This paper provides an important commentary on the ongoing measles outbreak spreading across the entire globe — present in over 170 countries, encompassing hundreds of thousands of cases worldwide, with thousands of deaths since its onset and no end in sight.
Although the authors focus on one small but important U.S. segment of this raging epidemic, the points they made are generalizable to other populations across the country and the world as well.
Any insular community — especially one with very large numbers of young children in a relatively circumscribed geographic location, with multiple opportunities through school, religious or social contexts for mingling — will be a haven for the spread of a highly contagious disease like measles. This has nothing to do with religion because measles outbreaks have occurred throughout the U.S. and the world in almost every ethnic, religious or nonreligious group. Indeed, as an orthodox rabbi, I can attest to the fact that there is no Jewish opinion that forbids vaccination, and indeed, the vast majority of preeminent rabbis strongly advocate and mandate vaccination. To my knowledge, all of the major religions of the world are also in favor of such immunizations.
The common denominator for trouble in all of these circumstances is suboptimal immunization rates, secondary to strong anti-vaccination influences from nonscientific and unsupported anecdotal positions. This misinformation can easily spread in many different communities, not just poor, uneducated groups. Indeed, there are studies demonstrating that some of the highest incidences of nonvaccination occur in middle to upper socioeconomic, highly educated populations.
Anti-vaxxers are a relatively small but highly visible and vocal group that have no real experts supporting their unscientific position. Yet, they have an inordinate number of supporters in the pop culture and political world, despite their lack of scientific credentials. Their popular appeal is often underestimated, and their influences are sometimes beneath the public health and establishment radar.
One scientific point that is frequently not given the high priority it deserves is that many of the cases in the current outbreak in orthodox Jewish communities were in very young children previously recommended NOT to get vaccinated, ie, children aged younger than 12 to 15 months. Vaccination is delayed to this point in the child's life because of the concern that maternal antibody might still be circulating in these infants and will result in a suboptimal response to vaccination. Likewise, the second MMR vaccination was recommended to be scheduled in children between 4 and 6 years of age, which meant that a small but significant percentage of children vaccinated with only a single dose (having only an approximately 93% chance of acquiring immunity) were, in fact, still at risk for infection.
However, in an epidemic situation, or when traveling to an endemic region, these recommendations are no longer appropriate. Instead, we now recognize that vaccinating at 6 months of age is preferred in such circumstances. Additionally, we recommend that the previously recommended second vaccination dose given between ages 4 and 6 years should now be provided much earlier — as soon as possible — 28 days after the dose given at 1 year. These new recommendations have brought a tremendous increase in vaccinations in the Rockland County outbreak, with over 22,000 doses of vaccine provided in the recent months vs. only 1,000 doses just a year ago. This is truly a phenomenal community and public health response to this epidemic.
Aaron Glatt, MD, FACP, FIDSA, FSHE
Spokesperson, Infectious Diseases Society of America
Chairman of medicine and chief of infectious diseases
South Nassau Communities Hospital
Oceanside, New York
Disclosures: Glatt reports no relevant financial disclosures.