2019 New York measles outbreak

Last updated
2019 New York measles outbreak
Disease Measles
Location New York metropolitan area and Israel
Index case Internationally imported case from a returning US traveler
DateApril 9 – September 3, 2019 (2019-04-09 – 2019-09-03)
Confirmed cases702 in New York City, 412 in New York State (CDC), [1] 649 in New York City (NYC Health) [2]
Deaths
0 [1]
Government website
www1.nyc.gov/site/doh/health/health-topics/measles.page

The 2019 New York City measles outbreak was a substantial increase in the number of measles cases reported in the state of New York, primarily in New York City and neighboring Rockland County, New York in 2019, relative to the previous year. [3]

Contents

History

The areas of Williamsburg and Borough Park, two Brooklyn neighborhoods with a high concentration of Orthodox Jews, have been most heavily affected. New York City mayor Bill de Blasio declared a public health emergency on April 9, 2019. [4] At that point, 285 cases of measles had been reported in Brooklyn and Queens since the October 2018. [4] By the beginning of May 2019, 423 confirmed cases of measles had been reported in New York City. [5] De Blasio's declaration required mandatory vaccinations in the neighborhoods corresponding to the zip codes 11205, 11206, 11211, and 11249. This required that everyone living or working in the neighborhood who is more than six months old receive a vaccination or be subject to a $1,000 fine. Prior to this order, the health commissioner had required schools and day care centers in the area to deny service to unvaccinated students to prevent the disease from spreading further. [6] In April, city officials ordered the closure of a preschool that had refused to cooperate with requests for vaccination information. [7] [8]

From October to April, 153 cases of measles were confirmed in Rockland County, New York. Despite 17,000 doses of the MMR vaccination being given, the vaccination rate of children in the area was 72.9 percent as of April. [9] In December 2018, public health officials in Rockland County banned unvaccinated students from attending school. Parents of 42 students at Green Meadow Waldorf School, a private school, sued the Rockland County health department, but a judge denied the request to over turn the order. [10] According to the health department, Green Meadow Waldorf School had a 56% vaccination rate. [10] In April 2019, a state of emergency was declared in Rockland County, and unvaccinated children were barred from public places for 30 days. Parents of unvaccinated children that did not abide by this condition face up to 6 months in jail or a $500 fine. [11] [9] A judge later lifted this ban, saying that the outbreak does not qualify for an emergency order. [12]

In March 2019, a flight attendant flew from NYC to Tel Aviv, Israel. Passengers on the flight were informed several days later that the woman had developed measles encephalitis and is in the ICU on a ventilator. The Israeli Ministry of Health reported that the woman may have been exposed in New York or in Israel. [13]

By mid-May 2019, measles cases in the United States had passed 800, with New York having the largest number of cases, with 274 to that point. [14]

On September 3, 2019, the New York City Health Department declared the outbreak to be over, due to the passage of a sufficient period of time with no new cases being reported in the city. [15] NYC Health reported 649 total cases, with 473 cases in Williamsburg and 121 cases in Borough Park. [2] 33,805 doses of the MMR vaccine were administered to people younger than 19 years old in Williamsburg and Borough Park.

Responses

The outbreak helped prompt President Donald Trump to shift away from his previous skepticism regarding vaccination, and to insist that parents must vaccinate their children, stating: "They have to get the shots. The vaccinations are so important". [16]

As of April 2019, New York was considering legislation to join the seven states and Washington DC that allow children 14 years and older to seek vaccination without parental consent. [17]

In June 2019, New York enacted a law repealing religious and philosophical exemptions for vaccination. [18] Prior to that enactment, New York had continued accepting claims for religious and philosophical exemptions, [5] and had not acted on a bill first proposed in 2015 to end religious exemptions. The bill had previously been stuck in the Assembly Health Committee led by Richard N. Gottfried, who had stated that he has First Amendment concerns about the idea. [5] It was reported that the association of the outbreak with the Jewish community led to a rise in instances of antisemitism being expressed in New York. [19]

Related Research Articles

Measles Viral disease affecting humans

Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

Vaccine hesitancy is a delay in acceptance, or refusal of vaccines despite the availability of vaccine services. Vaccine hesitancy is complex and context-specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience, a fear of needles, or a lack of understanding about how vaccines work. The term covers outright refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. Among the hesitant are groups known as "anti-vaxxers" or "anti-vax", who are generally against vaccination.

Vaccination and religion have interrelations of varying kinds. No major religions prohibit vaccinations, and some consider it an obligation because of the potential to save lives. And some people cite religious adherence as a basis for opting to forego vaccinating themselves or their children.

