A measles outbreak is raging in various frum communities on the East Coast. As of Motzoei Shabbos, there are 75 confirmed cases in Rockland County (in New Square, Monsey, and Spring Valley), 24 confirmed cases in Brooklyn (in Boro Park and Williamsburg), and 14 confirmed cases with another 12 under investigation in Ocean County (in Lakewood).
The current outbreak has been traced to Eretz Yisroel, which has more than 1,500 measles cases and one child fatality from complications from the virus.
According to Lohud.com, Israel’s outbreak can be traced to people who have traveled to other areas experiencing outbreaks, especially the Ukraine, where the World Health Organization said there are over 23,000 people affected.
New York City health officials add that in addition to the outbreak in Israel, there are large outbreaks in Europe, with over 41,000 measles cases and 40 deaths reported this year. The European Centre for Disease Prevention and Control stated that vaccination rates are below 95 percent in most countries in the region. The World Health Organization sets 95 percent as the number when so-called herd immunity is effective, which stops cases from spreading.
According to Lohud, Rockland was exposed to measles in early October when five travelers, mostly locals, arrived from visits to Israel; most of the exposure sites were in New Square, Monsey and Spring Valley. Rockland County has an overall vaccination rate of 94 percent and New York state is at 98 percent.
At Refuah Health Center in Spring Valley, over 6,100 MMR vaccines have been administered since the start of the outbreak.
In Brooklyn, as mentioned above, the outbreak has primarily affected children in Boro Park and Williamsburg. All of the patients are between 7 months and 4 years old.
Health officials recommend that anyone age six months and older get or complete their MMR vaccinations prior to taking an international trip. Likewise, health officials recommend that non-immunized students stay home from school during a measles outbreak. Students can return to school 21 days after the last known exposure.
In Lakewood, NJ, the outbreak is linked to the ones in Rockland and Brooklyn and also originated from an adult traveler coming from overseas.
About one out of every four people who get measles will be hospitalized, one out of every 1,000 cases can cause brain swelling and one or two people out of 1,000 may die, according to the Centers for Disease Control and Prevention.
Measles cases have been confirmed in 25 states, including Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Virginia, and Washington. Frum communities in Illinois, Michigan, Maryland, Connecticut and Florida have seen confirmed or suspected cases.
The majority of people who got measles were unvaccinated.
Measles is an extremely contagious disease that has been officially eradicated from the U.S. due to its highly effective vaccination, though it is often brought in from other countries by travelers. A single dose of the MMR vaccine is 93 percent effective in preventing the disease, and a double dose is 97 percent effective, according to the CDC. The health departments in all of the affected areas have lowered the standard recommended age for administering the vaccine, and now say that given the outbreak, children as young as six months old should receive the initial shot, with the booster administered 28 days later.
The health departments have also put into effect strict isolation requirements. Any un- or under-vaccinated student must be kept out of schools when a case has been reported in the school. The Rockland County Health Department has ruled that even when no case was reported in a school, non-vaccinated children must be sent home in schools where the vaccination rates are under 80 percent, which is the case in 34 area schools. The Ocean County Health Department mandates school exclusion when a case is reported, and gives schools the jurisdiction to determine whether to send non-vaccinated children home when no case was reported in the school.
In all the affected communities, there has been a deluge of people lining up at doctors’ offices and medical clinics to receive the vaccine. Doctors are strongly urging everyone to make sure that they are up to date on their immunizations. In Lakewood, 32 local pediatricians signed a letter advising everyone to get the vaccine immediately.
“Anyone who is unvaccinated can create a serious health risk to people who are immunosuppressed or not yet vaccinated,” they wrote. “Therefore, we collectively advise that those individuals should not go to school or playgroups until further notice.”
Some, however, refuse to vaccinate their children, citing negative side-effects that the vaccine may cause.
“Ironically, the issue that we’re having with vaccinations is that they are so effective,” Dr. Hertzka Grinblatt, a Chicago area doctor who has been treating patients for 30 years, said, according to a Yated Ne’eman report. “People today haven’t seen these diseases, so they think that the vaccine is the hazard. If they would see the disease, they would realize that the real danger is the potential for the disease.”
