Jun 4, 2013
Measles Outbreak in Frum Areas
NYC issues vaccine recommendations as 48 cases of measles occurred in the frum community in Boro Park and Williamsburg.
Notice by Department of Health of New York City:
ALERT # 15: Update on Measles in New York City: New Vaccine Recommendations
1) 48 cases of measles have occurred in the Orthodox Jewish community residing in Borough Park and Williamsburg, Brooklyn.
2) Because measles cases continue to occur, particularly among young infants, healthcare providers should now administer the first dose of MMR vaccine to all Orthodox Jewish children aged 6 months and older living in Borough Park, Williamsburg, and Crown Heights.
Distribute to All Primary Care, Infectious Disease, Emergency Medicine, Internal Medicine, Pediatrics, Family Medicine, OB/GYN, Laboratory and Infection Control Staff
There continues to be ongoing measles transmission among the Orthodox Jewish communities in Borough Park and Williamsburg, Brooklyn. To date, there have been 48 confirmed cases, including 28 in Borough Park and 20 in Williamsburg. Additional suspected cases are being investigated. In recent weeks, cases have begun occurring in younger children. During the past month, the median age of cases has declined to 2 years (age range 10 months – 17 years) with 19% aged less than 12 months, 52% aged 12 months to 4 years, and 29% aged 5 – 18 years. All cases were in persons who were unvaccinated at the time of exposure, because they were too young to have been vaccinated or because their parents delayed or refused vaccine for their children. Over 2,000 identified people have been exposed to measles in households (through relatives or friends), apartment buildings, and medical provider offices.
Measles transmission has been sustained by two factors: a large pool of susceptible children under 12 months of age and large family and communal gatherings. To interrupt the spread of measles in this community, the Health Department recommends that the first dose of measles-mumps-rubella-vaccine (MMR) now be given at 6 months of age to all Orthodox Jewish children living in Borough Park, Williamsburg, and Crown Heights.
Although cases of measles have not yet been identified in Crown Heights, we are extending this recommendation to this community to prevent introduction of measles. Further, non-Orthodox children receiving medical care in practices that serve predominantly Orthodox Jewish patients, should also receive MMR vaccine beginning at 6 months of age because of the increased risk of exposure.
A dose of MMR vaccine given prior to the first birthday (there is a 4 day grace period) will not be considered a valid dose in the Citywide Immunization Registry (CIR) or for daycare or school entry. Infants who receive MMR vaccine before their first birthday should receive an additional dose at 12 months of age as long as 28 days have passed after the initial vaccine dose. These children will still require a ‘second valid’ dose prior to school entry at 4 – 6 years of age.
In the setting of this outbreak, Orthodox Jewish children aged 12 months and older living in Borough Park, Williamsburg, and Crown Heights who have received their first dose of MMR should receive their second MMR dose now, as long as 28 days has elapsed after the first dose. This second dose will be considered valid and will count toward the school immunization requirements.
Vaccination at an earlier age is recommended by the Centers for Disease Control and Prevention for outbreak control when many cases are occurring among infants <12 months of age. This will increase the proportion of infants who are protected against measles. Ninety five percent of infants who were 6 months old at the time of vaccination demonstrated a response to the vaccine as measured by cell mediated immunity and/or seroconversion (Gans et al. JID 2004;190:83-90). The same study documented that an infant’s ability to respond to a second dose of MMR is not compromised by early administration of vaccine. MMR vaccination of children 6 – 11 months of age who will be traveling overseas is already a routine Advisory Committee on Immunization Practices recommendation and is considered safe.
Information about reporting suspect cases of measles, laboratory testing, isolation of suspected or confirmed cases, or post-exposure prophylaxis recommendations have been previously sent and are available at http://www.nyc.gov/html/doh/html/diseases/immmea.shtml