmed in 26 states and the District of Columbia. The public health agency's report covered cases reported with local and state health departments as of Nov. 3, and compares to 120 cases in the United States in all of last year.

More than half all the measles cases in the country are in New York.

Related: Measles Outbreak 2018: 88 Cases In Rockland, 34 In Brooklyn

In addition to New York, the other states are Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington, plus the District of Columbia.

At least 15 measles outbreaks - three or more linked cases - have been reported so far in 2018.

To get an idea of how highly contagious the measles virus is, an un-vaccinated or -immune person who shares close space with an infected person who sneezes or coughs has a 90 percent chance of contracting the illness. The measles virus lives in the nose and throat mucous of an infected person.

The virus is hearty, and can live for up to two hours in an airspace where an infected person coughed or sneezed. And people who have measles can spread it from four days before a rash appears to four days after it has cleared.

Globally, measles cases saw a 30 percent uptick in 2017 and killed an estimated 110,000 people, according to the World Health Organization.

The main reason for the increase in Europe, where 41,000 people were infected in the first six months of 2018, was the refusal by parents to have their children vaccinated, the global health agency said.

The CDC said the rise in measles in the United States can be traced to outbreaks in countries to which Americans often travel - including England, France, Germany, India, the Philippines and Vietnam.

Also, the agency said, measles is spreading in the United States in communities with unvaccinated people. For example: In 2017, 75 people were sickened in a Somali-American community in Minneapolis with poor vaccination coverage. A multi-state measles outbreak in 2015 - 147 cases - was tracked to an amusement park in California and further back to a large measles outbreak in the Philippines in 2014. Unvaccinated Amish communities in Ohio were disproportionately sickened in a 2014 outbreak associated with the outbreak traced to the Philippines.

Measles can be prevented with vaccination. While a 1978 goal by the CDC to eliminate measles from the country by 1982 fell short, widespread vaccination programs caused the agency to declare measles eliminated in the United States by 2000.

Some parents refuse to vaccinate their children amid incorrect claims around the world linking the vaccines to autism, but the CDC and global health agencies like the World Health Organization recommend that children one year old and over receive two doses of measles-rubella or measles-mumps rubella.

In Rockland, as the outbreak worsened, officials began recommending that children as young as six months start the vaccination process. They also warned that people born before 1957, who have always been considered immune, could get at least a mild case of measles if exposed in this outbreak.

Rockland health officials have placed restrictions on schools in the geographic center of the outbreak: Monsey, Spring Valley and New Square. Un- or under-vaccinated students may not attend any schools where the vaccination rate is lower than 80 percent until 21 days after the last confirmed case in the county. Officials said that could be months away.
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Measles Outbreak: Confirmed In 25 Other States As Well As NY

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You may have been surprised by the measles outbreak in Rockland County and Brooklyn. Many considered measles a childhood disease that was all but wiped out by 2000 due to widespread vaccination - but it is making a comeback worldwide. The U.S.

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Measles Outbreak Hits New York City (IFL Science)

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Measles Outbreak Hits New York City (IFL Science)

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Remember that map we showed you in January that tracks all the instances of completely preventable diseases that are re-emerging due to lack of vaccination? Sadly, it is receiving several new data points due to an outbreak of the measles in New York City. Nineteen people have been diagnosed with measles and health officials are blaming an influx of people opting out of vaccinations. Four have been hospitalized due to their symptoms.

Measles is a highly contagious, viral respiratory system infection that can be transmitted through the air. Symptoms include a fever, cough, and widespread rash that causes itching. Roughly 1 in 3 people who get diagnosed with measles will suffer a complication, according to the CDC. These complications vary in severity, ranging from pneumonia, ulcers on the cornea, swelling of the brain, and death. Measles can be easily controlled through vaccination and the United States saw a 99% drop in measles diagnoses since the vaccine was introduced in the 1960s. Unfortunately, the diseases have not been completely eradicated due to those in the anti-vaccination faction.

"As long as your kid is vaccinated, why should you care if mine is?" This statement is often cited among parents who choose not to vaccinate their children, probably because it would be a logical argument if this were a perfect world. For those of us stuck here in reality, it is easy to see the blatant flaws. First and foremost, you cannot claim that herd immunity keeps other children safe when you actively try to thin the herd by advocating against vaccines.

