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Is it Time to Declare Measles a Public Health Emergency?

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On April 9th, New York Mayor Bill de Blasio declared a public health emergency amid the ongoing measles outbreak in New York City and surrounding Burroughs. The Mayor’s declaration mandates unvaccinated people in certain zip codes in and around New York City receive the Measles, Mumps, and Rubella (MMR) vaccine in order to curb the outbreak. Those not vaccinated will be cited with misdemeanor violations and potentially fined. The outbreak, which began in October 2018, occurred when individuals and families traveled to Israel or Europe—where major outbreaks are occurring—before returning home to New York with the infection. The majority of the outbreak in New York has occurred primarily in orthodox Jewish neighborhoods and communities, where vaccination rates tend to be lower. So far only about 73% of people ages 1-18 in the affected area have been vaccinated, well below the 95% threshold needed to maintain population immunity.

Since October, 285 confirmed measles cases have been reported in New York; throughout the country, 465 total cases have been confirmed in 19 states, including Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Michigan, Missouri, New Hampshire, New Jersey New York, Oregon, Texas and Washington State, with each outbreak directly linked to travelers who brought the virus back from other countries where large outbreaks are occurring. This year, Florida, Indiana, Massachusetts, and Nevada have also reported their first cases. The 465 cases is the largest number seen since 2014, when the US saw a major spike of 667 cases. According to the CDC, an outbreak is defined as 3 or more confirmed cases.

Measles was declared eliminated in the United States in the Year 2000, due to a highly effective vaccination program sponsored by the Centers for Disease Control and Prevention. The disease has crept back into the country in recent years, however, in large part due to the anti-vaccine movement wherein parents refuse to vaccinate their children based on philosophical or religious grounds. This general mistrust of—or at the very least, reticence toward—vaccine programs in the United States has lowered population immunity, especially among insulated religious and orthodox populations, to the point where individuals who are unable to receive vaccinations are no longer protected by those around them who are able to attain immunity to the disease.

For example, Washington State is now considered a “hot-spot” due to a relatively large number of people and groups opposed to vaccinations. Washington is one of 17 states in the US that allows parents to object to vaccination schedules for their children on a moral basis. As a result, 74 cases have been confirmed in the state since 2018, and with fewer children vaccinated, more are at risk to catch measles or other diseases. Furthermore, the majority of cases in America originate from people who travel abroad, primarily to countries where vaccination rates are low due to inaccessibility. Africa, the Middle East, and parts of Asia specifically have lower vaccination rates due to the general lack of infrastructure needed to maintain and distribute enough vaccines to immunize a country’s population. As a result, the disease smolders amongst the population’s unhealthy and vulnerable, and allows for otherwise healthy individuals, whether resident or visiting, to fall ill and carry the virus back to their respective communities.

All of these elements—the low vaccination rates in poorer countries, the infected people returning to the United States from those countries, and the averse or inimical response to vaccination programs—combine to create a compounding effect that has culminated in a scenario like we are seeing in New York. Health and government authorities are working to get ahead of the outbreak, but much of the community response, at least amongst those who remain unvaccinated, has been at best nonchalant.

In late March, a mandate to ban children and teens not vaccinated against MMR from public places such as schools, buses, and stores, was rolled out by Rockland County executives to curtail the spread of the infection throughout the Jewish population in the area. The order was overturned when a state judge ruled in favor of parents who objected to the directive and called the order “arbitrary and capricious,” while the judge himself stated that too few cases existed in the region to constitute a true epidemic. In response, County Director Ed day stated, “It is my view that waiting for a medical catastrophe is ill advised, particularly given the fact that we can see it coming,” he said. He urged residents to get a free vaccination through the county health department. In the meantime, and especially if we continue to see the disease spread throughout the United States, it would behoove government and community leaders to follow Mr. Day’s and Mayor De Blasio’s lead and implement steps to stop the spread of measles, and to get our kids vaccinated.

Jon Hamilton earned his Master’s Degree in Biohazardous Threat Agents and Emerging Infectious Diseases from Georgetown University. He was briefly involved in Healthcare Association of Hawaii’s Ebola Virus Disease Prevention working group during the 2014 EVD outbreak. He has also worked with and done research for infectious disease physicians in Honolulu and at the National Institutes of Health in Washington, D.C. When Jon is not researching or writing, he can be found surfing in sunny San Diego, California, where he currently resides. Jon can be reached on LinkedIn or at jonhamilt@gmail.com.

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