Measles has certainly been the hot topic as of late, discussed in many shuls, newspapers, and Facebook groups. We know that measles has been an issue for months, so why are we just waking up now? What is measles and why should we be afraid of contracting it? How did a once-eradicated disease rear its ugly head? Why our community? What should we be doing to stop it from spreading further?
Where did this outbreak originate?
Last October, an unvaccinated Orthodox Jewish child returned to Brooklyn from a trip to Israel with measles. (Israel is also having a large outbreak of the illness.) As of April 8 of this year, 285 of the cases seen in 2019 have occurred in Brooklyn and Queens, most of which involved members of the Orthodox Jewish community. “Since then, there have been additional people from Brooklyn and Queens who were unvaccinated and acquired measles while in Israel. People who did not travel were also infected in Brooklyn or Rockland County,” according to the Centers for Disease Control and Prevention. According to the Centers for Disease Control and Prevention, another 90 cases of measles were reported just last week, out of 555 cases in 2019. This puts 2019 on track to be the worst year for the disease since it was eradicated in 2000.
What is measles, anyway?
Measles is commonly known as a virus characterized by fever (can be as high as 103° or 104° Fahrenheit) and a rash that covers the body. It is highly contagious, and anyone who is not vaccinated against the virus can get it at any age. It is an airborne disease, meaning that it can be spread simply by breathing in particles in the air after someone with measles has coughed; it is so resilient that the air can still be contaminated with germs even two hours after the contagious individual has left a room. It can take up to three weeks to show up after exposure. Unfortunately, it takes four days for measles’ trademark rash to develop after the first onset of symptoms, so some with measles may think they just have a bad cold and try to push through, leaving the house and spreading measles everywhere they go. For those who are susceptible, either because they haven’t been immunized, or because they are immunocompromised (due to other illnesses, age, pregnancy, etc.), “statistically, as many as 90 percent of unvaccinated people who are exposed will contract the disease,” said Dr. Sherry Neustein Orzel of West Hempstead. The side effects of pneumonia, encephalitis (swelling of the brain), death, and pregnancy loss, where applicable, are the side effects that cause the most concern with measles.
In the 1960s, before measles was eradicated, an average of 500 people died each year from the disease.
One-to-two out of 1,000 kids with measles will die. In the United States, we’ve seen 555 cases in 2019 and it’s only April. The medical community assumes that number will likely be 1,000, which means that, statistically, there will be a death. There have already been numerous measles patients in the ICU.
One out of 20 patients will get pneumonia, which is a leading cause of death for patients with the measles.
Encephalitis, or swelling of the brain, affects one out of 1,000 patients. Seven to ten years after an infection, it can still develop as a result of the measles. The danger in that is that you can think you’ve safely made it through the measles but you can still have an adverse reaction. This is called subacute sclerosing panencephalitis (SSPE). According to Wikipedia, “after the asymptomatic period, SSPE causes progressive neurological deterioration, characterized by behavior change, intellectual problems, seizures, blindness, ataxia, and eventually death.”
Why is it spreading?
In the United States, there is little understanding of the dangers of the measles, because it’s not a disease that we as a nation have experienced. With an increase in international travel, there are higher chances that a highly communicable disease can be brought to the US. According to the CDC, “although measles is rare in the United States because of high vaccination rates, it is still common in other parts of the world. Measles is common in some countries in Europe, Asia, and Africa, and is occasionally brought into the United States by unvaccinated travelers who return with measles infection.” Internationally, measles incidents are up around 300 percent so far this year, according to statistics reported by the World Health Organization.
Recently, cases had been reported in many of the Orthodox Jewish communities around us, including Williamsburg, Boro Park, Flatbush, Crown Heights, Monsey, Monroe, and Lakewood; but amazingly, members of our community in Queens seemed to be spared. However, last week, news media reported that there was a new case in Flushing, pushing many of our residents and local community leaders to take a more serious interest in the outbreak. For the most part, the community has been able to avoid a more widespread outbreak because, here in the Queens Jewish community, most of (if not all) of our Jewish schools require students to have up-to-date immunization records barring medical exemption, so the rate of vaccine coverage is very high.