The first dose of the MMR vaccine isn't administered until a child is 12-15 months old and doesn't offer full protection until the child receives the second dose between ages 4-6. The youngest New Yorker to be diagnosed with measles is 3 months old. This child was never even given the option to be vaccinated and protected against the disease.

In addition to the young, the immunocompromised also rely on being surrounded by vaccinated individuals in order to stay protected. Those with severe allergies to gelatin or are receiving blood products are not able to get vaccinated. New York has more citizens living with AIDS than any other state in the country and can be especially susceptible to infection. Those who are HIV+ are able to receive the MMR vaccines and may benefit from a booster, provided they are not showing symptoms of AIDS.

Health officials in New York are recommending that everyone who is able to get the MMR vaccine do so. If an adult is unsure if they were vaccinated as a child, they can either receive another dose or get blood work done to check their immunity status. Pregnant women are unable to receive the vaccine, though getting an infection can increase the chances of birth defects, miscarriage, or pre-term labor.

The MMR vaccine came under scrutiny in 1998 by Andrew Wakefield, who claimed it caused autism. Because autism symptoms typically appear around the same time that children get the bulk of their vaccines, parents began to worry and began rejecting vaccines. The rest of the scientific community denied his claims, as they were unable to reproduce the results. It was later revealed that Wakefield had actually falsified his data and was driven by financial motivation. His paper was retracted by the journal and his medical license was stripped, though some people still cling to the misinformation and view it as truth. There is absolutely zero scientific evidence to support a causal connection between vaccines and autism. This reckless anti-vax fear-mongering is absolutely responsible for this measles outbreak.

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Remember that map we showed you in January that tracks all the instances of completely preventable diseases that are re-emerging due to lack of vaccination? Sadly, it is receiving several new data points due to an outbreak of the measles in New York City.

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Measles outbreak NYC: What you need to know about the highly contagious disease (Independent)

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Measles outbreak NYC: What you need to know about the highly contagious disease (Independent)

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***Measles Outbreak in Brooklyn Makes International News!

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Health officials have issued warnings over a measles outbreak across New York state with at least 17 cases reported.

Six children in Brooklyn have been diagnosed with the highly contagious disease. NBC New York reports that some of the infected most likely picked up measles during travel to Israel.

There were also 11 cases reported in Rockland County in upstate New York.

Earlier this year, a widespread outbreak of measles infected 21 states and the District of Columbia. The US has been functionally free of measles since 2000, but it's still possible for an unvaccinated person to bring the disease home from another country.

Five of the New York children were unvaccinated, NBC reported. Four of those children were too young to receive the vaccine, and one had only received the first of two shots of the MMR vaccine.
What are the symptoms?
The symptoms of measles include high fever, cough, rash, runny nose, and watery eyes, according to the Center for Disease Control and Prevention (CDC).

Measles sometimes develop into more serious conditions like ear infections and diarrhoea. CDC reports that one out of 20 children who contracts measles will get pneumonia, some of whom die from the disease. About one in 1,000 children will develop encephalitis, or brain swelling. Sometimes, a swollen brain can leave a patient brain-damaged or deaf.
What treatment is available?
The best treatment is preventative. The MMR vaccine protects from measles, mumps and rubella.

After exposure, there is no formal medical cure for measles, but the symptoms can be treated while the infection subsides. Not all treatments are ideal for all patients, so it's important to consult a doctor as soon as possible for a prescription.

Mayo Clinic reports a post-exposure vaccine can sometimes prevent measles from developing if received within 72 hours of infection. If not, it can usually reduce symptoms. Immune serum globulin is also advised for people with weakened immune systems. Fever reducers, antibiotics and Vitamin A can also minimise symptoms.
Why is this happening now?
The New York City Health Department said that one child had just returned from Israel, where there is currently a large measles outbreak. At least 623 Israelis have contracted measles in 2018, according to Israel's Ministry of Health. Measles is most contagious before symptoms even start to develop, so it's likely that the first child brought it to Rockland county and Brooklyn.

Measles is so contagious that an unvaccinated person can become infected even if they're in the same room as someone with measles.

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Health officials have issued warnings over a measles outbreak across New York state with at least 17 cases reported. Six children in Brooklyn have been diagnosed with the highly contagious disease. NBC New York reports that some of the infected most likely picked up measles during travel to Israel.