Dr. Grinblatt himself caught measles in 1989 while treating a 19-year-old patient in Chicago. He had thought himself to be immune, believing that he had the disease as a child, but was mistaken.
“I got so sick – it was the only time in my life that I thought I would die,” Dr. Grinblatt relates. “I was admitted to the hospital, short of breath, with an inflamed liver. My vision was also effected, as the disease damaged my corneas. It was the most horrendous medical experience that ever happened to me.”
During that epidemic, the mortality rate was as high as one death per 250 patients. The general mortality rate for measles is currently roughly one per every thousand.
“This was a disease that used to affect at least half a million people a year,” he notes. “It was just a part of life. But they were able to almost completely get rid of it because of the effectiveness of the vaccine.”
Once the disease was eradicated, however, some people stopped giving the vaccine and the disease began to appear once again.
“Polio, for example, is not so infectious, so if 70 percent of the population gets the vaccine, the disease can disappear,” he explains. “With the measles, however, it is so contagious that you would need 95 percent of people to vaccinate in order to keep it under control.”
Dr. Grinblatt traces the history of the anti-vaccination movement.
“In 1998, an English doctor named Dr. Andrew Wakefield published a study in Lancet, in which he claimed to find a connection between the MMR vaccine and autism. His study was completely bogus, but he made a fortune off it, hiring himself out as an expert witness on the subject of vaccinations. Never has anyone been able to reproduce his findings, and the study was eventually debunked. He later even lost his medical license.
“There is no evidence at all tying vaccines to autism, besides for a bunch of ‘made up’ evidence. Yet, once people hear it, they accept it as a belief.”
Dr. Grinblatt believes that the issue is more prevalent in the Orthodox community because it is common for people to share ideas with each other and easily pass around conspiracy theories.
“People often say that the medical community makes money off vaccines and that is why they impose vaccines on everyone. In England, however, there is a national health service run by the government, with no financial stakes at all. Nevertheless, vaccines are promoted there as well.”
He reiterates the point and makes a suggestion.
“There has to be an across-the-board mandate for everyone to be vaccinated. It is not only for your child’s safety, but is needed for everyone else to remain healthy as well. You don’t want to vaccinate your child? No problem – just keep your kid out of the public and homeschool them.”
Many schools throughout the community were faced with a dilemma regarding whether or not to allow non-vaccinated children to attend school, as an infected child can potentially cause even vaccinated children to catch the disease.
“In order to get a clear p’sak on this inyan, you need to ask someone who knows halacha as well as medicine,” Rabbi Shlomo Chaim Kanarek, who heads multiple schools in Lakewood, told Yated Ne’eman.
Rabbi Kanarek contemplated arranging a meeting between Rav Dovid Feinstein and a number of doctors, so that Rav Dovid would be able to hear the medical angle and issue a p’sak. The arrangement, however, was too difficult to facilitate, and Rabbi Kanarek came up with another idea.
“Rav Dovid Uri Morgenstern is a well-known medical expert and was a ben-bayis by Rav Elyashiv for a number of years. I thought that he may be the right person to ask, and I contacted Rabbi Aryeh Krohn, who is very close to Rav Morgenstern. Sure enough, Rav Morgenstern was very familiar with the question. He actually once discussed the sugya with Rav Elyashiv in depth, and he wrote a letter delineating Rav Elyashiv’s p’sak. Rav Elyashiv ruled that it is incumbent on everyone to vaccinate their children, and that mosdos should reject non-vaccinated children because they can infect other children.”
Based on Rav Elyashiv’s ruling, Rabbi Kanarek informed parents to keep any non-vaccinated children home.
“The letter clears up all doubt,” Rabbi Kanarek concludes. “There is nothing better than a clear p’sak from Rav Elyashiv. If anyone tries to argue with me about this decision, I just refer them to the letter. There’s nothing more to discuss.”
Some anti-vaxxers, however, have stated that they will pursue legal action against schools who reject their kids based on their decision not to vaccinate. Retired pharmaceutical CEO and Lakewood askan Dr. Kasriel Roberts addresses their claims.