The disease has spread into 20 states in the US. In addition, presumably because we Jews travel a lot and gather together with other Orthodox Jews (minyan, for example), the disease has now spread into frum communities in Detroit, Baltimore, and other Jewish communities. Many rabbanim have taken a strong stand, requiring vaccinations for their local schools and even to enter shuls, and of course, these communities are working closely with public health officials to keep everyone safe.
Local doctors speak out
I had the opportunity to speak with a few doctors about the disease and about their experiences as practitioners who work with a heavily Jewish population:
Dr. Sherrie Neustein Orzel lives in West Hempstead, and although she recently started practicing in Syosset, she was previously practicing in Brooklyn. She said that, since the beginning of the outbreak, she has received lots of questions about early vaccinations or where to avoid traveling to. But she has also seen a lot of families who are uncomfortable with the idea of immunization – whether because of theological reasons or because of the misinformation on the Internet. She recognizes that it’s an emotionally-charged topic, especially for those who follow certain Rebbes who have espoused anti-vaccination rulings. She, along with an organization she helped found, Jewish Orthodox Women’s Medical Association (JOWMA) aims, in part, to approach public health education in the frum community by going through the rabbis, helping them understand the importance of vaccines, and encouraging them to rescind previous statements and start encouraging their followers to guard their health through vaccines. They, and doctors and public health professionals everywhere, are struggling to convince certain groups of people to immunize.
She also explained that in medical school, measles was covered only briefly as a historical illness; today’s younger doctors have never even seen measles cases before now.
Dr. Andrew Klein, who practices in Fresh Meadows, has seen measles before, leading him and his wife to keep a strict policy in their practice: They don’t feel comfortable risking the health of another child in the waiting room through exposure to potentially life-threatening illnesses, so any family that doesn’t vaccinate must find a different doctor. Moreover, if a patient or parent doesn’t trust their medical advice, they should find a doctor they feel more comfortable with. As a resident at Jacoby-Einstein, he saw his fill of kids who were hospitalized with the measles, and during an outbreak in the late 1980s, he had two patients with measles. Having seen most of the illnesses – including children who died from some of those illnesses – that one can vaccinate for (except diphtheria and tetanus), Dr. Klein labeled non-vaccination as “child neglect” to leave one’s child susceptible to a preventable illness. “Bottom line,” he said, “vaccines wouldn’t get FDA approval in this country if they were dangerous. They go through the most rigorous approval process for most Western countries, including the United States, and literally, millions of patients have been studied after undergoing the vaccine.”
Dr. Ellie Bennett, who practices privately in Kew Gardens Hills and works as an Emergency Room doctor at NewYork-Presbyterian Queens Hospital, echoed a strong line against skipping vaccines. In his experience, however, most of Kew Gardens Hills is immunized. Even some patients who don’t want a flu shot, get most of the other vaccines. But it’s not uncommon to see a child whose parents want to delay vaccine, which still leaves their children temporarily unprotected.
What about delaying vaccination?
While many doctors will work with a family to make a vaccination timeline that the parents are comfortable with, both Drs. Bennett and Neustein expressed frustration over the idea of delayed vaccination. “Ultimately, it means that for a specific amount of time as determined by the parent, the child goes unprotected,” said Dr. Neustein. “It’s like letting your child sit in the car seat unbuckled for the first mile of a trip, then partially buckling for the second mile, and only eventually buckling him in all the way, four miles down the road. It’s better than never buckling him in, but why take such a risk?” Dr. Ellie Bennett explained, “People who don’t get the shots don’t really understand what it is, so he added in his own similar analogy: You can drive around without a seatbelt for years without anything bad happening, but with one bad accident, it could save your life.” “It’s easy to say ‘my way or the highway,’ but then kids won’t get the proper care, said both doctors.” These doctors work with parents, even when they believe the parent is making a dangerous decision, because otherwise, parents will sometimes give the ultimatum that it’s either a delayed vaccine or none at all. These parents have been bombarded with misguided articles, which, to the untrained eye, can look pretty scientific, but it’s really dangerous propaganda. Dr. Neustein recommends looking at the website www.healthychildren.org, created by the American Academy of Pediatrics, as a better resource.
How can the decisions of one affect the masses?
