NYC Declares Measles Emergency as Cases Surge Across US

Troy Brown, RN

April 09, 2019

Amid a steady increase of measles cases across the United States, New York City (NYC) Mayor Bill de Blasio has declared a public health emergency, with mandatory vaccinations "in select zip codes in Williamsburg," in an effort to stem an ongoing measles outbreak in the Orthodox Jewish community there.

The declaration requires all individuals in the affected zip codes to be immunized with the measles, mumps, rubella (MMR) vaccine or pay a fine.

"Under the mandatory vaccinations, members of the City’s Department of Health and Mental Hygiene will check the vaccination records of any individual who may have been in contact with infected patients. Those who have not received the MMR vaccine or do not have evidence of immunity may be given a violation and could be fined $1,000," according to an April 9 NYC Department of Health and Mental Hygiene news release.

The declaration comes after at least one yeshiva failed to follow December 2018 orders from the NYC health department for all yeshivas and child care centers in the Orthodox Jewish community in the affected zip codes "to exclude all unvaccinated students from attending school or daycare until the outbreak is declared over."

One yeshiva in Williamsburg that failed to obey that directive was connected to more than 40 cases, spurring a large rise in measles cases and fueling the outbreak.

On April 8, the city of New York threatened to immediately fine or close schools that do not comply with these orders.

Including both Brooklyn and Queens, 285 confirmed cases have been reported since October, and members of the Orthodox Jewish community have accounted for most cases.

"Measles is a dangerous, potentially deadly disease that can easily be prevented with vaccine," Deputy Mayor for Health and Human Services Herminia Palacio, MD, MPH, said in the April 9 news release. "When people choose not to get their children vaccinated, they are putting their children and others — such as pregnant women, people on chemotherapy, and the elderly — at risk of contracting measles. The City has worked aggressively to end this outbreak, and today's declaration of a public health emergency and new vaccine mandate, in combination with the blanket Commissioner's Orders for yeshivas, ensures we are using every tool to protect New Yorkers."

"As a pediatrician, I know the [measles, mumps, rubella; MMR] vaccine is safe and effective. This outbreak is being fueled by a small group of anti-vaxxers in these neighborhoods. They have been spreading dangerous misinformation based on fake science," Health Commissioner Oxiris Barbot, MD, said in news releases on April 8 and 9. "We stand with the majority of people in this community who have worked hard to protect their children and those at risk. We've seen a large increase in the number of people vaccinated in these neighborhoods, but as Passover approaches, we need to do all we can to ensure more people get the vaccine."

Dozens of New Cases in US in Last Week Alone

The problem is more far-reaching than NYC alone, though. The United States is currently experiencing the second-largest number of measles cases since the disease was eliminated here in 2000.

Dozens of new measles cases were reported in the United States in just the last week. The number of reported measles cases since January 1, 2019, was 465 on April 8, up from 387 on April 1. The highest number of cases since 2010 was 667 in 2014; in 2018, 372 cases were reported.

During the past week, four more states have reported cases of measles (Florida, Indiana, Massachusetts, and Nevada), for a total of 19 states now. The other states with reported measles cases are Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.

In Rockland County, New York, where a state of emergency was declared at the end of March, 167 confirmed measles cases have been reported as of April; 82% of those occurred in unvaccinated individuals.

In Washington state as of April 8, there have been 73 confirmed cases of measles in Clark County; the last case was reported there on March 18. Of those, 63 (86.3%) occurred in unvaccinated individuals. One case of measles was reported in King County in January.

In California, 17 confirmed cases were reported as of April 3; 11 of those cases were outbreak associated, and six cases occurred in children. Two outbreaks have been associated with patients who traveled internationally.

New Jersey reported 13 confirmed cases as of April 5; 11 of these were associated with an outbreak (seven in Ocean County residents and four in a household in Mammoth County with a direct epidemiologic connection to the Ocean County outbreak community).

In Michigan, 41 cases have been reported between March 13 and April 8 — 39 in Oakland County, one in Washtenaw County, and one in Wayne County.

Additional information about measles and measles outbreaks is available at the CDC's website.

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