Dr. Roberts has spent much of the last year researching vaccinations and the anti-vaccination movement at the behest of two Lakewood pediatricians. He learned that although education is generally the most effective method of portraying the virtue of something, when it comes to vaccinations it hardly works.
“There is a small group of people fueling the whole anti-vaccination movement,” Dr. Roberts told Yated Ne’eman. “Most of these people are making money off it. Many of them practice kinesiology, alternative medicine, or deal in nutraceuticals, and make money manipulating people against being vaccinated and then selling their products or services to non-vaxxers as vaccination alternatives. Therefore, they don’t listen when you bring them proof or try to reason with them. All the data in the world means nothing to them. You can disprove a point they make and they’ll raise the same point five minutes later. It’s not a rational phenomenon.”
He agrees with Dr. Grinblatt’s assessment that Orthodox Jews are very vulnerable to becoming victims of the ideology, noting that they naturally trust their fellow Jews and don’t suspect that they are being misled, and also often don’t have access to all the debunking information available on the internet.
Realizing that an impact through education would not be effective, Dr. Roberts changed gears.
“I now believe that the only way to stop these charlatans is by shining a light on their fraudulent activities,” he asserts. “Law enforcement authorities will often silently investigate a situation for months or years, then suddenly arrest 30 or 40 people in their homes at 5 a.m. When an illegal activity is publicly exposed, almost anyone interested in self-preservation will stop victimizing and defrauding others.”
He stresses that he has no intention of involving the authorities, yet he believes that showing how vulnerable these leaders are to criminal legal ramifications can have a positive impact, and can also relieve some of the pressure placed on schools to accept non-vaccinated students.
“If you own a school and an anti-vaxxer threatens to sue you if you don’t take their child, make them put it into writing,” Dr. Roberts advises. “This puts them at legal risk through documenting their actions. Often, such people will refuse to put it in writing and thus their verbal threats can be ignored.”
Dr. Roberts hired a law firm to explore the legality of schools rejecting students based on their refusal to vaccinate. Cozen O’Connor, a prestigious Philadelphia based law firm, reviewed the pertinent laws and determined that religious schools have the full jurisdiction to exclude any non-vaccinated child, even if the child has a religious exemption. They also stated that they believe there is an extreme likelihood that schools would win any potential lawsuit brought against them by parents of rejected non-vaccinated students, and that in all probability the judge would force the plaintiffs to foot the cost of the school’s legal fees and court fees.
Dr. Roberts also hinted that if a school is taken to court over their rejection of non-vaccinated students, legal representation from top firms may be covered pro-bono.
“Cozen O’Connor focused their review on New Jersey law and U.S. federal law,” Dr. Roberts adds for clarification. “However, I have instructed them to review New York law next, and I hope to have the results shortly.”
A letter from the firm also expounded on a number of criminal offenses that anti-vaccination advocates may be charged with if ever prosecuted by authorities.
Dr. Roberts relates that since he first publicized his desire to explore the criminal liabilities involved, some of those who threatened lawsuits against schools have backed down.
“I personally have been harassed and threatened by anti-vaccinating parents,” a school administrator wrote to Dr. Roberts in an email he shared with the Yated. “Since you [spoke up], they’re backing off. We are not allowing any students into our school if they are not vaccinated.”
“Please relay to Dr. Roberts that as a result of his involvement in this area, one particular family took back their threats to sue the school,” another wrote.
Dr. Roberts also noted that a certain anti-vaccination hotline removed lectures in which parents were encouraged to trick schools into accepting their non-vaccinated children, seemingly due to the potential criminal ramifications he exposed.
Vaccinations have been heralded for eliminating many once-common illnesses. Recognizing the effect that vaccinations have had on the world can give skeptics a new perspective on the role of immunization shots.
Dr. Alan Werzberger is a pediatrician who has been treating patients in Monroe since 1985. In 1991, with the blessing of Rav Moshe Teitelbaum of Satmar, he conducted an efficacy trial for the then newly developed Hepatitis A vaccine, with the participation of over a thousand Kiryas Yoel children. His double blind, placebo-controlled trial proved the effectiveness of the vaccine, and he successfully rid the community of the Hepatitis A disease that had frequently plagued the town.