In Judaism, we are relatively used to the idea that what I do or don’t do, ultimately can affect the klal. There’s a subset of the population that is either too young (infants), immunocompromised due to other medical circumstances, or for whatever reason, didn’t form an adequate immune response to the vaccine who are susceptible to getting the measles. While journalists don’t always share their own experiences, as a mom of a child born prematurely and a husband who is immunocompromised, I’ll be upfront to say that this is a subset that’s pretty close to my heart. When diseases like measles are a non-issue, people who aren’t protected are still relatively safe from contracting the illness; this is what’s known as herd immunity. But by skipping or even delaying the vaccines, a larger portion of the population can obtain, and then spread, disease around, creating a very scary – and indeed, life-threatening – situation for someone who is susceptible.
How do I know if I’m susceptible? I’ve heard of getting titers tested, but what does that mean?
“A titer test is a blood test that checks for the presence of certain antibodies in the bloodstream to determine whether you’re immune to a specific disease. Antibodies are made by your immune system to help fight and control infection, such as measles,” according to Go Health, Urgent Care’s website. Most doctors’ offices and urgent care clinics can perform the blood test, and typically the wait time is 1-3 days to get the results. Dr. Bennett mentioned that his office has been packed with patients coming in for their titer test, so it might be worthwhile to call his walk-in clinic or any urgent-care type of office to coordinate a quieter time to come. If a person’s titers are low, a booster vaccine will likely be administered to increase immunity. That said, it takes an MMR 2-6 weeks to go into effect, so if your titers are low, speak to your medical professional about any precautions you should take in the meantime.
What about pregnant women?
Titer checking is routine during early pregnancy blood work, but it is advisable to get the test done before becoming pregnant since an MMR vaccine cannot be administered during pregnancy, and a woman should avoid getting pregnant for three months after receiving the vaccine. If a pregnant woman gets measles, the disease is very dangerous to the developing fetus. If a woman has low titers, she should get the vaccine shortly after giving birth to help protect herself and her newborn. And “yes,” says Dr. Neustein, “it’s perfectly safe to get vaccinated while breastfeeding.”
What about newborns?
The MMR vaccination was intended to be given to children at 12 months of age, based on scientific calculations about a baby’s immune development, but in times of an epidemic, like now, it is considered safe to give the vaccine to a baby as young as 6 months old. Scientists know that 93 percent of people become immune after the first vaccine, but studies have not been conducted on babies getting the shot at 6 months, so it is unknown if their immune response will be as complete. Of course, this is a topic that must be discussed with one’s pediatrician.
Why is there extra concern about Pesach, and what should we do?
There has been a growing concern amongst medical professionals and epidemiologists (public health professionals who investigate patterns and causes of disease and injury in humans) that with extra travel between communities and large gatherings that typically take place over the holiday, the large numbers of measles cases we’ve seen could increase exponentially over and shortly after Pesach.
If you’re thinking of checking titers, getting a booster, or vaccinating a not-yet vaccinated child, in preparation for the holiday, do it right away. At this late date, getting the shots won’t offer full protection, but it may be better than doing nothing. As explained in a letter put out by Chevrah Hatzalah, “If you think you or your child has been exposed to measles, contact your health care provider before going to the facility so they can prevent exposure to other patients. Tell the medical staff if you have a fever and a rash and about any known exposures or international travel.”
Dr. Neustein says, “You have every right to ask if someone is vaccinated and decide whether or not you want to allow him or her into your home or shul. Deliberately choosing not to vaccinate is irresponsible, for themselves and the entire community, and people shouldn’t feel they have to worry so much about offending someone who acts irresponsibly.” In fact, the popular Yiddish newspaper Der Yid just published an article calling members of the frum community who aren’t vaccinating: “Senseless! Heartless! Torah-less, and Reckless” in a shocking but abundantly clear headline.
What is the community doing to protect us?
Last week, Dr. Bennett wrote a letter to the members of his bungalow colony requesting they not come without immunizations, as with the intermingling of children from different locales and closer quarters, disease “could spread like wildfire.” His message to friends in the bungalow colony spread virally (pun somewhat intended). “While a city like New York might be forgiving of those who allowed measles to spread,” he said, he predicts that a smaller community like Sullivan County, where he practices during the summers, won’t tolerate it.
In reaction to his post, people suggested that more should be said and done, especially by community leaders and rabbanim, prompting Dr. Bennett to coordinate with the author to put together letters that we sent around to Queens doctors and rabbanim to sign. We worked in conjunction with the Vaad Harabonim of Queens, who graciously agreed to help spread the word and encourage their rabbis to sign on.