Vaccination policy is the health policy a government adopts in relation to vaccination. Vaccination policies have been developed over the approximately two centuries since the invention of vaccination with the purpose of eradicating disease from, or creating a herd immunity for, the population the government aims to protect. Vaccination advisory committees within each country are usually responsible for providing information to governments that is used to make evidence-based decisions regarding vaccine and immunization policy.

Health in the United States is the overall health of the population of the United States. Many diseases, including COVID-19, have spread rapidly throughout the country. Notable pandemics have also struck, including the Influenza pandemic of 1918. Recently, obesity has also become a struggle for the United States population.

Measles vaccine Vaccine used to prevent measles

Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When rates of vaccination within a population are greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if rates of vaccination decrease. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.

Robert William Sears, known as Dr. Bob, is an American pediatrician from Capistrano Beach, California, noted for his unorthodox and dangerous views on childhood vaccination. His book, The Vaccine Book: Making the Right Decision for your Child (2007), proposes two alternative vaccination schedules that depart from accepted medical recommendations. His proposals have enjoyed celebrity endorsement, but are not supported by medical evidence and have contributed to dangerous under-vaccination in the national child population. While he denies being anti-vaccine, Sears is characterized as anti-vaccine and as a vaccine delayer.

Jay N. Gordon is an American pediatrician, lecturer, and author. He is well-known within the anti-vaccine movement for his promotion of vaccine hesitancy. He is also a long-time advocate of breastfeeding; he became a member of the International Health Advisory Council of the La Leche League in 2005.

Epidemiology of measles

Measles is extremely contagious, but surviving the infection results in lifelong immunity, so its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000.

In early 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; outbreaks in 2019 in areas including Brooklyn and Rockland County, New York have since seen far greater numbers of cases.

2019 measles outbreak in the Philippines

The 2019 Philippines measles outbreak began in early 2019. An outbreak of measles was officially declared in February 2019 in select administrative regions in Luzon and Visayas including Metro Manila by the Philippine government. The outbreak is attributed to lowered vaccination rates, from a high of 88% 10 to 15 years previous to 74% at the time of the outbreak, allegedly caused by the Dengvaxia controversy.

Children's Health Defense is an American activist group mainly known for anti-vaccine activities and has been identified as one of the main sources of misinformation on vaccines. It was founded and is chaired by Robert F. Kennedy Jr.​ Established under the name World Mercury Project in 2016, it has been campaigning against various public health programs, such as vaccination and fluoridation of drinking water.​ The group has been contributing to vaccine hesitancy in the United States, encouraging citizens and legislators to support anti-vaccine regulations and legislation.​​​ Arguments against vaccination are contradicted by overwhelming scientific consensus about the safety and effectiveness of vaccines. The group is a registered 501(c)(3) nonprofit.​

The 2019 measles outbreaks refer to a substantial global increase in the number of measles cases reported, relative to 2018. As of April 2019, the number of measles cases reported worldwide represented a 300% increase from the number of cases seen in the previous year, constituting over 110,000 measles cases reported in the first three months of 2019. In the first half of 2019, the World Health Organization received reports of 364,808 measles cases from 182 countries, up 182% from the same time period of 2018 when 129,239 confirmed cases were reported by 181 countries.

The 1990–1991 Philadelphia measles outbreak was a medical event in and around Philadelphia, Pennsylvania, in which over 1,400 people, mostly children, became sick with measles, and nine children died. There were two epicenters for this outbreak within the area: The Faith Tabernacle Congregation and the First Century Gospel Church. Both churches discouraged the use of not only vaccinations, but also all other forms of medical treatment, instead relying solely on faith healing. Following an investigation into the death of the first victim of the outbreak, a court order was obtained to forcibly treat and vaccinate children whose parents would not agree to seeking medical care. Nine children eventually died as a result of this outbreak.

Measles resurgence in the United States Sharp increase in measles cases between 2010 and 2019

Measles was declared eliminated from the United States in 2000 by the World Health Organization due to the success of vaccination efforts. However, it continues to be reintroduced by international travelers, and in recent years, anti-vaccination sentiment has allowed for the reemergence of measles outbreaks.

Vaccination policy in the United States Overview of the vaccination policy in the United States of America

Vaccination policy in the United States is the subset of U.S. health policy that deals with immunization against infectious disease. It is decided at various levels of the government, including the individual states. This policy has been developed over the approximately two centuries since the invention of vaccination with the purpose of eradicating disease from the U.S. population, or creating a herd immunity. Policies intended to encourage vaccination impact numerous areas of law, including regulation of vaccine safety, funding of vaccination programs, vaccine mandates, adverse event reporting requirements, and compensation for injuries asserted to be associated with vaccination.

2019 Samoa measles outbreak Measles epidemic in Samoa in late 2019

The 2019 Samoa measles outbreak began in September 2019. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. Over three percent of the population were infected. The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%.