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New York’s Orthodox Jewish community is battling measles outbreaks. Vaccine deniers are to blame. (VOX news)

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New York’s Orthodox Jewish community is battling measles outbreaks. Vaccine deniers are to blame. (VOX news)

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Anti-vaccine advocates have swayed parents in New York to refuse immunizations for their kids, sparking two of the largest measles outbreaks in the state's recent history, according to local health officials.

As of January 8, 55 people in Brooklyn - mainly in the Williamsburg and Borough Park neighborhoods - had fallen ill, along with 105 people in nearby Rockland County, and seven in Orange County. Additional cases are currently under investigation, and the number is expected to rise.

What's notable here is that the cases are mostly occurring among unvaccinated or under-vaccinated Orthodox Jews, particularly children. When asked why people are opting out of vaccines, the city health department said anti-vaccine propagandists are distributing misinformation in the community.

The fearmongerers include the Brooklyn group called PEACH - or Parents Teaching and Advocating for Children's Health - which spreads misinformation about vaccine safety, citing rabbis as authorities, through a hotline and magazines. Brooklyn Orthodox Rabbi William Handler has also been proclaiming the well-debunked link between the measles-mumps-rubella (MMR) vaccine and autism. Parents who "placate the gods of vaccination" are engaging in "child sacrifice," he told Vox.

I talked to Orthodox Jews in New York about the outbreak and their vaccine concerns. And I learned that a minority distrust vaccines - for reasons that have nothing to do with religious doctrine.

Yet the fact that some Orthodox Jews live outside the mainstream, avoid technology, and hold rabbinic opinion in high esteem may leave them particularly vulnerable to anti-vaxxers.

"Being a religious Jew, you also get used to having a minority viewpoint," said Alexander Rapaport, the CEO of the Masbia Soup Kitchen Network in Brooklyn, and a public face of the Hasidic community. "So if something is not mainstream, it doesn't take you away from believing it."

He also explained that some Orthodox Jews in Brooklyn go to school together, worship together, and live and travel together. This means a few unvaccinated people living in close proximity can be dangerous. But it also means making inroads with public health messages requires extra effort. "We see government invest in public health awareness a lot," Rapaport said. "But it never trickles down to Yiddish speakers or people who don't own TV sets."

The story in New York is familiar: Other tight-knit communities - like the Somali-American community in Minnesota and the Amish in Ohio - have recently fallen victim to measles outbreaks as a result of vaccine refusal. This latest outbreak is a reminder of how vulnerable more insular groups can be to anti-vaxxers, and the unique challenges for public health advocates in countering their messages in these communities.

Measles was eliminated in the US in 2000 - but outbreaks linked to vaccine refusal have been popping up in insular communities

There's one fact that makes the measles virus really scary: It's one of the most infectious diseases known to man. A person with measles can cough in a room, leave, and - if you are unvaccinated - hours later, you could catch the virus from the droplets in the air that they left behind. No other virus can do that.

So if you're not vaccinated, it's extremely easy to catch measles. In an unimmunized population, one person with measles can infect 12 to 18 others. That's way higher than other viruses like Ebola, HIV or Sars.

By 2000, because of widespread vaccination, the virus was declared eliminated in the United States: Enough people were immunized that outbreaks were uncommon, and deaths from measles were scarcely heard of.

But in order for any vaccine to be effective, you need to have a certain percentage of people in a population immunized. That's what's known as "herd immunity," and it means diseases can't spread through populations very easily. With the MMR vaccine, 95 percent of people need to get the shot. So just a few people refusing vaccines can be dangerous.

Since 2000, we've seen outbreaks every year in populations with lower levels of vaccine uptake, totaling between 37 and 667 cases. The virus typically spreads when unvaccinated travelers visit places where measles is circulating widely and bring it back to other unvaccinated or under-vaccinated people in a close-knit community where some parents have been opting out of vaccines for their kids.

That's what happened in two of the largest recent measles outbreaks in the US since the disease was eliminated. In 2014, measles spread among unvaccinated Amish people in Ohio after a missionary brought the virus back from the Philippines. And in 2017, a traveler sparked an outbreak in an unvaccinated Somali-American community in Minnesota.

In New York, the current outbreaks also originated with travelers who had recently visited Israel, where a massive measles epidemic is currently underway. The travelers returned to the US and spread it among unvaccinated or under-vaccinated New Yorkers.

