The measles outbreak in the Orthodox Jewish communities of Brooklyn is ongoing. As of February 19, there have been 90 confirmed cases of measles in Brooklyn, including 41 in Borough Park and 47 in Williamsburg, with recent cases in both neighborhoods. In addition to transmission within Brooklyn, there have been importations from Israel (3 cases), the United Kingdom (1 case) and Ukraine (1 case). Eight cases have been hospitalized, including one ICU admission; seven cases have had pneumonia and 14 have had otitits media.
Most of these infections could have been prevented if the children had received the 1st dose of MMR vaccine as soon as the children turned one year of age, when the vaccine is routinely recommended. Cases have ranged in age from 6 months to 59 years, with the majority of cases being unvaccinated children aged 1 to 4 years (n=51, 55%). Because of an increase in measles among infants (n=17, 18%), the NYC Department of Health and Mental Hygiene also recommends that providers serving the Orthodox communities in Borough Park and Williamsburg administer an additional, early dose of MMR vaccine to all patients aged 6 to 11 months during this outbreak. This dose does not count toward the routine, 2 dose vaccine series but may offer some protection during the outbreak. Providers should immediately recall for MMR all children aged 6 months to 18 years who are unvaccinated. Unvaccinated patients presenting for care should not leave your facility without being vaccinated. Mild illness, including fever, is not a contraindication to giving MMR. The second dose of MMR may be given earlier than age 4 years, provided it has been at least 28 days since a previous dose of MMR, varicella or live intranasal influenza vaccine. If you need assistance with generating a list of unvaccinated patients using the Citywide Immunization Registry, please contact the Bureau of Immunization at 347-396-2400 or e-mail the address provided below. Please make sure you have an adequate supply of MMR vaccine on hand. For providers enrolled in the Vaccines for Children (VFC) program, if you need more vaccine, place your order through the On-line Registry as you normally do. If you need an expedited shipment or need assistance with ordering MMR vaccine, please call 347-396-2405 or e-mail firstname.lastname@example.org.
Over 4,400 identified individuals have been exposed to known cases of measles and transmission of measles has occurred in health care facilities. It is imperative that all patients are screened for rash with fever, international travel, and exposure to measles, both when calling for appointments and at the point of entry of a healthcare facility along with signage outside the facility. Patients with these risk factors for measles should not be seen in the facility where other patients could be exposed. In the absence of negative pressure isolation rooms, providers in the community have reported seeing such patients outside, in their cars, after-hours or in exam rooms with separate entrances to avoid exposures (do not use the room for 2 hours after the patient has left). Any unvaccinated child aged 6 months to 18 years who is in the facility at the same time as the patient with suspected measles, through two hours after they left, must be notified of the potential exposure and vaccinated BEFORE they leave the facility.Do not wait for laboratory confirmation. This will prevent secondary transmission and will eliminate the need to recall these patients later. Please review the attached document which outlines guidance and timing for post-exposure prophylaxis and share with your colleagues.
As a reminder, If you receive a request for measles titers from families of unvaccinated children whose titers should otherwise be negative (i.e. they want titers in order to return to school), please have a high index of suspicion for measles infection and obtain information about symptoms and onset dates; in these specific situations, please also collect blood for measles IgM (which remains positive for a few weeks to months after infection) and, if rash onset was within the past 7 days, also collect a nasopharyngeal swab for PCR. Specimens for IgM or PCR testing should NOT be sent to commercial laboratories and providersmust report these suspected cases to the NYC DOHMH at 347-396-2402 (Mon-Fri, 9am-5pm) or 866-692-3641 (after-hours). Testing will be performed at the NYC DOHMH laboratory.
The DOHMH will be hosting a conference call for providers to review updates on the outbreak and control measures; the date/time will be shared in the coming week.
Contact DOHMH at 866-692-3641 if you have questions or to report a suspected patient with measles. For immediate consultation regarding a patient, you can also call 347-396-2402 during business hours. As always, your cooperation is appreciated. Thank you in advance.
Jennifer Rosen, MD
Director, Epidemiology & Surveillance
Bureau of Immunization, NYC DOHMH