In fact, around the same time, Rabbi Chaim Schwartz, executive director of the Vaad Harabonim of Queens (VHQ) mentioned in a Pesach shiur with Rabbi Herschel Welcher that “the official position of the VHQ is that it encourages and requires the olam to vaccinate – it’s obligatory – to ensure that ‘va’chai bahem.’”
Similar letters in favor of vaccines have been put out in the past week by organizations such as Hatzalah and Agudath Israel, and Rabbi Menachem Genack, CEO of OU Kosher, publicly refuted fears about “unkosher ingredients” in vaccines.
In addition, some rabbis in the Queens Jewish community, including Rabbi Shaul Arieli of Kehilat Ohel Yitzchak and Rabbi Yoel Schonfeld of the Young Israel of Kew Gardens Hills, have sent out similar messages to their membership in the past week, informing them that they must be vaccinated in order to attend shul. Rabbi Schonfeld’s letter reads: “Should a child of age not be vaccinated, he/she may not be brought to shul out of concern for the other people in our shul, which includes the elderly and small children. If we are made aware that such a child has been brought to shul, we will politely but firmly ask the parent to take the child out. Naturally, that is an embarrassing situation, which we would all like to avoid. So it is up to parents of non-vaccinated children to make the proper decision in advance to avoid all unpleasantries.”
What does halachah say about vaccinations?
Rabbi Welcher shared that he consulted with major rabbanim in Eretz Yisrael, who concluded that a person who doesn’t get vaccinated is a mazik d’rabbim. Rabbi Ezriel Auerbach, Rav Moshe Sternbuch, Rav Yitzchak Zilberstein (a phenomenal mumcheh in medicine), and Rav Asher Weiss all paskened that it’s a chiyuv. As Rabbi Welcher said, “We need to protect the community and we are not capable of doing so if we have a significant amount of people who are not vaccinated”; we put others who cannot be vaccinated at risk. “I implore, really, everyone in our community, for the sake of the rabbim (the community at large), please undertake to vaccinate everyone in your family. The misinformation that’s out there that it’s associated with autism has been refuted... Not only was it not in agreement with scientific inquiry, but he was a total fraud.” Measles can be a very serious disease. Very serious health issues can arise from it.
In addition, a kol korei was put out and signed by leading g’dolim and poskim in Eretz Yisrael, unequivocally stating, “Whoever isn’t vaccinated is a murderer.” The g’dolim who signed the kol korei include HaGaon HaRav Yitzchak Zilberstein, HaGaon HaRav Shimon Baadani, HaGaon HaRav Sriel Rosenberg, HaGaon HaRav Moshe Shaul Klein, and HaGaon HaRav Menachem Mendel Lubin.
The VHQ didn’t just speak publicly in favor of vaccines; they also decided to work and co-host an event locally to help community members protect themselves and each other. By the time this article hits the newsstands on Wednesday, an event sponsored by the Vaad, the offices of Assemblyman Rosenthal, Councilman Rory Lancman, Representative Grace Meng, and Kamin Health, will have been held in Kew Gardens Hills. From 2 to 8 p.m., the Young Israel of Kew Gardens Hills is hosting a free titers-checking event, where community members can get their blood drawn and receive expedited results in 24 hours – whether or not they have health insurance.
It’s in Your Hands
I had the opportunity to discuss the event with Assemblyman Daniel Rosenthal, who explained, “With Pesach coming up and more people traveling,” many of his constituents have gotten nervous, so the event partners brainstormed about how best to help, and were able to quickly put this event together. It is aimed to help adults who aren’t even sure if or when they got vaccinated, or if they still have enough antibodies to the disease. The Department of Health and other agencies will have representatives there to give more information to help address people’s concerns.
By ensuring that you and your family members are as resistant to the virus as possible, you can truly play a large role in preventing the spread of measles (and other preventable diseases). Doing so is not only in the interests of your family’s safety, but that of my family, and of anyone with whom you may indirectly come into contact. It is my hope that, if you’ve made it to the end of this article, you’ve learned something new about measles and immunizations. By getting vaccinated according to the recommended timeline, you’re affecting global public health. 2019 may have seen a tremendous rise in measles so far, but let’s work together to stop it before even one more person gets sick – or worse.
By Rachel Goldsmith