But this is not an isolated incident. The Orthodox Jewish community has already faced numerous outbreaks ofvaccine-preventable diseases in recent years, including whooping cough and mumps. As recently as 2013, another measles outbreak involving 58 cases became the largest in the city since 1992, nearly a decade before measles was eliminated, and cost the city $400,000 to contain.

The reason parents aren't vaccinating in New York

Most of the people I spoke to for this story had no concerns about vaccine safety and happily vaccinate their families. The majority view is also that there's no religious reason to avoid vaccines.

"From a religious point of view, people have to vaccinate," Rabbi David Niederman, executive director and president of the United Jewish Organizations of Williamsburg, told me. Instead, people have a duty to protect their families and the most vulnerable in their communities. "Anything that causes harm - you have to do whatever you can to [avoid] that."

Yet Rabbinic authority, and the argument about avoiding harm, is being used by anti-vaccine campaigners as a vehicle to spread misinformation.

Consider the story of Rachel,* an Orthodox Jew in Brooklyn. When her eldest child was 18 months old, she brought her baby to the doctor for the MMR vaccine. Soon after, the girl came down with a fever that climbed up to 106 and eventually had to be hospitalized.

"The doctor said there was no correlation with the vaccine," the mother of seven, ranging in age 11 months to 15 years, recalls. But Rachel was skeptical. After that, she noticed her daughter was getting sick all the time. "Ear infections, viruses. I lived at the doctor's office." She thought vaccines might be the culprit.

So she read up on the shots in PEACH's pamphlets, watched the anti-vaccine documentary , and talked to her neighbors in her Brooklyn Orthodox Jewish community.

"The rabbis that don't think vaccines are the right way to go keep a low profile," she said, "but I could name you a bunch of them."

She read and heard about things that concerned her. The ingredients in vaccines didn't seem safe or healthy, and she heard rumors of neighbors whose kids got autism right after their shots. (For the record, data on thousands of people over the past half-century have found vaccines are overwhelmingly safe and effective.)

So over the years, Rachel has vaccinated her kids "less and less." Her two youngest aren't immunized at all.

Nowadays, between bringing her children to school and changing diapers, the stay-at-home mom hosts a library in her home, where parents can borrow books about vaccines and discuss what they read. The library includes both pro- and anti-vaccine books. "People can read and decide for themselves."

Her library is advertised in anti-vaccine materials that are being spread in Rachel's community,and she's now part of the minority who resists vaccines - one that's helped spark two of the largest measles outbreaks in recent US history.

"It has been very difficult to dissuade parents"

Some of Rachel's concerns are reflected in the Vaccine Safety Handbook, purportedly produced out of Brooklyn by a group called PEACH - or Parents Teaching and Advocating for Children's Health. (The group declined to be interviewed for this story.) The book carries the slogan, "You can always vaccinate later. You can never unvaccinate," pages of misinformation about vaccines, including the well-debunked link with autism, as well as advice from rabbis about the "Biblical commandment" to avoid putting one's life or health in danger - including the danger of vaccines.

Another source of vaccine misinformation is Rabbi William Handler, who also holds the view that vaccines cause autism - and shares it with parents. "I explain to parents that public health authorities like [the Centers for Disease Control and Prevention] are not interested in individual children," he said. The best way to avoid potential harm is to avoid getting immunized, he advises. "[Parents] don't want to play Russian roulette with their children. It's like child sacrifice."

Though large-scale studies involving thousands of participants in several countries have failed to establish a link between the MMR vaccine and the mental developmental disorder, it's the autism views that the New York City health department hears a lot of.

"Unfortunately the concern about whether there's any linkage has really lingered and [because of] misinformation, and it has been very difficult to dissuade parents," Jane Zucker, New York City's assistant commissioner of the bureau of immunization, told Vox. "We hear they want to wait until the child is older so they know the child doesn't have autism, then get the child vaccinated."

The challenge of countering anti-vaccine rhetoric in isolated communities

New York State does not allow parents to refuse vaccines forphilosophical reasons, though parents can get exemptions for health and religious reasons. Once children reach school, they have to present evidence that their kids have been vaccinated, unless they have been granted an exemption.

Zucker says vaccine levels in Jewish schools in New York City look average, although religious schools have more religious exemptions than non-religious schools. And before kids get to school, there's a problem in Williamsburg: It has one of the lowest rates of vaccine coverage among young children, ages 19 to 35 months, in the city.