“In Kiryas Yoel, people tend to take vaccines more seriously, because they know firsthand the ramifications of not vaccinating,” Dr. Werzberger told Yated Ne’eman. “This had a major, dramatic effect on everyone in the community. Everyone saw with their own eyes how a long-running, terrible illness was completely eradicated from the community. Since then, Kiryas Joel residents have always been less skeptical about vaccines.”
About a year prior to his Hepatitis A trial, there was a measles outbreak across the country.
“At the time, the recommended MMR regimen consisted of only one shot, with no recommendation for a booster shot,” Dr. Werzberger explains. “The recommendations changed after, and as a result of, that outbreak. But it was recommended at the time to inject family members and friends with the measles vaccine within 72 hours of being exposed to prevent secondary spread. However, since it is so contagious, if you have one case, you need to inject the entire class. It was just before Shavuos, which was a three-day Yom Tov that year, and one of the bochurim in yeshiva was diagnosed with the measles. The looming three-day Yom Tov meant that if we did not act immediately, hundreds of boys could get sick. We collaborated with Hatzolah, who jumped into their cars and went around Monroe making announcements via loudspeaker systems. We ended up giving 600 shots in three hours before Shavuos.”
Dr. Werzberger, who lives in Monsey, ended up spending Shavuos in Monroe, as he remained to administer the vaccines up until the zeman. The effort paid off, though, as no other bochur in the yeshiva came down with the measles.
Later, there was a measles case in the girls’ school. Dr. Werzberger set up shop to administer shots to the girls’ school as well.
“All told, we administered 4,000 shots over one month, and as a result of the quick action, we prevented a significant measles outbreak. There were only nine cases total in Monroe – a tremendous feat for such a contagious disease.”
Dr. Werzberger notes that the percentage of vaccinated children in Kiryas Yoel schools is 93 percent, substantially higher than in some other frum communities. He credits this to the schools and the local health department, and especially to Rabbi Eli Shlomo Kohn, the menahel of Bais Rochel, who serves as a liaison between community members and the Health Department. Dr. Werzberger cites the high percentage of vaccines as the reason a measles case has yet to be confirmed there during the current outbreak.
“Although we have a lot of interaction with Monsey, where there are 55 reported cases of measles, Kiryas Yoel currently has zero confirmed cases! This is because we have a history with vaccines and we understand their importance.”
He concedes that there is one suspected case of measles in the community: A child who was not yet vaccinated spent Shabbos at the home of an anti-vaxxer relative in Monsey. The child was immediately isolated, so as not to pose a threat to others.
“Kiryas Yoel is proof that if people listen to their doctors and follow authority, this can absolutely be prevented,” he stresses. “But there has to be a 93 or 95 percent rate. You won’t be able to achieve herd immunity with a lower percentage.”
Dr. Werzberger addresses the anti-vaccination movement. He points out that a common claim of anti-vaxxers is bias within the medical community, and he portrays how his trial was conducted in a manner that eliminated the possibility of bias.
“Everyone naturally wants their study to prove something. That is why we conduct double blind, placebo controlled tests. This means that half the shots are the vaccine and the other half are dummy needles, and neither the patient nor the doctor knows who got which shot. This eliminates any possibility to alter results, as those diagnosing the disease don’t know until it’s done if that patient got the vaccine or the placebo.”
Another major talking point of the anti-vaccine movement is their claims that doctors lack credibility, stating, “Doctors will always say what the medical world wants them to say,” “If a doctor admits that vaccines are bad, they will lose their license,” and other such rhetoric. Dr. Werzberger addresses this misconception as well.
“When New York City sought to ban metzitzah b’peh, the entire medical world banded together behind the city to decry the practice. I, and many other doctors, stood up against the medical establishment and were not concerned about speaking out. I wrote affidavits, based on results from my practice, against some of America’s most prestigious doctors. I wasn’t scared to stand alone. If I felt that there was something wrong with vaccines, I would have no problem standing up against the rest of the world and announcing my beliefs. But in all my experience, I’ve never seen any serious adverse effects from vaccines. And we have all seen the positive effects that the vaccine has in curbing the disease.”