Mayor Bill de Blasio on Tuesday declared a public health emergency in several zip codes in Williamsburg, Brooklyn to stem a nascent measles outbreak among Orthodox Jewish children. The order requires every unvaccinated adult and child who lives, works, or goes to school in these areas to receive the measles-mumps-rubella (MMR) vaccine or face a fine of up to $1,000.
“We have a situation now where children are in danger,” de Blasio said at a news conference in Williamsburg where he announced the emergency. “This is the epicenter of a measles outbreak that is very, very troubling and must be dealt with immediately. The measles vaccine works. It is safe, it is effective, it is time-tested.”
Under the measure, the New York City Department of Health and Mental Hygiene will have the authority to check vaccination records. People who can demonstrate that they are immune from the measles or have a medical exemption need not get vaccinated.
Since September of 2018, there have been 285 documented cases of measles in Brooklyn and Queens – most of them in the Orthodox community. Twenty-one of those led to hospitalizations, including five admissions to the intensive care unit.
(In January, The Jewish Press filed a Freedom of Information Law request with the city’s health department, requesting the number of religious exemptions requested from the measles vaccination as well as records relating to those requests. The health department has yet to send the newspaper any records.)
The city’s order affects the zip codes of 11205, 11206, 11211, and 11249 and represents the most ambitious move by an American city to stem an infectious disease outbreak in three decades. (In 1991, Philadelphia police officers went into the homes of members of the Faith Tabernacle congregation and forcibly vaccinated nine children.)
This year, 465 cases of measles have been confirmed across the country – 78 of which arose last week, according to the Centers for Disease Control and Prevention. In 2018, New York and New Jersey accounted for more than half of the measles cases in the country.
“I wish [the city] would be cautious,” Dorit Reiss, professor of law at UC Hastings College of Law, an expert on the intersection of law and vaccines, and an immunization advocate, told The Jewish Press. “I am concerned that this move…is going too far – that it’s too broad and potentially unjustified in this situation.”
She added: “New York City, traditionally, has a lot of authority to respond to cases of infectious diseases and preventing them from spreading. The classic case in the city is Mary Mallon, known as ‘Typhoid Mary.’” In the early 20th century, Mallon contracted typhoid and was presumed to have infected 51 others. Twice, she was forcibly isolated by public health authorities and died after almost three decades in isolation.
Reiss said, “When this current measure inevitably comes before a judge, the court will ask two questions: Is it a public health emergency and is this specific measure justified?”
In response to a request for comment, Rabbi David Niederman, president of the United Jewish Organizations of Williamsburg and North Brooklyn, told The Jewish Press, “Fortunately well over 95 percent of the Williamsburg Jewish community heeds the advice of the Department of Health and the community medical professionals and vaccinate their children.
“During the current outbreak, we reinforced the necessity to vaccinate with support from schools, rabbinic leadership and the Department of health and an enormous uptick in vaccinations followed. The mayor and health officials lauded our collaboration and the cooperation of yeshivahs and the community leaders in this effort.
He added, though: “Despite all our efforts, a small fraction of people here have been influenced by anti-vaxer ideology that spreads fear of vaccines. Unfortunately, this infects people from all ethnicities and religions and we are not immune to those same anti-vaxer forces.”
New York State requires students to receive the MMR vaccination, among several others, but normally permits exemptions for a valid religious or medical reason. In December, the health department ordered all schools in several zip codes in Williamsburg to exclude all non-vaccinated students from attending until the outbreak was declared over – even those with an exemption.
So far, at least five yeshivahs, which allowed non-vaccinated children back into school, have been found to be not in compliance with this order. New York City officials claim one of these yeshivas is connected to more than 40 cases.
The Gothamist website reported that more than 96 percent of children in the 133 yeshivahs located in the selected zip codes are vaccinated, according to 2017-2018 state records, and another 7,000 have received shots since the outbreak began. Public schools in the city have a vaccination rate of 99.3 percent.
On Monday – one day before de Blasio’s emergency declaration – the city’s Health Department went a step past its December order and issued a blanket order to all yeshivahs in Williamsburg allowing the Health Commissioner to immediately issue a violation if he sees a school is not properly excluding students.
In response to this move, Rabbi Dr. Aaron Glatt, chairman of the Department of Medicine at South Nassau Communities Hospital and clinical professor of medicine at Icahn School of Medicine at Mount Sinai, told The Jewish Press:
“How very sad and tragic that the Department of Health has to step in and regulate yeshivahs for not doing what the gedolei Yisrael have required us to do. HaRav Elyashiv, zt”l, and – yibadeil bein chayim lechayim – HaRav Moshe Shternbuch, shlita, HaRav Asher Weiss, shlita, HaRav Elya Brudny, shlita, and HaRav Herschel Schachter, shlita, as well as the vast majority of contemporary and prior gedolim from all sects of Orthodox Yiddishkeit, have mandated measles and similar vaccinations to prevent these potentially fatal childhood vaccine preventable illnesses.