So it was no surprise to Zucker that the children currently affected by measles in this outbreak were all too young to be in school. According to the city health department, the Williamsburg and Borough Park measles cases involved only small children, ages ranging from seven months to 4 years old. (Rockland declined to provide details about the affected, citing privacy concerns.)

That means there's a cohort of kids for which state vaccine laws aren't applicable, and who are vulnerable to vaccine-preventable diseases.

"Once the kids get into school we know we have good vaccine uptake," said Zucker. "It's the delay, though, and that's what's linked to this outbreak."

Reaching vaccine-hesitant parents isn't easy, however. The public health department has sent notifications to schools and hospitals with large Orthodox Jewish populations, done outreach, and placed ads and distributed posters in Orthodox papers in both Yiddish and English.

Public health officials need to intervene before outbreaks start

But they need to try harder, community leaders said, and intervene before outbreaks start.

"We have a language barrier, a culture barrier," said Rabbi Avi Greenstein, executive director of the Boro Park Jewish Community Council, in one of the affected areas, "and it only makes sense the health department should reach out to [our community]."

After outbreaks, posters about the importance of vaccines from the public health department will show up in community centers and neighborhood bodegas, said Alexander Rapaport, the Masbia Soup Kitchen CEO. But, "The posters from the city are reactionary," he added, and not enough is being done to educate people ahead of outbreaks.

According to the latest data from New York City's health department, there's been a surge in uptake of the MMR vaccine among children since the outbreak started. That mirrors a state-wide effort that's seen 13,000 people, mostly children, vaccinated since early fall.

So maybe it's an opportunity to change people's views. "It's becoming increasingly clear if people take the position [not to vaccinate], they are an irresponsible person, an irresponsible parent," Greenstein reiterated. "This is the challenge for the community."
*We did not use Rachel's real name because she was concerned about privacy and backlash about her views.

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New York's Orthodox Jewish community is battling measles outbreaks. Vaccine deniers are to blame.

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Anti-vaccine advocates have swayed parents in New York to refuse immunizations for their kids, sparking two of the largest measles outbreaks in the state's recent history, according to local health officials. As of January 8, 55 people in Brooklyn - mainly in the Williamsburg and Borough Park neighborhoods - had fallen ill, along with 105 people in nearby Rockland County, and seven in Orange County.

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Department of Health Reports Measles Outbreak in Brooklyn (News 12)

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Department of Health Reports Measles Outbreak in Brooklyn (News 12)

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Dept. of Health reports measles outbreak in Brooklyn

Posted: Wednesday, January 9, 2019 6:03 PM EST Updated: Wednesday, January 9, 2019 6:03 PM EST

BOROUGH PARK -

Health experts say there's a measles outbreak specifically among the Orthodox Jewish community.

The Department of Health reported at least 55 cases of measles among the Orthodox Jewish community since October.

Health officials say measles are highly contagious and potentially deadly.

The department's numbers show the neighborhoods most severely affected by the measles are Borough Park and Williamsburg. Those areas have a large population of Orthodox Jewish residents.

Pediatrician Lee Waldman says that everyone should get the measles vaccine.

Health officials tell News 12 that the outbreak is one of the largest in recent history in Brooklyn and that they plan to continue to investigate measles cases, ensuring clinics and doctors in the area are fully stocked with the vaccine for the disease.

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health experts say there's a measles outbreak specifically among the orthodox jewish community.

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Dept. of Health reports measles outbreak in Brooklyn

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Posted: Wednesday, January 9, 2019 6:03 PM EST Updated: Wednesday, January 9, 2019 6:03 PM EST BOROUGH PARK - Health experts say there's a measles outbreak specifically among the Orthodox Jewish community. The Department of Health reported at least 55 cases of measles among the Orthodox Jewish community since October.

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New York tackles 'largest measles outbreak' in state's recent history as cases spike globally (CNN)

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New York tackles 'largest measles outbreak' in state's recent history as cases spike globally (CNN)

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new york tackles 'largest measles outbreak' in recent history - cnn

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NY tackles 'largest measles outbreak' in state's recent history

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Since the outbreak emerged in September, measles has been diagnosed in at least 112 people across New York's Rockland and Orange counties and at least 55 in New York City.

