Measles outbreaks call attention to importance of vaccinations

On Board Online • February 25, 2019

By Merri Rosenberg
Special Correspondent

Measles is back.

In 2000, U.S. health officials noted that a year had passed without continuous transmission of measles, and they declared the intensely contagious childhood disease to be eliminated. But elimination is not the same as eradication, and there have been regional outbreaks.

Now experts say growing numbers of unvaccinated children pose a threat to public health.

According to the U.S. Centers for Disease Control and Prevention, more than 100,000 American babies and toddlers have not been vaccinated. And when an under-vaccinated population comes in contact with those affected, the disease's spread is rapid.

As On Board went to press, there were 137 reported cases of measles in Rockland County. The outbreak began in October 2018 in the East Ramapo community, which is home to Hasidic Jews, many of whom object to immunization.

An outbreak in Brooklyn has about 67 cases, according to health officials in New York City, and two patients were treated for measles at Yale New Haven Hospital in New Haven, Conn. Erie County has also reported a case, and Monroe County has seven.

Elsewhere, there was recently an outbreak of measles that affected 55 children and young adults in southern Washington State and Portland, Ore. The disease then spread to Hawaii when an infected child from Washington traveled there recently.

To be considered of low risk for an outbreak, each school ought to have a vaccination rate of at least 95 percent, according to Dr. Patricia Schnabel Ruppert, health commissioner for Rockland County. That triggers the so-called "herd effect," where enough students are vaccinated to confer a high degree of protection for the population.

Excluding New York City, about 97 percent of K-12 schools in the state have a measles vaccination rate of 95 percent or more, according to the state Department of Health. (Look up your school district here: .)

While all states require children to be vaccinated before entering kindergarten, exemptions are possible.

Medical exemptions. All 50 states offer exemptions for medical reasons; in New York State, any medical exemption must be signed by a physician licensed to practice medicine in the state.

In New York, each medical exemption must be reviewed annually, according to Jill Montag, a spokeswoman for the state Department of Health. The principal or person in charge of the school may require additional information supporting the exemption, she added.

Religious exemptions. All but three states (California, Mississippi and West Virginia) allow religious exemptions, according to the National Conference of State Legislatures.

In New York State, school officials grant religious exemptions. A religious exemption is a written and signed statement from the parent, parents or guardian of such child, stating that the parent, parents or guardian objects to their child's immunization because of sincere and genuine religious beliefs which prohibit the immunization of their child, Montag said. The principal or person in charge of the school may require supporting documents. In New York City, religious exemptions for public schools are granted by the city Department of Education, and religious exemptions for private schools are granted by the individual school.

A pending bill in the New York Legislature would end childhood exemptions based on religion in the state. It is sponsored in the Assembly by Jeffrey Dinowitz (D-Bronx) and in the Senate by Brad Hoylman (D-Manhattan).

Personal or philosophical exemptions. Sixteen states allow parents of K-12 public school students to not immunize their children for personal or philosophical reasons, according to the National Council of State Legislatures. That includes the state of Washington, where a bill to remove this exemption is pending in the state House of Representatives. (Missouri only allows personal exemptions in child care facilities.)

New York does not allow personal or philosophical exemptions, and NYSSBA has opposed annual legislative efforts to create one, according to Julie Marlette, NYSSBA's director of governmental relations.

"Immunizations give children the best protection from serious childhood diseases and have an excellent track record of safety and effectiveness," said Montag of the Department of Health. "Parents should talk to their pediatrician and work with their school's health services to make sure that all of their children's immunizations are up-to-date."

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