“It is a great chillul Hashem that Orthodox Jews are at the center of this serious epidemic, and that we are forcing the Department of Health to take such action.”
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ORDER OF THE COMMISSIONER
All persons who reside, work or attend school in the neighborhood of Williamsburg, Brooklyn, New York and to the parents and/or guardians of any child who resides, works or attends school in the neighborhood of Williamsburg, Brooklyn, New York
WHEREAS, there is an active outbreak of measles among people residing in the neighborhood of Williamsburg in Brooklyn, New York who live within zip codes 11205, 11206, 11211 and 11249. Since September 2018, more than 250 cases of measles have been documented among people living in Williamsburg and that number continues to grow as new cases are still occurring; and
WHEREAS, measles is a highly contagious viral disease that can result in serious health complications, such as pneumonia and swelling of the brain. About a third of reported measles cases have at least one complication and in some cases, measles can cause death. Measles can be serious in all age groups. However, infants, young children, pregnant persons, people whose immune systems are weak and adults are more likely to suffer from measles complications; and
WHEREAS, measles is easily transmitted from a sickened person to others who lack immunity to the disease. The virus can live for up to two hours in air or on surfaces where an infected person coughed or sneezed and people who lack immunity are highly likely to become sick if they are in contact with an infectious person or near where an infectious person recently has been; and
WHEREAS, although measles is highly contagious, the Measles-Mumps-Rubella (MMR) vaccine is an effective and safe vaccine that will prevent its transmission. While measles remains one of the leading causes of death among young children in parts of the world where the vaccination is not available, the disease until this outbreak was largely eliminated in the United States; and
WHEREAS, the measles outbreak persists in Williamsburg despite other efforts taken by the Department of Health and Mental Hygiene to stop it, including orders excluding unvaccinated children from attending preschools and daycare programs, because a high rate of people living within Williamsburg have not been vaccinated against measles; and
WHEREAS, pursuant to section 556 of the Charter of the City of New York, the Department is responsible for controlling communicable diseases within the City of New York and for supervising the abatement of nuisances that affect or are likely to affect the public health; and
WHEREAS, pursuant to section 3.01 of the New York City Health Code, I am authorized to declare a public health emergency and issue orders and take actions that I deem
necessary for the health and safety of the City and its residents when urgent public health action is necessary to protect the public health against an existing threat; and
WHEREAS, I find the ongoing measles outbreak in Williamsburg to be an existing threat to public health in the City of New York; and
WHEREAS, I also find that the presence of any person in Williamsburg lacking the MMR vaccine, unless that vaccine is otherwise medically contra-indicated or such person has demonstrated immunity against measles, creates an unnecessary and avoidable risk of continuing the outbreak and is therefore a nuisance, as defined in New York City Administrative Code §17-142; and
WHEREAS, pursuant to New York City Health Code §3.07, no person “shall do or assist in any act which is or may be detrimental to the public health or to the life or health of any individual… or …shall fail to do any reasonable act or take any necessary precaution to protect human life and health.”
IT IS HEREBY ORDERED that any person who lives, works or resides within the 11205, 11206, 11221 and/or 11249 zip codes and who has not received the MMR vaccine within forty eight (48) hours of this Order being signed by me shall be vaccinated against measles unless such person can demonstrate immunity to the disease or document to the satisfaction of the Department that he or she should be medically exempt from this requirement.
IT IS FURTHER ORDERED that the parent or guardian of any child older than six months of age who lives, works or resides within the 11205, 11206, 11221 and/or 11249 zip codes and who has not received the MMR vaccine within forty eight (48) hours of this order being signed by me shall cause such child to be vaccinated against measles unless such parent or guardian can demonstrate that the child has immunity to the disease or document that he or she should be medically exempt from this requirement.
THIS ORDER shall remain in effect until the next meeting of the New York City Board of Health scheduled for April 17, 2019 at which time it may be continued or rescinded by the Board.
Dated: April 9, 2019
Oxiris Barbot, M.D.
Commissioner of Health
Failure to comply with this Order is a violation of §3.05 of the New York City Health Code, and a misdemeanor for which you may be subject to civil and/or criminal fines, forfeitures and penalties, including imprisonment.
Anyone wishing to object to the order, please write or fax Thomas G. Merrill, General Counsel, New York City Department of Health and Mental Hygiene, 42-09 28th Street (WS 14-38) Long Island City NY 11101-4132; firstname.lastname@example.org, telephone: 347-396-6116; fax: 347-396-6087, providing a statement of the reasons for your objection to the order. If you have any questions about how to comply with this Order, please telephone Jane R. Zucker, M.D., M.Sc., Assistant Commissioner, Bureau of Immunization at 347-396-2471.