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55 Cases of Measles Confirmed (AM New York)

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55 Cases of Measles Confirmed (AM New York)

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Fifty-five cases of measles have been confirmed in several Brooklyn neighborhoods, according to the city's Department of Health, which is urging New Yorkers to get vaccinated to prevent the spread.

Several of the diagnosed cases involved children who have not been vaccinated against the virus and who recently visited Israel, which is seeing a major measles outbreak, according to the health department.

"Children who did not travel were also infected in Brooklyn or Rockland County," the department said.

As of Jan. 2, Borough Park has seen the highest number of cases since October 2018 with 32 diagnoses, followed by Williamsburg with 21 cases. Bensonhurst and Midwood each had one measles diagnosis since October, however the health department said no new cases have been reported in the last two months.

Vaccination is the only way to prevent the contraction and spread of measles, which is highly contagious and more severe for infants, pregnant women and people with poor immune systems, the health department said. Symptoms include severe rash and fever, and could lead to death.

The city and state mandate vaccinations for any child attending day care or school. Children enrolled in grades K through 12 and college students must have two doses of measles vaccine, the health department said.

Anyone who thinks they may have contracted the virus is urged to call a doctor immediately.

Eat it. Drink it. Do it. Tackle the city, with our help.

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55 cases of measles confirmed in Brooklyn: Health Dept.

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Fifty-five cases of measles have been confirmed in several Brooklyn neighborhoods, according to the city's Department of Health, which is urging New Yorkers to get vaccinated to prevent the spread. Several of the diagnosed cases involved children who have not been vaccinated against the virus and who recently visited Israel, which is seeing a major measles outbreak, according to the health department.

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Measles Outbreak in Brooklyn (NYC Gov Resources)

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Measles Outbreak in Brooklyn (NYC Gov Resources)

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Information from the NYC Government

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There is an ongoing measles outbreak in the Orthodox Jewish communities in Brooklyn affecting Williamsburg and Borough Park. Cases have also been identified in Midwood/Marine Park and Bensonhurst. Most of the cases have occurred in Williamsburg and Borough Park.

Students attending a child care program serving the orthodox community, or pre-K program or grades K-12 in a yeshiva who do not have the required number of doses of measles-mumps-rubella (MMR) vaccine must be excluded from school effective immediately including those who are not in compliance with daycare and school MMR vaccine requirements and those with a medical or religious exemption.

This exclusion applies to child cares serving the Orthodox Jewish community and yeshivas in the following zip codes:

These zip codes may be changed or updated based on the status of the outbreak. For children attending daycare and pre-kindergarten, one dose of MMR is required; for children attending kindergarten through 12th grade, two doses are required.

If a parent needs to have their child vaccinated with the measles-mumps-rubella (MMR) vaccine, they should first check with the child's medical provider. If they need to find a clinic for MMR vaccine, they can call the H+H clinics located in Brooklyn. Last, for children 4 years of age and older, they may be seen at the health department Fort Greene immunization clinic.

Students cannot return to school until they are appropriately vaccinated, or until the outbreak is declared over, even if they have an approved religious or medical exemption to measles immunization.

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There is an ongoing measles outbreak in the Orthodox Jewish communities in Brooklyn affecting Williamsburg and Borough Park. Cases have also been identified in Midwood/Marine Park and Bensonhurst. Most of the cases have occurred in Williamsburg and Borough Park.

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New York Confronts Its Worst Measles Outbreak in Decades (New York TImes)

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New York Confronts Its Worst Measles Outbreak in Decades (New York TImes)

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Borough Park, Brooklyn, has seen 35 cases of measles in an outbreak affecting more than 200 people in ultra-Orthodox Jewish communities in New York and New Jersey. Credit Credit Bryan Thomas for The New York Times

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Through the fall, traveler after traveler arrived in the ultra-Orthodox Jewish communities of New York from areas of Israel and Europe where measles was spreading. They then spent time in homes, schools and shops in communities where too many people were unvaccinated.

Within months, New York State was facing its most severe outbreak of the disease in decades, with 182 cases confirmed by Thursday, almost exclusively among ultra-Orthodox Jews. Health officials in New Jersey have reported 33 measles cases, mostly in Ocean County, driven by similar conditions.

In 2018, New York and New Jersey accounted for more than half the measles cases in the country.

Alarmed, health officials began a systematic effort to bring up vaccination rates and halt the disease's spread.

