Measles outbreak – a modern-day plague?

TALI FEINBERG

There have been 285 confirmed cases of measles in Brooklyn since October, and last week, New York City Mayor Bill De Blasio declared it a public health emergency.

He also made it a requirement by law to vaccinate children who reside in four Brooklyn areas with the measles, mumps, and rubella (MMR) vaccine. If the parents refuse, they can be required to pay fines of up to $1 000 (R13 986).

“This is the epicentre of a measles outbreak that is very, very troubling, and must be dealt with immediately,” De Blasio said. “The measles vaccine works. It is safe, it is effective, it is time-tested. The faster everyone heeds the order, the faster we can lift it. We cannot allow this dangerous disease to make a comeback here in New York City. We have to stop it now.”

The order came a day after the New York City Department of Health threatened to fine or even close yeshivas in Williamsburg if students who are not vaccinated against measles are allowed to attend classes, reports the Jewish Telegraphic Agency.

Last Friday, a New York state judge lifted the state of emergency imposed by Rockland County that would have barred minors not vaccinated against the measles from public places.

There have been warnings of “disastrous consequences” for children if the disease continues to spread unchecked. A worldwide survey by the United Nations Children’s Agency, Unicef, said 98 countries around the globe had reported a rise in measles cases in 2018 compared with 2017, according to The Guardian.

That total includes a number of countries that had previously eradicated the disease. Highly contagious, measles spreads more easily than Ebola, tuberculosis, or influenza.

The outbreak in New York has been tied to an unvaccinated child who contracted the disease during a trip to Israel, the Washington Post reported. But how did it spread so easily?

“These outbreaks happen in pockets of communities where the levels of immunisation drop. Vaccine hesitancy, or vaccine rejection, is a feature in very conservative religious communities and the ultra-orthodox Jewish community is no exception,” says Professor Barry Schoub, the former executive director of the National Institute for Communicable Diseases and Emeritus Professor of Virology at the University of the Witwatersrand.

“Measles is a potentially serious disease with a significant incidence of serious complications such as pneumonia, otitis media, blindness, deafness, brain damage, and even death.

“Unfortunately there is a lot of ignorance and suspicion about modern science in these communities and vaccine hesitancy is high, resulting in a substantial build-up of community susceptibility to vaccine-preventable diseases such as measles,” he says.

“There have been similar outbreaks in conservative religious communities, both Jewish and Christian. Measles is on the one hand a highly contagious disease, but on the other very easily preventable by a safe and effective vaccine.”

Why does it take something like this outbreak to make the MMR vaccine compulsory? “Making vaccination compulsory and [non-vaccination] punishable by law is a very necessary public health measure when one has outbreaks such as the current measles outbreak in New York,” says the professor. “Anti-vaccination doesn’t only harm children who are not being vaccinated, but threatens those who, unfortunately can’t be vaccinated for medical reasons, or who have not been successfully vaccinated – a small percentage of those vaccinated fail to respond successfully.”

The professor says outbreaks of measles could certainly occur in South Africa, and have occurred here recently. “It happens when immunisation levels drop. They need to be high to prevent outbreaks, particularly for measles.”

If we compare measles to other “modern-day plagues” like HIV, the difference might be that there is more awareness of how to prevent HIV, even though there is no cure. “Clearly there is a need for a vigorous educational effort to enlighten parents about the ease of vaccination, and the risk to their own children as well as others, should they fail to vaccinate,” says Schoub.

“There is a religious Halachic obligation to take active steps like vaccination against preventable diseases. The esteemed sage, the Tiferet Yisrael [Rabbi Israel Lifschitz 1782-1860], encouraged his community to be vaccinated during a smallpox outbreak even though the vaccine in those days itself carried a risk, obviously very much smaller than the disease itself.”

Schoub says that vaccines, as well as the provision of clean water, have done more for human health than any other intervention. “Whether you are ‘pro’ or ‘anti’, vaccination is a no-brainer. It is equivalent to asking if one is pro or anti-science. Vaccines have saved millions of lives since 1798, when the first human vaccines were introduced.”

Schoub doesn’t like to use the world “plague”, but says that the illnesses affecting millions include tuberculosis, HIV, and multi-resistant bacterial infections. Other “modern-day plagues” could include starvation, poverty, natural disasters caused by climate change, malaria, and even lice (taken more seriously here than in Israel!). But when science and medicine can stop an epidemic such as measles, perhaps we should use it to prevent such a plague.