COVID-19 pandemic in New York (state) Ongoing COVID-19 viral pandemic in New York state

The first case of COVID-19 in the U.S. state of New York during the pandemic was confirmed on March 1, 2020, and the state quickly became an epicenter of the pandemic, with a record 12,274 new cases reported on April 4 and approximately 29,000 more deaths reported for the month of April than the same month in 2019. By April 10, New York had more confirmed cases than any country outside the US. As of August 18, 2021, the state has reported 63.2 million tests, with 2,213,176 cumulative cases, and 54,136 deaths.

COVID-19 pandemic in Missouri

The COVID-19 pandemic was confirmed to have reached the U.S. state of Missouri in March 2020. A university student who had recently been to Italy, was the first index case for COVID-19 in Missouri. She was treated at Mercy Hospital St. Louis. As of February 8, 2021, the Missouri Department of Health and Senior Services has confirmed 502,432 cumulative cases and 7,562 deaths.

Oxiris Barbot is an American pediatrician who served as the Commissioner of Health of the City of New York from 2018 to 2020.

References

  1. 1 2 "National Update on Measles Cases and Outbreaks — United States, January 1–October 1, 2019". CDC.gov. U.S. Centers for Disease Control. October 11, 2019. Archived from the original on May 5, 2020. Retrieved May 13, 2020. During January 1–October 1, 2019, a total of 1,249 measles cases were reported in 31 states and New York City, including 1,211 (97%) among U.S. residents. Overall, 119 (10%) patients were hospitalized; no deaths were reported to CDC. Beginning in late 2018, two closely related outbreaks within Orthodox Jewish communities were reported in NYC and NYS. The first began in NYC with an internationally imported case in a returning U.S. traveler on September 30, 2018; this outbreak lasted 9.5 months and included 702 cases. The second outbreak, which began in NYS with an internationally imported case in a foreign visitor on October 1, 2018, lasted 10.5 months and included 412 cases.
  2. 1 2 "Measles - NYC Health". nyc.gov. City of New York. Archived from the original on May 10, 2020. Retrieved May 13, 2020. 649 Confirmed cases from September 1, 2018, to August 19, 2019
  3. ↑ Scutti, Susan (30 January 2019). "Measles outbreaks in Washington and New York challenge public health systems". CNN.
  4. 1 2 Scutti, Susan (April 9, 2019). "New York City declares a public health emergency amid Brooklyn measles outbreak". CNN.
  5. 1 2 3 Kilgannon, Corey (2 May 2019). "What We Know About the Measles Outbreak in N.Y." The New York Times.
  6. ↑ "New York City declares public health emergency over measles outbreak". www.cbsnews.com. Retrieved 18 April 2019.
  7. ↑ "Officials announce new measures to fight New York measles outbreak". PBS NewsHour . 17 April 2019. Retrieved 18 April 2019.
  8. ↑ Pager, Tyler (15 April 2019). "Measles Outbreak: Yeshiva's Preschool Program Is Closed by New York City Health Officials". The New York Times . Retrieved 18 April 2019.
  9. 1 2 Gold, Michael; Pager, Tyler (26 March 2019). "New York Suburb Declares Measles Emergency, Barring Unvaccinated Children From Public". The New York Times. Retrieved 18 April 2019.
  10. 1 2 Gold, Michael (13 March 2019). "Parents Wanted Their Unvaccinated Children in School, but a Judge Said No". The New York Times. Retrieved 18 April 2019.
  11. ↑ "Measles outbreak: Rockland County, New York, declares state of emergency". www.cbsnews.com. Retrieved 18 April 2019.
  12. ↑ "Rockland County measles outbreak: Judge lifts ban on unvaccinated children, but not because outbreak ended". www.cbsnews.com. Retrieved 18 April 2019.
  13. ↑ "Flight attendant in coma after contracting measles". www.cbsnews.com. Retrieved 18 April 2019.
  14. ↑ Goldschmidt, Debra. "More than 800 cases of measles in US, with NY outbreak continuing to lead". CNN.
  15. ↑ Howard, Jacqueline (September 3, 2019). "New York City measles outbreak has ended, health officials say". CNN.
  16. ↑ Vazquez, Maegan (April 26, 2019). "Trump now says parents must vaccinate children in face of measles outbreak". CNN.
  17. ↑ March 13, Jonathan LaPook CBS News. "Judge bars unvaccinated students from returning to Rockland County school". www.cbsnews.com. Retrieved 18 April 2019.
  18. ↑ McKinley, Jesse (June 13, 2019). "Measles Outbreak: N.Y. Bans Religious Exemptions for Vaccinations". The New York Times.
  19. ↑ Green, Emma (25 May 2019). "Measles Can Be Contained. Anti-Semitism Cannot". The Atlantic.
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