Other Countries and New York Fuel NJ’s Measles Outbreak, Officials Say

Lilo H. Stainton | May 1, 2019 | Health Care
Travelers returning from countries where the disease is widespread and cross-border contamination from New York are responsible for uptick in New Jersey

Credit: CDC Global
Measles
New Jersey’s growing measles outbreak appears to have roots in Israel, New York City and New York’s Rockland County, according to Garden State officials.

Department of Health Commissioner Dr. Shereef Elnahal said a combination of travelers returning from countries where measles is rampant, and individuals crossing back and forth between neighboring states, is largely responsible for the situation in New Jersey. Fourteen Garden State residents have been diagnosed with the virus this year, in addition to the 33 infections detected last fall. Another case is expected to be confirmed this week.

But with New York City experiencing a more severe outbreak, with at least 420 cases, and another 200-plus diagnosed in nearby Rockland County, the threat of cross-border contamination is significant, Elnahal said. Most of the infections have been found within Orthodox Jewish communities in both states, including Ocean County’s Lakewood.

Since community members often travel back and forth for family visits, work or worship, Elnahal said “the transit between New York and New Jersey is the biggest concern now. And the collaboration with (local and state health officials in New York) has been critical.” International travelers have long been the source of viral infections in the United States, Elnahal said, but with more people refusing the vaccine there is a greater chance that infected voyagers can transmit the disease, which spreads quickly in communities with low immunization rates.

The commissioner shared his concerns Tuesday during a call with public health leaders from California and Rhode Island, organized by the Association of State and Territorial Health Officials to discuss the impact of the measles outbreak, which has reached record levels this year. The group underscored the importance of vaccination, which they said is the only practical way to combat the virus.

Disease was declared eradicated

The federal Centers for Disease Control and Prevention has recorded more than 700 cases nationwide in 2019, nearly twice last year’s level, and the highest number on record since 2000, when officials determined there were no reservoirs of infection in this country and declared the disease eradicated.

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Most of the cases are in the New York region and officials there have taken aggressive steps, attempting to ban unvaccinated individuals from public spaces and threatening them with fines of up to $1,000 — moves Elnahal said are not appropriate in New Jersey at this point. In California, where 38 cases have been confirmed this year, officials quarantined some 800 people at two Los Angeles college campuses earlier this month to curb the spread of the virus.

Dr. Karen Smith, the director of California’s Department of Public Health, said on Tuesday’s call that most of these quarantined individuals have since been released, after proving they had been properly immunized. The large-scale response was necessary given how the highly contagious virus can remain active in the air for several hours, she said, and is transmitted when someone who is infected coughs, sneezes or talks.

“This means a lot of people can be exposed from a single case and this is what happened in Los Angeles,” Smith explained. All of the California case originated overseas, she added, urging international travelers to confirm their immunization status before they go abroad.

The measles virus, which can take up to 21 days to develop, often reveals itself through a cough, runny nose, itchy, watery eyes, a fever or rash. While its effects are minor in most cases — something underscored by advocates for vaccine choice — it can involve ear infections, pneumonia, brain swelling and more, and children are most vulnerable. For every 1,000 youngsters infected, one or two will die, according to the DOH.

Inoculations… and exemptions

There is no cure for the infection, only treatments to ease the symptoms. So, preventing the spread of the measles virus is key, public health officials said, which means proper inoculations. In the United States, children are required to get two doses of the MMR vaccine, or measles/mumps/rubella, before they enter school.

Exemptions are permitted for medical reasons (those with compromised immune systems are at risk) and also for religious reasons, although lawmakers in New Jersey and several other states are looking to eliminate the religious opt-out. Elnahal said all the religious leaders he has encountered, including prominent Jewish officials, have urged their followers to comply with vaccination laws.

According to state records, nearly 95 percent of Garden State pupils received all their shots for the 2017-2018 academic year; California enjoys a similar rate, Smith said Tuesday. If the 5 percent of unvaccinated children were spread across the state there would be almost no risk, she added. “However they tend to cluster” in certain communities, Smith noted. (While New Jersey’s outbreak has been concentrated among Orthodox Jews, in California it tends to involve Ukrainian communities and wealthy white families who send their children to certain elite private schools, she said.)

School vaccination rates don’t paint a full picture of public immunity since they don’t include adults, the experts agreed. Neither California nor New Jersey require adults to report their vaccination status, and immunization laws have changed over time, so that different generations may have varying levels of protection against the virus. (In New Jersey, the cases have occurred in people from age 5 to 51, but a full breakdown was not immediately available.)

Little information on adult vaccination rates

“We have fairly good information on school-aged children, but not a whole lot of information about adult vaccine rates,” lamented Kevin Sumner, a regional health official based in Green Brook Township, who heads a national organization of his peers and joined Tuesday’s call. “One of the things we find is that adults don’t know their immune status.”

Officials urge adults to confirm their vaccination status by consulting with their doctor. In New Jersey, residents can also submit a form to obtain their immunization history; a blood test can also be used to determine risk. New Jersey health leaders took to social media last week to promote vaccination, including among adults, and to push back against critics who suggest the shots do more harm than good.

The issue of adult immunization is particularly important for people who are planning to travel abroad, especially to a country experiencing high levels of measles. In addition to Israel, outbreaks have devastated Madagascar — where 70,000 people have been infected and more than 1,000 have died — and impacted Brazil, Philippines, Ukraine and Venezuela, among other nations.

To help address questions, the New Jersey Immunization Network is holding a “Safe Travel Vaccine” webinar today to educate the public and reduce the risk of importing the virus to the Garden State.

The group’s goal is to encourage enough individuals to become vaccinated so that the general public is protected through what’s called “herd immunity,” network director Michael Weinstein explained. “This is especially important to protect the vulnerable (very young, elderly and immune-compromised) against this extremely contagious — but preventable — disease,” he said.