New York City on Tuesday declared a public health emergency and ordered mandatory measles vaccinations to halt an outbreak concentrated among ultra-Orthodox Jews in Brooklyn, becoming the latest flashpoint in a nationwide battle to try to stop the second biggest flare-up of the disease since 2000.
New York's imposition of mandatory vaccination in four Brooklyn zip codes is by far the toughest action taken to date by state or local officials, as 19 states report 465 individual cases and officials elsewhere face pushback for barring unvaccinated children from public places.
Officials at the Centers for Disease Control and Prevention also announced Tuesday that they were setting up a special team to oversee and manage the agency's response to ongoing measles outbreaks.
The agency said it "continues to be seriously concerned about the accelerating numbers of measles cases being confirmed nationally."
New York's action comes as health officials have scrambled to blunt the spread of measles. At least 285 people have contracted the disease in the city since September, mostly in Brooklyn's Williamsburg neighborhood.
City officials said Tuesday that 246 cases were in children. Twenty-one people have been hospitalized, with five ending up in the intensive care unit, but there have been no deaths.
This is the largest outbreak in the city in nearly three decades.
"This is the epicenter of a measles outbreak that is very, very troubling and must be dealt with immediately," Mayor Bill de Blasio (D) said Tuesday.
"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."
The mandate orders all unvaccinated people in four zip codes, including those with a concentration of Orthodox Jews, to receive inoculations, including for children as young as 6 months old. Anyone who resists could be fined up to US$1,000.
"We cannot allow this dangerous disease to make a comeback here in New York City," de Blasio added. "We have to stop it now."
Some Orthodox Jews have resisted vaccines. City health officials said Monday that yeshivas in Williamsburg that do not comply will face fines and possible closure.
As The Washington Post's Frances Stead Sellers reported, government pushes for inoculations and the barring of unvaccinated children from public spaces have prompted a backlash among anti-vaccination activists, whose misinformation campaigns have led to declines in immunizations against one of the world's most contagious diseases.
In New York City late last year, the health department ordered yeshivas and child-care centers in the Orthodox Jewish community to bar unvaccinated students.
One school that violated the mandate has been linked to more than 40 cases, the health department said.
"We're making clear that unvaccinated students will not be allowed in schools or day cares," de Blasio said.
Insured adults and children will be covered. Those who are uninsured will pay what they can afford, de Blasio said, and those who cannot afford the vaccination will receive it free.
There is no stricture against vaccinations in Judaism and the overwhelming majority of American Jews are vaccinated.
The reasons for the explosion of cases among members of insular, ultra-orthodox communities has more to do with their frequent contacts with Israel, which is undergoing its own measles crisis, combined with their insularity and mistrust of government.
"Most rabbis encourage vaccination based on the Torah commandment to protect one's life," Rabbi Yuval Cherlow, founder and head of the ethics department of the Tzohar Rabbinical Organization in Israel, told The Post on April 3.
"In Judaism, the majority has the right to dictate what takes place in the public space to ward off danger."
Still, he said, "there is no pope in Judaism, and no one can force you to vaccinate."
The outbreak in the area has been tied to a child who had not received the measles, mumps and rubella (MMR) vaccine and contracted the disease during a trip to Israel.
"Since then, there have been additional people from Brooklyn and Queens who were unvaccinated and acquired measles while in Israel," according to the city's health department.
New York has contended with measles outbreaks and the legal challenges that have arisen in efforts to contain them.
An outbreak, also within an ultra-orthodox Jewish community in Rockland County, outside New York City, led officials to ban unvaccinated children from public places in mid-March. A state judge overturned that decision 10 days later.
In Kentucky, a high school student sued state health officials after he was barred from playing basketball because he wasn't vaccinated for chickenpox.
He claimed the vaccine was against his religious beliefs. In early April, a judge ruled against his request to rejoin activities at his school.
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