Dr. Warns of Measles Outbreak

As many of you may have heard by now, there is an outbreak of measles affecting the Orthodox Communities in New York associated with an outbreak of measles in Israel. The purpose of this article is to inform and address possible concerns or questions people may have.

As of this writing there have been at least 35 cases confirmed in Rockland County (Monsey and surrounding area), and 11 confirmed in Williamsburg and Borough Park, Brooklyn. The Ocean County Department of Health has also confirmed one case in Lakewood, New Jersey.

It is likely there are more cases that will emerge, as those initially affected will have spread it to more people. Since the illness is contagious before symptoms present, there have been large numbers of people exposed to each of the individuals with measles.

The majority of cases in New York City have been among young children who are unvaccinated because their parents delayed vaccination.
The illness seems to have been brought over from Israel, where there is currently a large measles epidemic affecting the Orthodox, and specifically the Chareidi community.

According to Haaretz newspaper there have been 882 cases of measles in Israel in the past year, including 529 in the Jerusalem area, 115 in Tzfat, 74 in Petach Tikva and 55 in the Tel Aviv area. Of these cases, more than 200 were in the month of September indicating the outbreak is not slowing down.

Measles is a highly contagious viral illness that occurs in many parts of the world. The early symptoms are very typical of what we might call “flu like”. They include cough, runny nose, congestion, and pink eye. Typically there is a very high fever (in the 104-105 range). Two to four days after the onset of fever the patient will break out in a rash that usually, but not always, begins on the face and spreads down the body. The patient generally begins to improve within 48 hours of the onset of the rash. The rash darkens to a brownish color and then fades over the next week. The cough may continue for one to two weeks, but the fever usually goes away after the second day of the rash.

Measles can be a very serious illness. One or more complications occur in approximately 30% of cases. Diarrhea is the most common complication, and ear infections are quite common as well. More alarming, measles weakens the immune system and puts the patient at risk for potentially severe respiratory illness. In fact, pneumonia is the cause of the vast majority of deaths from measles. Pneumonia as a complication is most likely in those under age 5 or over age 20. Women with measles who are expecting are at risk for preterm labor and miscarriage. Because of large measles outbreaks in Europe, this year alone, there have been 40 deaths, mostly in unvaccinated children.

The other serious potential consequence of measles virus includes several severe neurologic conditions that may occur immediately or even years later. Encephalitis (brain inflammation) occurs in 1/1000 cases with the potential for brain damage and death. Other neurologic diseases, while rare, may occur as well.

Historically, measles was an illness that every child contracted, and the morbidity and mortality from the illness would horrify us today. History books, and even a number of works of fiction from previous centuries, such as “Oliver Twist”, make much mention of the ravages of measles.

Measles is preventable. The MMR (Measles, Mumps, Rubella) vaccine is extremely effective in preventing contracting the illness. The first dose is given at 1 year of age, ideally at 12 months, and a second dose at 4-6 years of age. The second dose of MMR may be given earlier than age 4 years, as long as the doses are 28 days or more apart. Women of child-bearing age should make sure that they are immune to measles before becoming pregnant. Pregnant woman and people with a weakened immune system should not get an MMR.

It is critical that children aged 12 months and older and adults travelling overseas are up to date with measles vaccination. In addition, it is recommended that an early, extra dose of MMR be given to infants aged 6 to 11 months of age before travel overseas to prevent them from getting measles.

The rate of measles vaccination among young children in the Orthodox community is lower than that of other communities, putting the community at risk for the ongoing spread of infection.

Fortunately, the majority do vaccinate. The problem is that when the vaccination rates drop below 95%, the illness can spread to anyone who is not vaccinated. This includes infants who are less than one year of age, and therefore too young to have been vaccinated, and to pregnant women whose immunity to measles may be low. People with weakened immune systems are also at high risk for serious complications if exposed. No vaccine works perfectly and we all depend on the overall high rate of immunization to be protected.

Measles is transmitted by airborne particles. That means that there does not need to be close contact for it to spread. If the contagious person is in a shul, store, or classroom anyone in that location EVEN UP TO 2 HOURS LATER can contract the illness.

A patient with measles is contagious 4 days before the appearance of the rash until 4 days after it’s appearance. The incubation period is 7 to 21 days, meaning a vulnerable exposed person is at risk of illness during that period.
If someone believes that they or their child may have measles, they should alert their doctor before coming in to a healthcare facility so that proper precautions can be taken so as not to expose others at the doctors office. It goes without saying that at all times sick children should be kept home from school and other public gatherings.

The best way to protect yourself and your family from measles is by vaccination. With good immunization practices and keeping sick children out of public areas we hope not spread much further.

Dr. Abie Gottesman 10/30/18

If you have any questions please feel free to contact Dr. Gottesman at his office phone number, (646) 757-8751, extension 203, or at [email protected].