New York City mayor declares end of measles public health emergency

Earlier this month, New York City Mayor Bill de Blasio and city health officials announced an end to the public health emergency declared April 9 for the greatest measles outbreak in the city in almost 30 years. With the passage of two incubation periods totaling 42 days with no new cases verified, the emergency measures for dealing with the eruption of 654 cases since the outbreak began October 2018 were set aside.

During the nine-month period, 52 persons were hospitalized and 16 individuals were placed in intensive care units. Eighty percent of those contracting measles were children. Of all the persons infected, 73 percent were unvaccinated, 7 percent were incompletely vaccinated, and 15 percent did not know their vaccine status.

Andrew Cuomo, governor of New York, signed a law repealing religious and personal philosophical exemptions for mandatory receipt of the measles mumps and rubella (MMR) vaccine and other vaccines for children attending school. Medical exemptions for being unable to receive vaccines were continued, as they are in all states.

The majority of New York cases, 72 percent, occurred in the Brooklyn neighborhoods of Williamsburg and Borough Park and in Rockland County where ultra-orthodox Jewish persons had declined vaccination for themselves and their children.

When de Blasio declared the emergency in April, parents and officials at yeshivas and schools were informed they must admit only vaccinated students and children or receive citations and fines or be closed for the duration of the emergency.

New York City deployed 500 staff and spent some $6 million on the administering of 15,541 doses of measles vaccine and the distribution of tens of thousands of booklets, posters, leaflets, texts, robo-calls, television and radio ads and the holding of town hall meetings, in part to combat anti-vaccine propaganda, until the outbreak was arrested late this summer. The infection had spread to all five boroughs.

Health Commissioner Dr. Oxiris Barbot pointed out, “Measles is one of the most contagious diseases on the face of the earth. There may no longer be local transmission of measles in New York City, but the threat remains given other outbreaks in the US and around the world. Our best defense against renewed transmission is having a well immunized city.”

According to the Centers for Disease Control and Prevention (CDC), as of September 5 there were 1,234 reported cases of measles in the US this year, a record not seen since 1992, and the greatest number since measles was declared eliminated from the US in 2000. The New York cases constituted three-quarters of the total measles infections in the country so far in 2019.

Dr. Aaron Glatt, chief of infectious diseases at South Nassau Community Hospital on Long Island and the hospital’s epidemiology consultant, told Kaiser Health News (KHN), “Vaccination is critically important, I cannot stress that enough.”

Dr. Glatt is a rabbi and told KHN, “Measles is not a religious issue. I don’t think any religion objects to vaccines from a religious point of view.”

However, in New York State for the 2017-2018 school year, 26,217 vaccine exemptions were issued for students attending public, private and religious schools, according to the state health department.

Measles virus can live on dry surfaces and in the air for hours, and it’s been estimated that 90 percent of unvaccinated persons exposed to the virus will become infected. In unvaccinated populations, one measles infected person will infect another 12 to 16 persons, compared to one flu virus infected individual infecting another 1 or 2.

Serious complications include death, primarily in the young, for 1-3 persons per 1,000, often from secondary measles pneumonia and resulting respiratory failure. One ill person in 1,000 will develop brain swelling and viral encephalitis, with the risk of impaired intellectual function, seizures, and/or deafness.

Before the availability of measles vaccinations in the United States in 1963, there were approximately 4 million cases annually, with some 400 to 500 deaths.

The term herd immunity means that a sufficient majority of a population carries immune resistance to an infectious disease so that the infecting agent has insufficient opportunity to survive and propagate, thus providing protection for the population’s unvaccinated minority. The minority would include either immune deficient or suppressed persons, those who cannot receive a vaccine because of a preexisting disease such as cancer, or some other medical contraindication to vaccination.

For measles prevention, health authorities advise vaccinations be administered as comprehensively as possible. Herd immunity for measles is effective in the range of 92 to 96 percent. In 2017, vaccine coverage in the US for persons 19 to 35 months of age was at 92.7 percent, according to the CDC. However, 11 states were known to be below 90 percent.

Two doses of MMR vaccine are recommended, the first at age 12 to 15 months and the second 4 to 6 years of age. The vaccine is 97 percent effective.

After Gov. Cuomo signed the vaccine exemption repeal law, Democratic Party operative and attorney Robert F. Kennedy, Jr. and another civil rights lawyer, Michael Sussman, filed suit in New York State Supreme Court on behalf of 55 New York families declining vaccinations for their children. A court justice ruled against the plaintiffs and the case is on appeal.

The Washington Post published stories and photos of anti-vaccine activists targeting the measles outbreak neighborhoods this year with anti-vaccine rallies, exhorting unvaccinated residents and parents to ignore the appeals by health authorities to accept the preventive measures. One of the rally’s speakers in June, Del Bigtree, was reported by the Post to have referred to measles as a “trivial illness.”

The Post also published an article June 19 identifying an upper east side Manhattan hedge fund manager and his wife, Bernard and Lisa Selz, who have been donating millions of dollars to anti-vaccine campaigns carried on throughout the United States. The couple declined to discuss their activities and donations with the Post. Tax filings for the couple’s charitable foundation reveal they donated $200,000 to a legal fund for the disgraced and defrocked British former physician Andrew Wakefield.

Dr. Barbot, the NYC health commissioner, told the Post that she’d not heard of the Selzes, “But I do know the science and the science is clear—the MMR vaccine prevents measles. Any suggestion to the contrary is a threat to the health and well-being of New Yorkers.”

In 1998, Wakefield authored fraudulent claims that the MMR caused autism and colitis in a dozen children, reported in an article published in the Lancet medical journal. Afterwards, the journal’s editors, the British Medical Journal (BMJ), and the London Sunday Times determined that Wakefield had falsified the published findings for the children. The Lancet thereafter published a full retraction of the article’s claims, explaining that Wakefield had lied to its editors about his data.

The majority of his co-authors thereafter disassociated themselves from the completely discredited publication.

Multiple studies since have thoroughly disproven Wakefield’s claims of vaccine links to autism, the latest from Denmark published this spring involving 657,461 children born between 1999 and 2010 without any evidence whatsoever of autism following MMR administration.

Lancet, the BMJ and the Times also determined that Wakefield had an undeclared conflict of interest in his attempt to destroy public confidence in the use of measles mumps and rubella vaccine.

He was discovered to have filed for patents on both a test kit for autism, in advance of the 1998 fraudulent medical journal claims, and for a stand-alone measles vaccine, from which he reported had hopes of making tens of millions of dollars.

The British General Medical Council (GMC), which regulates the licensing of health professionals in the United Kingdom, concluded that he had performed “dishonestly and irresponsibly.” The GMC subsequently revoked his license to practice medicine in the UK.

A Wikipedia entry about Wakefield features his photograph at an anti-vaccine rally this April in Poland.