But while there has been progress, the outbreak is not yet over. Health officials said part of the problem has been resistance among some people in ultra-Orthodox neighborhoods to fully cooperate with health workers, get vaccinations and promptly report infections.

"Sometimes they hang up and they don't want to open the door," said Dr. Patricia Schnabel Ruppert, the health commissioner of Rockland County, northwest of New York City, where the worst of the outbreak has been, with 116 confirmed cases. "It's hard to break an outbreak if you are not getting cooperation."

Dr. Ruppert said that health officials discovered that some religious schools, or yeshivas, in ultra-Orthodox communities in Rockland County had vaccination rates as low as 60 percent, far below the state average of 92.5 percent. Audits found that some schools were overreporting vaccination rates, she added.

Delayed vaccination also helped fuel the outbreak in the Orthodox communities of Williamsburg and Borough Park in Brooklyn, which had reported 58 cases as of Thursday, said Dr. Jane R. Zucker, head of the city health department's Bureau of Immunization.

There have been no deaths in the outbreak, but there have been a few serious cases in young children that required hospitalization.

Measles is one of the most contagious infections and can live for up to two hours in the airspace where an infected person breathed, coughed or sneezed. It usually affects children, and symptoms include high fever and a rash of red spots all over the body, as well as a cough and runny nose. Some 90 percent of unvaccinated people exposed in proximity to an infected person will get it.

But the vaccine, when given in two doses - typically around age 1 and age 5 - is about 97 percent effective.

Health officials and sociologists say the reasons for low vaccination rates among the ultra-Orthodox are complex.

In part they are tied to the wider anti-vaccination movement globally, including concerns that the measles vaccine, which also protects against mumps and rubella, causes autism or other diseases. The idea has been widely debunked but persists in some circles.

Rabbi Yakov Horowitz, founder of Darchei Noam yeshiva in Monsey in Rockland County, said that some parents considering admission to his school agonized over giving their children vaccines because they had heard they were dangerous. His yeshiva insisted on them, he said, though he knew of others that did not.

"Good people, great parents were terrified," he said. "They felt that I was asking to give their children something that would harm them."

Alexandra Khorover, general counsel for Refuah Health Center, one of the largest health providers in the Rockland community of Spring Valley, said her health workers had encountered "a small pocket of people who are anti-vaccine who have been peddling this information, fostering confusion and fear."

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New York and New Jersey accounted for half the measles cases in the country in 2018. Credit Schneyder Mendoza/Agence France-Presse - Getty Images

Part of the reluctance to vaccinate or allow a government health worker to enter the home, though, is cultural.

Samuel Heilman, a Queens College sociology professor who studies the ultra-Orthodox, said that there is a "fear of interference from the outside" rooted in the community's origins in pre-World War II Europe. More recently, the ultra-Orthodox have fought back against other health department efforts, such as New York City's efforts to limit a controversial circumcision practice, metzitzah b'peh, because of warnings from health officials that it causes herpes in infants.

"They have accepted the idea that they live by different rules than others in the outside community," Mr. Heilman said.

While this insularity allowed the measles to spread, it has also had a protective effect on wider public health, at least so far. In part because ultra-Orthodox Jews tend to attend their own religious schools and patronize their own shops and restaurants, the disease has remained in Orthodox circles, save for several infections among non-Jewish workers linked to their communities, health officials said.

The outbreak in New York and New Jersey can be traced to the rise of measles in Israel, where some 2,700 cases and two deaths were reported in 2018, centered in Jerusalem.

In Europe, which was the source of at least some of the Brooklyn infections, some 65,000 cases were reported in the year ending October 2018, with high concentrations in Balkan countries and Ukraine.

A flier distributed in ultra-Orthodox Jewish communities by the New York City Health Department. Credit New York City Department of Health & Mental Hygiene

As measles spread in New York, public health officials swung into action. Some 40,000 fliers were printed in English, Yiddish, Spanish and other languages warning of the Israeli outbreak and calling for people to be vaccinated. Health officials met with rabbis and pediatricians, who sounded the alarm to their congregations and patients.

"We are telling people the health department is looking out for your health," said Rabbi David Niederman, a community leader and executive director of the United Jewish Organizations of Williamsburg. "They are the experts and you should take the vaccinations."

