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Once thought eradicated in the United States due to the introduction of the measles vaccine, an outbreak hits New York City in 2018.

Population affected: Jewish Orthodox community.  Cause: Un-vaccinated travelers.

This community is very private, and members remain guarded of outsiders.

Measles is an air-borne disease that can be spread through droplets produced from the respiratory tract.

Vaccinations are an essential component to re-eradication of this deadly disease.

It is important for healthcare workers to incorporate evidenced based practice into their interventions, along with providing culturally competent communication and care.

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10/01/2018 Rockland County (NYC) DOH notified NYS DOH that a un-vaccinated teenager traveled & was diagnosed with measles.

Within 17 days Rockland County DOH added 6 more un-vaccinated travelers with measles to that list.

10/01/2018-4/30/2019 there were 242 lab confirmed and epidemiologically linked measles cases in NY.

All traveled to Israel where there was an outbreak of 3150 cases of Measles.

All were primarily members of Jewish Orthodox Communities.

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There is currently no specific delivery of care model being utilized in NYC among the Jewish Orthodox community.

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Health Fair & Vaccination Drive utilizing the PDSA (Plan Do Study Act) EBP intervention.

Process Measure:

Measurement of Jewish Orthodox individuals who seek out information on the disease process and disease prevention.

Measurement of the number of individuals within this particular community who agree to participate in a health fair and agree to being vaccinated.

Outcome Measure:

Increase in vaccination rates among individuals in Jewish Orthodox communities.

Statistical decrease in measles cases reported in NYC specifically, among Jewish Orthodox communities.

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Engaging in Medical Education with Sensitivity (EMES)

Started April, 2019, as a 501(c)(3) nonprofit organization under the laws of the State of New York by a group of dedicated, concerned, and highly educated nurses.

In response to the measles outbreak in the ultra Orthodox Jewish community of New York City and New York State.

Recognized the need for increased health literacy in the Orthodox Jewish community.

Main Goal: Gaining trust and providing education thereby improving vaccination rates and limiting spread of disease.

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It was October 31, a balmy day in Brooklyn, and Alexander Arroyo was walking around his neighborhood dressed as an octopus, pushing his 2-month-old daughter in a carriage, as his wife chased their toddler [...]

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Our Mission To advance healthcare education for communities with healthcare information barriers. Health literacy skills are an important asset for maintaining or improving health.

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Centers for Disease Control and Prevention. (2019, April 15). Epidemiology and Prevention of Vaccine-Preventable Diseases. Retrieved from U.S. Department of Health & Human Services: https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#measles

Gramigna, J., & Glatt, A. (2019).  Interviews with orthodox Jewish moms reveal barriers to measles vaccination. Infectious Diseases In
Children, 32(7), 18.

Marcus, B. (2020). A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History: Lessons Learned Battling Homegrown Vaccine Hesitancy. Online Journal of Issues in Nursing, 25(1), N.PAG. https://doi-org.ezproxy.daemen.edu/10.3912/OJIN.Vol25No01Man03

McDonald, R., Ruppert, P. S., Souto, M., Johns, D. E., McKay, K., Bessette, N., McNulty, L. X., Crawford, J. E., Bryant, P., Mosquera, M. C., Frontin, S., Deluna-Evans, T., Regenye, D. E., Zaremski, E. F., Landis, V. J., Sullivan, B., Rumpf, B. E., Doherty, J., Sen, K., & Adler, E. (2019). Notes from the Field: Measles Outbreaks from Imported Cases in Orthodox Jewish Communities - New York and New Jersey, 2018-2019. MMWR: Morbidity & Mortality Weekly Report, 68(19), 444–445. https://doi-org.ezproxy.daemen.edu/10.15585/mmwr.mm6819a4

Schmidt, K. (2019). Measles and Vaccination: A Resurrected Disease, A Conflicted Response. Journal of Christian Nursing, 36(4), 214–221. https://doi-org.ezproxy.daemen.edu/10.1097/CNJ.0000000000000654

Turner, A. (2017).  Jewish decisions about childhood vaccinations: The unification of medicine with religion.  Pediatrics and Health, 5(1), 1-5.

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Reservoir

Human

Transmission

Respiratory-Airborne

Temporal pattern

Peak in late winter – spring

Communicability

4 days before to 4 days after rash onset

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Important in tracking transmission pathways during outbreak investigations.

Helps confirm, disprove, or detect connections among cases.

Only way to distinguish whether a person has wild-type measles virus infection, or a rash caused by a recent measles vaccination.

Can help establish which foreign country may be the source of an imported U.S. case, since different geno-types circulate in different countries.

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Determine the factors that influence individuals within the Jewish Orthodox community to vaccinate their loved ones.

Partner with Rabbis, medical professionals who identify as Orthodox Jews, and individuals within the Jewish Orthodox community who are advocators for vaccinations.

Partner with those organizations and local health services that Jewish Orthodox communities trust. For example: United Jewish Organization in NYC and surrounding areas, Agudath Israel of America, and the Orthodox Jewish Nurses Association.

Promote our interventions to individuals in the infected areas of the Jewish Orthodox Community with the use of posters and flyers written in English, but also translated into Hebrew and Yiddish.

Organize a health fair that focuses on education and the prevention of measles through vaccination.

Educate community members about the risk of traveling outside of the immediate area while un-vaccinated. Focusing on disease prevention through minimizing the exposure to and the spread of this deadly disease.

Utilize Rabbi’s as speakers at our health fair, in particular, past historical Rabbi’s who are known to support vaccinations.

Utilize medical professionals within the Jewish Orthodox communities to deliver factual, evidence-based information.

Provide clear evidence-based answers to questions.

Recruit community organizations, medical centers, and hospitals to assist in organizing a vaccination drive, that is free of charge to those individuals now choosing vaccination.

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The outbreak of measles is a major concern for all healthcare providers and it is our role as providers to ensure the communities we serve understand the importance of vaccination to prevent the spread of this disease (nationwide and globally).

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Measles is an issue worldwide. The World Health Organization (WHO) indicates that during 2019 there were more measles cases reported worldwide than in any year since 2006.  Case numbers in 2019 dwarfed the 353,236 confirmed measles cases reported to WHO in 2018.

Measles is everywhere.  Multiple countries have declared outbreaks; outbreaks are declared when the number of cases reported in an area exceeds the expected number of cases. The risk of measles virus transmission spreading to affect multiple communities within a country or across international borders is especially concerning.

Measles is extremely contagious. Approximately 9/10 people who are not protected will become infected following exposure to the measles virus.

Being infected with the measles virus is serious. In 2017, measles caused an estimated 110,000 deaths.  In developing countries, approximately 1 of every 100 children with measles will die from the disease or its complications.

Measles is preventable.  More than 21 million lives have been saved and measles deaths have been reduced by 80% since 2000, due to vaccines.  Additional work is required to ensure high levels of vaccination coverage in all areas.  Without urgent efforts to address gaps in coverage, outbreaks like the ones occurring now will continue to occur.