Caution is best weapon against rising number of measles cases

A sign warns people of measles in the ultra-Orthodox Jewish community in Williamsburg in New York City. As a measles epidemic continues to spread, New York City Mayor Bill de Blasio recently announced a state of emergency and mandated residents of the ultra-Orthodox Jewish community in Williamsburg at the center of the outbreak to get vaccinated for the viral disease. Those who choose not to will risk a $1,000 fine. SPENCER PLATT / GETTY IMAGES

A sign warns people of measles in the ultra-Orthodox Jewish community in Williamsburg in New York City. As a measles epidemic continues to spread, New York City Mayor Bill de Blasio recently announced a state of emergency and mandated residents of the ultra-Orthodox Jewish community in Williamsburg at the center of the outbreak to get vaccinated for the viral disease. Those who choose not to will risk a $1,000 fine. SPENCER PLATT / GETTY IMAGES

Rabbi Ilan D. Feldman of Beth Jacob Atlanta recently sent a clear message to his congregation.

“In no uncertain terms,” Feldman said in an emailed message, any child who is not vaccinated “is prohibited from attending shul or any other public gathering” at the Lavista Road synagogue.

The policy, he said, extends to adults in the Orthodox congregation as well.

Though Georgia has seen just three cases of the measles this year, outbreaks around the U.S., where the highly contagious disease was declared eliminated in 2000, have prompted extra caution.

>> RELATED: Georgia health officials confirm three cases of measles

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Feldman knew his message might not sit well with some, though surprisingly, there has been little criticism.

“To be clear, I do not claim to be a medical expert, and am not acting based on my own understanding of medical information; rather, I am following the halachic guidelines set by the authorities we routinely follow and their judgment based on the consensus of the medical community,” he said in the email.

Brooklyn and Rockland County, northwest of New York City, account for more than half the 465 U.S. cases of measles reported in 2019, as of April 4. ARTURS BUDKEVICS / DREAMSTIME / TNS

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Measles is easily preventable with vaccination.

In the first few months of 2019, the Centers for Disease Control and Prevention reported the second-largest number of measles cases in the U.S. since 2000. The CDC has identified 555 cases in 20 states so far this year, with 90 new cases in one week.

>> RELATED: U.S. measles count up to 555, with most new cases in New York

“My goal was simply to create a standard going forward,” Feldman said in an interview. “I didn’t want people to have to argue it out among themselves. A small minority of people are — for one reason or another — not comfortable with vaccines and that’s fine. People are entitled to make their own decisions, but as a public institution, we chose to follow medical science.”

New York City Declares Health Emergency After Measles Outbreak

Several parts of the country are contending with outbreaks, some linked to people who’ve traveled to countries with their own measles outbreaks.

In Washington state, for instance, there have been 74 cases of measles since the start of the year.

The first case in Clark County was a child who had traveled internationally and had contact with several community groups with low or no vaccination rates.

The Washington outbreak may be waning, though, said a public health spokeswoman this week.

New York City declared a public health emergency and instituted mandatory vaccinations in certain ZIP codes after hundreds were sickened. Overall this year, there have been 105 confirmed cases of measles in New York state outside of New York City, including 86 in Rockland County, a spokeswoman for New York’s health department said Tuesday.

As of April 15, there have been 329 confirmed cases of measles in Brooklyn and Queens since October. Most of those cases were in the Orthodox Jewish community. In the initial case, a child, who was unvaccinated, contracted measles on a visit to Israel.

New York City Mayor Bill de Blasio speaks at a news conference at the Williamsburg branch of the Brooklyn Public Library, in an area where a measles outbreak occurred. While many ultra-Orthodox leaders have come out in favor of measles vaccinations, some say that the mayor has gone too far in legally mandating them. JOHN TAGGART / THE NEW YORK TIMES

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Georgia, though, has not seen that level of outbreak.

Why not?

Experts say the state has an average overall school compliance rate for all vaccines of 98%. In Gwinnett County Schools, Georgia’s largest school system, the rate is 99%, including the measles vaccine, a schools spokeswoman said Tuesday.

Ben Sloat, immunization program deputy director for the Georgia Department of Public Health, said the state allows only two types of exemptions — medical or religious — from school immunization requirements. A medical exemption could result from an allergic reaction to the vaccine or if a person has a compromised immune system, say from chemotherapy. Sixteen students in Gwinnett schools have medical exemptions; 1,374 have religious exemptions.

There have been three cases of measles in Georgia. They were reported in January, all within the same metro Atlanta family, and none were vaccinated, according to state health officials.