In Rockland County, which includes the large ultra-Orthodox community of New Square, the authorities put 59 schools under "exclusion orders," forbidding unvaccinated children to attend even if they had a valid religious or medical exemption to the vaccine. The orders are lifted when a school's vaccination rate reaches 95 percent, which state authorities consider protective of public health. Eighteen schools have had the orders lifted, officials said.

In Brooklyn, some children have been out of school for months because of similar exclusion orders by health officials, said Rabbi David Zwiebel, the executive director of Agudath Israel, an ultra-Orthodox umbrella organization. Tensions are high, with some parents still refusing to vaccinate because of health fears, and others relenting.

"There has been some harsh language exchanged on both sides," Rabbi Zwiebel said.

The information campaign has had an impact. In Rockland County alone, more than 13,000 vaccines have been given since October.

While the rate of infection has slowed regionwide, Rockland has recorded an uptick - 18 new cases in January, after a drop in December.

Dr. Ruppert advised caution for all residents of Rockland County, particularly for parents of young infants and others who are not immunized, because just about everyone in the county shops at the same malls and box stores.

"Rockland is a small county, and I consider everyone potentially exposed," she said.

In New York City, health officials had sounded a hopeful note after no new cases surfaced for a week.

"I think we have promising news, Dr. Zucker said on Jan. 9, "but I don't want to be optimistic too soon."

Then on Wednesday, three cases were confirmed in Borough Park, indicating that the outbreak there has not come to an end.

Liz Robbins contributed reporting.

A version of this article appears in print on , on Page A19 of the New York edition with the headline: The Worst Measles Outbreak in Decades, Mostly Among Ultra-Orthodox Jews. Order Reprints | Today's Paper | Subscribe

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New York Confronts Its Worst Measles Outbreak in Decades

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What you need to know to start the day: Get New York Today in your inbox .] Through the fall, traveler after traveler arrived in the ultra-Orthodox Jewish communities of New York from areas of Israel and Europe where measles was spreading.

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New York Battles Worst Measles Outbreak in Decades (New York Post)

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New York Battles Worst Measles Outbreak in Decades (New York Post)

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New York state is battling one of the worst measles outbreaks in two decades as the highly contagious disease hits Orthodox Jewish communities in Brooklyn and Rockland County.

Fifty-five confirmed cases of the virus have affected unvaccinated children in Borough Park, Bensonhurst, Midwood/Marine Park and Williamsburg since October, according to the city Department of Health.

The measles outbreak in Brooklyn began when a child was infected on a trip to Israel, which also is seeing a large spread of the disease.

"Since then, there have been additional children from Brooklyn who were unvaccinated and acquired measles while in Israel," DOH said.

"Children who did not travel were also infected in Brooklyn or Rockland County."

As of Tuesday, the statistics include 32 cases in Borough Park, 21 in Williamsburg and one each in Bensonhurst and Midwood/Marine Park. Borough Park saw two new cases last week, while Williamsburg had one new case.

There have been 112 confirmed cases in the rest of New York state.

One hundred and five of those cases have been in Rockland County, which also has a high Orthodox Jewish population, with the rest in Orange County, officials said.

Rockland also currently has four suspected cases, pending test results. Eighty percent of the cases involved people under age 18.

The troubling spike has prompted Rockland and state health officials to recommend that parents have their children get the measles, mumps and rubella vaccine earlier than scheduled.
Typically, the first dose of the vaccine is administered at the age of 1 and again at 4.

"We changed it to get their first shot at 6 months old," said Rockland County spokesman John Lyon. "The second shot you can get 28 days after the first shot. We've been recommending that people do it immediately."

Children who are vaccinated on the expedited schedule will need to receive another MMR shot at 4, Lyon said.

With the help of the state Health Department, Rockland has doled out 11,000 MMR vaccinations since October.

"Anyone who has not received an MMR vaccine should go to the doctor and get one as soon as possible," advised state Health Department spokesman Jonah Bruno.

Early symptoms of measles appear 10 to 12 days after exposure and include fever, cough, runny nose and red, watery eyes. Three to five days later, a rash of red spots begins to appear on the face and spread over the entire body.

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New York battles worst measles outbreak in decades

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New York state is battling one of the worst measles outbreaks in two decades as the highly contagious disease hits Orthodox Jewish communities in Brooklyn and Rockland County. Fifty-five confirmed cases of the virus have affected unvaccinated children in Borough Park, Bensonhurst, Midwood/Marine Park and Williamsburg since October, according to the city Department of Health.