“Our mission is to increase the immunization rate and decrease vaccine-preventable diseases, whether we’re talking about measles or the flu,” said Sloat.

It’s recommended that children get the first dose of the MMR (measles, mumps and rubella) vaccine between the ages of 12 and 15 months and the second dose between the ages of 4 and 6 years old.

>> RELATED: Not sure if you got the measles vaccine as a kid? Here's how to find out

Measles is spread in the air through coughing and sneezing. It usually starts with fever, runny nose, cough, red eyes and sore throat. That can be followed by white spots in the throat and a rash.

The MMR vaccine is considered the best weapon to avoid contracting measles. According to the CDC, one dose of the MMR vaccine is about 93% effective, while two doses are about 97% effective.

Still, people are concerned.

Rabbi Adam Starr and the board of directors of Young Israel of Toco Hills sent a message last December to the congregation strongly urging parents to vaccinate their children based on their pediatrician’s recommendation. The message also stated that children who are not vaccinated should refrain from attending any Young Israel-sponsored events, including child care on the Sabbath and holidays.

He recently renewed that message as the start of Passover — or Pesach — neared. “If during Pesach you or your child develops any rash AND fever we ask that you please exercise the utmost precaution and obtain a medical evaluation BEFORE you enter any public spaces including shul.”

Starr said there are about 250 children ages 18 and under in the congregation.

“If people aren’t vaccinated, then they’re in danger and they put others in danger,” he said.

Starr is unaware of anyone in the congregation who isn’t vaccinated “but not everyone would share something like that with me.”

He also asked adult members to make sure they have had the full dosage of the MMR vaccine by consulting with their personal health care provider.

Parent Dov Wilker said he tries to avoid taking his two young children around others who are not vaccinated.

“I feel strongly about this,” said Wilker, regional director of the American Jewish Committee in Atlanta. “We won’t associate with people who won’t get vaccinated.”

But some parents are reluctant to vaccinate their children.

Ingrid Scott, who lives in North Georgia, is the mother of three boys ranging in age from nearly 2 to 12. Her two oldest sons have received the full dosage of the MMR vaccine, but she’s hesitant to vaccinate her youngest.

She’s skeptical about the MMR vaccine and believes there is a link between her oldest son getting the vaccine and a diagnosis of autism, as well as her second-oldest exhibiting signs of sensory processing disorder.

“I’m not anti-vaccine,” said Scott. “I believe that vaccines are important, but I don’t think they’re studied enough. … I don’t think it’s fair to never be able to have both sides of a conversation. If you don’t get your children vaccinated, people say you’re a bad mom, but people don’t get it. … I feel so conflicted. I swear after MMR, he (her 12-year-old) was a different child.”

Experts have debunked claims that there is a link between MMR vaccines and autism.

Dr. Walt Orenstein, associate director of the Emory Vaccine Center, said the safety benefits of vaccines “far outweigh any risks. There’s a very careful process before a vaccine can be licensed and a very careful recommendation process. There’s continued monitoring and making changes if they are appropriate. MMR is very safe.”

In many incidents in the U.S., early cases can be tied to people who have traveled internationally or from people who are visiting from other nations. It then shows up in clusters of unvaccinated people.

“In a sense, the vaccine is a victim of its own success,” he said. “Some people have never seen measles. They don’t understand how serious it can be, so they don’t see the benefit (of getting the vaccine).”

But they are at risk because if they and others don’t vaccinate, Orenstein said, the number of people susceptible to measles grows, and can ultimately lead to a major epidemic.

The issue of vaccinations came up twice in the last legislative session. House Bill 416 called for the formation of a State Vaccine Consumer Protection Office, and House Bill 615 would have allowed certain minors to receive vaccinations without parental consent. Neither bill passed in the session that just ended, but they could come back next year.

Rep. Rick Williams, R-Milledgeville, who sponsored the vaccine consumer protection bill, said he isn’t an anti-vaxxer. In fact, his three adult children and eight grandchildren were vaccinated.

“I feel like people’s genetics are changing,” he said. “What I’m after is more study, more research. All the time on TV, we’re seeing that medications are being pulled from the market because of adverse reactions. I just think more research needs to be done looking at vaccine injury and let’s make them safer.”


Year, Number of cases

2010, 63

2011, 220

2012, 55

2013, 187

2014, 667

2015, 188

2016, 86

2017, 120

*2018, 372

**2019, 555

* Cases as of Dec. 29, 2018. Case count is preliminary and subject to change.

** Cases as of April 11, 2019. Case count is preliminary and subject to change. Data is updated every Monday.